Efficacy of Extracorporeal Shockwave Therapy on Knee Osteoarthritis Related Pain and Activities of Daily Living: A Systematic Literature Review

Extracorporeal Shockwave Therapy (ESWT) is currently being marketed and advertised as a safe treatment alternative for various musculoskeletal conditions including osteoarthritis. There has been an increased interest in the use of ESWT as a noninvasive passive modality by physical therapists as an adjunct to holistic care. This literature review aims to look at the state of evidence among previous systematic reviews and randomized controlled trials examining the application of ESWT for pain and activities of daily living (ADL) outcomes for individuals with knee osteoarthritis (OA).Systematic literature searches for randomized controlled trials between 2010-2021 were performed in the databases of PubMed, PEDro Database, Google Scholar, Cochrane Library, EBSCO between November 18 to December 8, 2021. A total of six randomized controlled trials (full text available, PEDro score > 6, and conducted in the past 11 years) with a total of 459 subjects met quality guidelines using the PEDro scale. There were 5 systematic reviews (full text available, inclusion criteria, pain and ADL outcome measures, and conducted in the past 11 years) with a total of 6922 subjects that met methodological guidelines.A total of 2682 articles were screened, and 6 studies with a total population of n = 459 were included in this review. With heterogeneity in frequency, dosage, and volume no meta-analysis was conducted. There were statistically significant improvements reported in the use of ESWT in terms of pain and ADL outcomes associated with knee OA in 5 of the studies (n= 370). No clinically significant differences were found in the use of ESWT for knee OA related pain and ADL outcomes in 1 of the studies (n=89), and no studies found nil effects. The results suggest that in the management of symptoms related to knee OA, the use of ESWT has some effect on pain and activities of daily living outcomes.A review of current randomized controlled trials and systematic reviews presented some evidence for the use of ESWT in knee OA. While the use of ESWT may improve pain and ADL outcomes, further studies towards dosing and prescription is suggested.