PAIN+ CPN

OBJECTIVE: To compare the efficacy of extracorporeal shock waves versus corticosteroids injections on pain, thickness of plantar fascia and foot function in patients with plantar fasciitis. Secondarily, to assess the efficacy of radial and focused extracorporeal shock waves and the most appropriated intensity (high, medium or low).

DATA SOURCES: PubMed, SCOPUS, CINAHL and PEDro, until April 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

REVIEW METHODS: Randomized controlled trials comparing the efficacy of extracorporeal shock waves versus corticosteroids injections on pain intensity and sensitivity, thickness of plantar fascia and foot function in patients with plantar fasciitis. Methodological quality and risk of bias were assessed using PEDro Scale and Cochrane Risk of Bias Tool. Pooled effect was calculated using the standardized mean difference (SMD) and its 95% confidence interval (95%CI).

RESULTS: Sixteen studies involving 1121 patients, showing a mean of 6 points in PEDro scale, were included. At three months, extracorporeal shock waves were better than corticosteroids injections in reducing pain (SMD -0.6; 95%CI -1.1 to -0.11) and thickness of the plantar fascia (SMD -0.4; 95%CI -0.8 to -0.01) and increasing foot function (SMD 0.27; 95%CI 0.12-0.44). At six months, extracorporeal shock waves are more effective in reducing pain (SMD -0.81; 95%CI -1.6 to -0.06) and increasing foot function (SMD 0.67; 95%CI 0.45-0.89). Local pain and slight erythema were the most frequent adverse events.

CONCLUSIONS: Extracorporeal shock waves are a safe therapy, presenting more efficacy than corticosteroids injections in improving pain, thickness of plantar fascia and foot function at mid-term.

Prof. Mike Poling (5/28/2024 8:17 AM)

These reviews really need to consider not only the stats used, but the MEANING of said stats. An SMD of such small magnitude is relatively meaningless clinically. There is no mention of whether it was even statistically significant, but it most certainly isn't clinically significant.