The Effectiveness Of Extracorporeal Shock Wave Therapy For Adhesive Capsulitis: A Meta-analysis

Objective:Aiming to investigate the clinical effectiveness and operational safety of extracorporeal shock wave therapy(ESWT),this study had undergone meta-analysis to evaluate practical trails on patients of adhesive capsulitis.Method:Of the way manual searching randomize controlled trials(RCTs)on applying ESWT to treat adhesive capsulitis were identified with online databases(Cochrane Library,Pubmed,Embase,CNKI,CBM,VIP and WanFang Data).Publication date from inception to December 2017.This study also retrospected the references from the included literature.Two individual investigators assessed and screened out the included literature adherence to the protocols of inclusion and exclusion criterions from Cochrane Handbook for Systematic Reviews of Interventions.After extracting characters and data,this meta-analysis was conducted with StataMP 14 and RevMan 5.3 software.Heterogeneity must to be cared,of which consist clinical,methodological and statistical aspects respectively.A random or fixed effects model was proceed according to the heterogeneity.The primary end points were pooled,while the weighted mean differences(WMD)and 95% confidence intervals(95%CI)estimated,and inspection level was set at 0.05(α=0.05).Results:15 RCTs containing 1063 patients suffered pain and disability for adhesive capsulitis were included.The outcome of meta-analysis indicated that,compared to control group,ESWT led to significant improvement of symptoms(RR=1.60,95%CI,1.11 to 2.29),acceleration of functional restoration(WMD=18.71,95%CI,10.66 to 26.76),reduction of pain(WMD=-1.54,95%CI,-2.79 to-0.28),and facilitation of calcification absorbed(RR=12.10,95%CI,5.56,26.34,Z值为6.28,P<0.00001).Moreover,there were no severe adverse events observed.Conclusion:Based on current literature,a reliable definition can be pointed out that ESWT as an effective therapy is beneficial to improve the symptoms of whom suffers from adhesive capsulitis,it also accelerates process of restoration and increases range of motion,as well as achieving pain release,overall resulting in melioration of life.Nevertheless,bias should not be ignored,which causes from limitative existent literature,quantity of subjects,and the incomplete description about designs or methods of included trials.Therefore,including more qualified,rigorous and multiple central randomized controlled trials must be taken to verify the stability and confidence level of this meta-analysis outcome.