Extracorporeal shockwave therapy in the management of knee osteoarthritis: A systematic review of dose-response meta-analysis.

Introduction: The aim of the research was to conduct a systematic review of dose-response meta-analysis, examining the correlation between the energy of extracorporeal shockwave therapy (ESWT) and clinical outcomes for patients with knee osteoarthritis (OA). Methods: We conducted a systematic review of three online databases - PubMed, Embase, and Cochrane Library - to collect relevant articles from their inception to May 2023. We included the articles that investigated the efficacy of ESWT in treating knee OA and were designed using randomized controlled trials (RCTs). The main outcomes were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for primary outcomes and the Visual Analog Scale (VAS) for secondary outcomes. We conducted a dose-response meta-analysis to examine the correlation between the energy of ESWT and clinical outcomes. Results: Our study included a total of 7 RCTs (comprising 450 subjects) that met the inclusion criteria. We found a negative linear relationship between the doses of ESWT and WOMAC scores at the 1-week (p = 0.0398) and 4-week (p = 0.001) follow-up periods, but not at the 12-week follow-up period (p = 0.202). Furthermore, at the 4-week (p = 0.0477) and 12-week (p < 0.001) follow-up periods, a negative linear connection was found between the ESWT dose and VAS scores, but not at the 1-week follow-up period (p = 0.2268). Conclusions: Our results demonstrate a dose-response connection between the energy of ESWT and clinical outcomes. This suggests that using higher energy levels of ESWT to treat knee OA could lead to greater improvement in clinical outcomes compared to using lower energy levels.