Greater trochanteric pain syndrome 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 | |||||
| HHS Follow-up: 1 and 3 months | ESWT: the mean HHS was 72.3 (range 69.8– 74.8) | Controls*: the mean HHS was 55.65 (range 54.4– 56.9) | MD 16.75 (14.31 to 19.19) The difference was clinically and statistically significant | 66/1 | ⊕ Very low1 | Very low level of evidence in favour of radial ESWT compared with traditional conservative treatment in HHS |
| HHS Follow-up: 12 months | ESWT: mean±SD was 79.9±6.2 | Controls*: mean±SD was 57.6±5.8 | MD 22.30 (19.40 to 25.20) The difference was clinically and statistically significant | 66/1 | ⊕ Very low1 | Very low level of evidence in favour of radial ESWT compared with traditional conservative treatment in HHS |
| Self-perceived recovery Follow-up: 3–4 months | ESWT: 79 of 111 (71%) participants reported satisfactory recovery | Controls*: 40 of 109 (37%) participants reported satisfactory recovery | OR 5.02 (1.62 to 15.56) The difference was statistically significant | 220/2 | ⊕⊕ Low2 | Low level of evidence in favour of radial ESWT compared with controls in patient-rated recovery |
| Follow-up≥12 months | ESWT: 84 of 111 (76%) participants reported satisfactory recovery | Controls*: 73 of 109 (67%) participants reported satisfactory recovery | OR 2.08 (0.24 to 18.10) The difference was not statistically significant | 220/2 | ⊕⊕ Low2 | Low level of evidence of equal results between radial ESWT and controls in patient-rated recovery |
| Self-perceived recovery Follow-up: 1 month Follow-up: 4 months | ESWT: 10 of 78 (13%) participants reported satisfactory recovery | Corticosteroid injection: 56 of 75 (75%) participants reported satisfactory recovery | OR 0.05 (0.02 to 0.12) The difference was statistically significant | 153/1 | ⊕⊕ Low3 | Low level of evidence in favour of corticosteroid injection compared with radial ESWT in patient-rated recovery |
| ESWT: 53 of 78 (68%) participants reported satisfactory recovery | Corticosteroid injection: 38 of 75 (51%) participants reported satisfactory recovery | OR 2.06 (1.07 to 3.98) The difference was not statistically significant | 153/1 | ⊕⊕ Low3 | Low level of evidence in favour of radial ESWT compared with corticosteroid injection in patient-rated recovery | |
| Follow-up≥12 months | ESWT: 58 of 78 (74%) participants reported satisfactory recovery | Corticosteroid injection: 36 of 48 (67%) participants reported satisfactory recovery | OR 3.14 (1.59 to 6.21) The difference was not statistically significant | 153/1 | ⊕⊕ Low3 | Low level of evidence in favour of radial ESWT compared with corticosteroid injection in patient-rated recovery |
| NRS pain score Follow-up: 1 month | ESWT: mean±SD was 5.6±3.7 | Corticosteroid injection: mean±SD was 2.2±2.0 | MD 3.40 (2.46 to 4.34) The difference was clinically and statistically significant | 153/1 | ⊕⊕ Low3 | Low level of evidence in favour of CI compared with ESWT in NRS scores |
| ESWT: mean±SD was 5.6±3.7 | HT: mean±SD was 5.9±2.8 | MD −0.30 (−1.33 to 0.73) The difference was not statistically significant | 154/1 | ⊕⊕ Low3 | Low level of evidence of equal results between radial ESWT and HT in NRS scores | |
| Follow-up: 4 months | ESWT: mean±SD was 3.2±2.4 | Corticosteroid injection: mean±SD was 4.5±3.0 | MD −1.30 (−2.16 to 0.44) The difference was statistically, but not clinically significant | 153/1 | ⊕⊕ Low3 | Low level of evidence in favour of radial ESWT compared with CI in NRS scores |
| ESWT: mean±SD was 3.2±2.4 | HT: mean±SD was 5.2±2.9 | MD −2.00 (−2.84 to 1.16) The difference was clinically and statistically significant | 154/1 | ⊕⊕ Low3 | Low level of evidence in favour of radial ESWT compared with HT in NRS scores | |
| Follow-up: 15 months | ESWT: mean±SD was 2.4±3.0 | Corticosteroid injection: mean±SD was 5.3±3.4 | MD −2.90 (−3.92 to 1.88) The difference was clinically and statistically significant | 153/1 | ⊕⊕ Low3 | Low level of evidence in favour of radial ESWT compared with CI in NRS pain scores |
| ESWT: mean±SD was 2.4±3.0 | HT: mean±SD was 2.7±2.8 | MD −0.30 (−3.92 to 1.88) The difference was not statistically significant | 154/1 | ⊕⊕ Low3 | Low level of evidence of equal results between radial ESWT and HT in NRS scores | |
| Patient-rated pain reduction** Follow-up: 1 month | ESWT: MD from baseline was 0.7 points | Corticosteroid injection: mean difference from baseline was 3.6 points | Not estimable | 153/1 | N/A | ESWT: no change Corticosteroid injection: much improved |
| ESWT: MD from baseline was 0.7 points | HT: mean difference from baseline was 0.3 points | Not estimable | 154/1 | N/A | ESWT: no change HT: no change | |
| Follow-up: 4 months | ESWT: MD from baseline was 3.1 points | Corticosteroid injection: MD from baseline was 1.3 points | Not estimable | 153/1 | N/A | ESWT: much improved Corticosteroid injection: minimally improved |
| ESWT: MD from baseline was 3.1 points | HT: mean difference from baseline was 1.0 point | Not estimable | 154/1 | N/A | ESWT: much improved HT: no change | |
| Follow-up: 15 months | ESWT: MD from baseline was 3.9 points | Corticosteroid injection: MD from baseline was 0.5 points | Not estimable | 153/1 | N/A | ESWT: much improved Corticosteroid injection: no change |
| ESWT: MD from baseline was 3.9 points | HT: mean difference from baseline was 3.5 points | Not estimable | 154/1 | N/A | ESWT: much improved HT: much improved | |
*Controls received stretching and strengthening programme or traditional non-operative treatment (ie, stretching and strengthening, physical therapy modalities, iontophoresis, rest).
**Cut-off points adjusted from Farrar et al. 44
1 Data from non-randomised controlled study of high-quality and long-term follow-up.
2 Inclusion in quantitative synthesis of a non-randomised controlled study.
3 Only one randomised controlled trial included in analyses.
ESWT, extracorporeal shockwave therapy; GRADE, Grading of Recommendations Assessment, Development and Evaluation; HHS, Harris hip score; HT, home training; MD, mean difference; N/A, not available; NRS, numeric rating scale.