ESWT compared with placebo shock wave in patellar tendinopathy summary of evidence
| Outcomes | Comparisons | Relative effect (95% CI) | Patients /studies (n) | Quality of evidence (GRADE) | Clinical significance | |
| Average estimate /assumed risk in the ESWT group | Average estimate /assumed risk in the control group | |||||
| VISA-P scores Follow-up: 3 months Follow-up: 5–6 months | ESWT: The mean VISA-P score was 66.2 (range 65.7–66.7) | Placebo ESWT: the mean VISA-P score was 70.2 (range 68.9– 71.5) | MD −3.79 (−10.84 to 3.26) The difference was not statistically significant | 114/2 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence of no difference between ESWT and placebo ESWT in VISA-P |
| ESWT: the mean VISA-P score was 70.7 (range 70.5– 70.9) | Placebo ESWT: the mean VISA-P score was 75.5 (range 72.7– 78.2) | MD −4.72 (−11.26 to 1.82) The difference was not statistically significant | 114/2 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence of no difference between ESWT and placebo ESWT in VISA-P | |
| Self-perceived recovery Follow-up: 3 months Follow-up: 6 months | ESWT: 6 of 18 (33%) participants reported satisfactory recovery | Placebo ESWT: 11 of 25 (44%) participants reported satisfactory recovery | OR 0.64 (0.18 to 2.24) The difference was not statistically significant | 52/1 | ⊕⊕ Low1,2,3 | Low level of evidence of no difference between ESWT and placebo ESWT in patient-rated recovery |
| ESWT: 10 of 15 (67%) participants reported satisfactory recovery | Placebo ESWT: 18 of 26 (61%) participants reported satisfactory recovery | OR 0.89 (0.23 to 3.46) The difference was not statistically significant | 52/1 | ⊕⊕ Low1,2,3 | Low level of evidence of no difference between ESWT and placebo ESWT in patient-rated recovery | |
| VAS/NRS pain score* Follow-up: 3 months Follow-up: 5–6 months | ESWT: mean pain score was 2.7 (range 2.0– 3.3) | Placebo ESWT: mean pain score was 3.4 (range 2.9–3.8) | MD −0.75 (−1.62 to 0.11) The difference was not statistically significant | 114/2 | ⊕⊕⊕ Moderate1,3 | Moderate level of evidence of no difference between focused ESWT and placebo ESWT in pain scores |
| ESWT: mean pain score was 2.5 (range 1.8–3.2) | Placebo ESWT: mean pain score was 2.9 (range 2.2–3.6) | MD −0.40 (−1.29 to 0.49) The difference was not statistically significant | 114/2 | ⊕⊕⊕ Moderate1,2 | Moderate level of evidence of no difference between focused ESWT and placebo ESWT in pain scores | |
| Patient-rated pain reduction** Follow-up: 3 months Follow-up: 5–6 months | ESWT: MD from baseline ranged from 1.3 to 2.1 points | Placebo ESWT: MD from baseline ranged from 0.8 to 1.8 points | Not estimable | 114/2 | N/A | ESWT: minimal improvement Placebo ESWT: minimally improved/no change |
| ESWT: MD from baseline ranged from 1.4 to 2.3 points | Placebo ESWT: MD from baseline ranged from 1.0 to 2.5 points | Not estimable | 114/2 | N/A | ESWT: minimal improvement Placebo ESWT: no change/ minimally improved | |
*Pain scores are referred to 10 decline squats on injured leg.
**Cut-off points adjusted from Farrar et al. 44
1 Increased drop-out rate/attrition bias.
2 Indirect comparison.
3 Only one randomised controlled trial included in analysis.
ESWT, extracorporeal shockwave therapy; GRADE, Grading of Recommendations Assessment, Development and Evaluation; MD, mean difference; N/A, not available; NRS, numeric rating scale; VAS, visual analogue scale.