Eficácia da terapia por ondas de choque em disfunções musculoesqueléticas: revisão sistemática com meta-análise

Abstract

Shockwave Therapy (SWT) has been an innovative intervention for the management of pain in musculoskeletal disorders. However, similar to any type of intervention, SWT needs to be compared to another inert treatment intervention, commonly called a placebo. There are several clinical trials comparing SWT to placebo, however, there are no systematic reviews that assess whether SWT is superior to placebo in musculoskeletal disorders. Therefore, the objective of this systematic review was to evaluate the effectiveness of SWT compared to placebo in musculoskeletal disorders. The primary outcome was pain intensity. Secondary outcomes were adherence to treatment and whether there was a blinded analysis in the included studies. In addition, the risk of bias of the studies was assessed using the PEDro scale and the GRADE system was used to assess the quality of evidence. Within the eligibility criteria, 76 studies were included, totaling 5037 participants. Our study found that studies that use SWT for musculoskeletal disorders show good adherence to treatment, with a loss of participants less than 9%, with no differences between the active SWT or placebo SWT groups, however, only four studies that used focal SWT performed analysis of successful blinding of its participants. On average, studies with focal SWT had a mean score of 6.7 points, with a moderate risk of bias, and 7.5 points for radial SWT, with a low risk of bias. For the primary outcome, there were only data from 3951 participants available to perform the pain intensity meta-analysis. For pain intensity, we performed sub-analyses for general, focal and radial SWT, in addition to evaluating its effectiveness in relation to the region of the body that SWT was applied to. The evaluations also took into account the moment of time that was evaluated, being evaluated soon after the treatment protocol, after 6 weeks and after 3, 6 and 12 months. We found that there was a decrease in pain intensity when using SWT in general compared to placebo after all time segments evaluated, however, when evaluating radial and focal SWT alone, it was more effective right after the treatment protocol and after 3 and 6 months of follow-up. Overall, the quality of evidence from SWT-related studies is too low for the low quality of evidence by GRADE. In conclusion, it was observed that, in general, SWT was more effective than placebo in all time segments, however, the type of SWT when used and for what period should be carefully considered. Studies related to SWT have a low risk of bias, it is a therapy with excellent adherence, however the quality of the evidence of the studies is very low to low and there is a need to perform more analysis on the success of blinding in this type of study.