The Effectiveness Of Extracorporeal Shock Wave Therapy For Lateral Epicondylitis: A Meta-analysis

Objective:To systematically review the safety and effectiveness of extracorporeal shock wave therapy for lateral epicondylitis(tennis elbow).Methods:Randomized controlled trails(RCTs) on extracorporeal shock wave therapy and other therapies in treating lateral epicondylitis were retrieved in Pubmed、EMbase、The Cochrance Library、CNKI、CBM、VIP and WangFang Date from creation to November2014. We also retrieved the references of the included studies. The included studies were screened and assessed by two investigators according to the inclusion and exclusion criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Then, we conducted meta-analysis using RevMan 5.3 software. We evaluated the heterogeneity to choose the random or fixed model. Evaluation indicators were assessed by using 95% confidence interval and we set ɑ=0.05 as inspection level.Results:Eleven RCTs involving 708 patients were included. The results of meta-analysis indicated that,compared with control group, extracorporeal shock wave therapy reduced visual analog scale scores(SMD=-1.04,95%CI-1.56 to-0.51,P<0.0001), increased the population of 50% improvement or above of symptoms from baseline(RR=1.50,95%CI1.07 to 2.11,P=0.02), increased upper extremity function scale(SMD=-0.65,95%CI-0.94 to-0.35,P<0.0001), excellent or good result population of roles and maudsley score(RR=1.75, 95%CI1.12 to 2.74,P=0.01). However, there were no severe adverse events occurred.Conclusion:Current evidence indicates that, extracorporeal shock wave therapy can effectively reduce the symptom of pain and improve function and the quality of life compared with other treatments. The quantity of involved RCTs are moderate and the quality varies.This may lead to selective bias, confounding bias and other bias. Meanwhile, there were no severe adverse events. Due to the restricted quality and quantity of the included studies, Multiple center, more high quality and designed strictly studies are needed to verify its effectiveness and safety.