• Chun-De Liao, Jau-Yih Tsauo, Tsan-Hon Liou, Hung-Chou Chen, and Shih-Wei Huang.
• 1 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei.
• Clin Rehabil. 2019 Sep 1; 33 (9): 1419-1430.

ObjectiveThis study determined the clinical efficacy of extracorporeal shockwave therapy and the predictors of its efficacy for knee osteoarthritis.Data SourcesElectronic databases and search engines, namely MEDLINE, PubMed, EMBASE, Cochrane Library Database, Physiotherapy Evidence Database (PEDro), China Academic Journals Full-text Database, and Google Scholar, were searched until 5 March 2019, for randomized controlled trials without restrictions on language and publication year.Review MethodsEligible trials and extracted data were identified by two independent investigators. The included articles were subjected to a meta-analysis and risk of bias assessment. Outcomes of interest included treatment success rate, pain, and physical function outcomes. A meta-regression analysis was performed to determine the predictors of treatment outcomes following shockwave therapy.ResultsWe included 50 trials (4844 patients) with a median (range) PEDro score of 6 (5-9). Meta-analyses results revealed an overall significant effect favoring shockwave therapy on the treatment success rate (odds ratio 3.22, 95% confidence interval (CI) 2.21-4.69, P < 0.00001; heterogeneity (I2) = 62%), pain reduction (standardized mean difference (SMD) -2.02, 95% CI -2.38 to -1.67, P < 0.00001; I2 = 95%), and Western Ontario and McMaster Universities Osteoarthritis Index function outcome (SMD -2.71, 95% CI -3.50 to -1.92, P < 0.00001; I2 = 97%). Follow-up duration and energy flux density were independent significant predictors of shockwave efficacy.ConclusionShockwave therapy is beneficial for knee osteoarthritis. Shockwave dosage, particularly the energy level and intervention duration, may have different contributions to treatment efficacy.

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