Authors' objectives: HTW undertook an evidence review to address the following question: is extracorporeal shockwave therapy (ESWT) clinically and cost effective in comparison to other interventions, no treatment or placebo for the treatment of musculoskeletal conditions?

Authors' results and conclusions: HTW identified a large body of evidence on the effectiveness of ESWT, the majority of which was for the treatment of tendinopathies and plantar fasciitis. Most of the evidence reported by HTW is from systematic reviews of randomised controlled trials. However, these reviews were limited by reliance on a small number of trials for each indicated condition and trials with small sample sizes. Overall, the evidence identified by HTW suggests that ESWT is a safe treatment option. However, its effectiveness varied according to the specific condition treated and what outcomes were measured (these included pain relief, functional outcomes, quality of life improvement, and patient satisfaction). For most outcomes and conditions, the available evidence suggests that there is no statistically significant difference between ESWT and no treatment/placebo/sham treatment. Three network meta-analyses (NMA) were identified investigating ESWT in patellar tendinopathy, plantar fasciitis and mid-portion Achilles tendinopathy. The NMAs generally suggest that ESWT is not superior to other interventions available. The outcomes where ESWT was ranked highest were medium-term pain relief and medium- and long-term function outcomes in patellar fasciitis. Estimated costs of using ESWT were included in this report, but no relevant health economic studies were found. It is therefore difficult to fully assess the health economic implications of using ESWT because of a lack of evidence on outcomes relevant to health economic analysis. In particular, there is a lack of evidence available that would allow for quality-adjusted life-years to be estimated.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Project Status: Completed

Year Published: 2021

URL for published report: https://www.healthtechnology.wales/reports-guidance/extracorporeal-shockwave-therapy/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk

Copyright: Health Technology Wales