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Patients with severe motor and intellectual disability (SMID) experience persistent spastic pain and severe malpositioning of the limbs, exacerbated by the lack of effective treatment for severe spastic palsy. This study (UMIN-CTR, UMIN000048842) aimed to evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for spastic palsy in these patients. rESWT was applied to the biceps brachii of 15 elbow joints with flexion pattern spastic palsy of Modified Ashworth Scale (MAS) grade 1+ or greater in 11 patients with SMID. The MAS score, elbow range of motion (ROM) and adverse events were monitored for up to 10 weeks. Electromyography signals at rest were recorded on 8 elbow joints. Following a single rESWT session, the spasticity of the elbow joint immediately decreased, the MAS score significantly decreased from 2 (range, 2–3) to 1 (range, 1–2), and the elbow ROM significantly increased by 10° (range, 0°–15°). Moreover, muscle activity decreased by 24% (range, 11–37%), being clinically meaningful in SMID. rESWT resulted in an immediate and clear improvement in the MAS score for approximately 8 weeks and in the elbow ROM, continuing even at 10 weeks. Our findings highlight rESWT as a non-invasive therapy for spastic palsy in patients with SMID.

ObjectivesWhile extracorporeal shockwave therapy (ESWT) may be an efficacious adjunctive treatment option for musculoskeletal injuries, current research is limited by significant heterogeneity within treatment protocols. This study aims to establish international expert consensus recommendations on ESWT terminology, parameters, procedural considerations, contraindications and side effects in the application of ESWT to sports injuries.MethodsA systematic literature search was performed on the use of ESWT for musculoskeletal and sports medicine injuries to identify potential panellists, followed by the development of a steering committee-led questionnaire. A three-stage, modified Delphi questionnaire was provided to a panel of 41 international clinical and research experts across 13 countries. Panellists had the opportunity to suggest edits to existing statements or recommend additional statements in Round 1. Consensus was defined as≥75% agreement.ResultsAll 41 panellists completed Rounds 1, 2 and 3. Consensus was reached on 69/118 statements (58.5%), including recommendations on terminology and fundamental concepts, indications for use, procedural aspects for tendinopathy and bone pathologies, treatment correlations with imaging, periprocedural and postprocedural considerations, absolute and relative contraindications and potential side effects. Of the 49 statements that did not reach consensus, 17/49 (34.7%) were related to procedural aspects of bone pathology.ConclusionThis international panel presents recommendations on ESWT terminology, indications and treatment considerations to guide ESWT use and decision-making by sports medicine clinicians. While our panel supported the use of ESWT in the treatment of bone pathologies, certain procedural aspects of ESWT specific to these injuries did not reach consensus and require further investigation.

Background. The superiority of focused shockwave therapy (F-SWT) versus radial shockwave therapy (R-SWT) for treating noncalcific rotator cuff tendinopathies remains controversial. This study is aimed at comparing the effectiveness of F-SWT versus R-SWT for the management of noncalcific rotator cuff tendinopathies. Methods. A total of 46 patients affected by noncalcific rotator cuff tendinopathies were randomly divided into 2 groups of 23 individuals. Patients in group A received 4 sessions of F-SWT, while patients in group B were treated by 4 sessions of R-SWT. In each session, mean energy flux density (EFD) for F-SW 3000 shots was 0.09±0.018 mJ/mm2 with 5.1±0.5 Hz, while average pressure for R-SW 3000 shots was 4.0±0.35 bar with 3.2±0.0 Hz. Pain level and shoulder function were assessed with the numerical rating scale (NRS) and Constant-Murley Scale (CMS). The primary endpoint was the change in the mean NRS pain score from baseline to 24 weeks after the intervention. Secondary endpoints were changes in the mean NRS pain scores at all other follow-up points, changes in the mean CMS scores, and radiographic findings. Results. There were no significant differences between the two groups regarding NRS pain score and CMS score within 24 weeks after intervention (all p>0.05). However, F-SWT resulted in significantly lower NRS compared with R-SWT at 24 weeks and 48 weeks after treatment (2.7±1.0 vs. 4.5±1.2 and 1.4±1.0 vs. 3.0±0.8, respectively, all p<0.001). Similar results were found in CMS changes and radiographic findings. Conclusions. Both F-SWT and R-SWT are effective in patients with noncalcific rotator cuff tendinopathy. F-SWT proved to be significantly superior to R-SWT at long-term follow-up (more than 24 weeks). This trial is registered with ChiCTR1900022932.

Objectives:To report the one-year results of ESWT on CPPS patients and the possible clinical characteristics that may affect its efficacy.Patients & methods:A prospective randomized clinical study between January 2017 and January 2021 on 155 adult patients with chronic pelvic pain syndrome. All patients were initially evaluated with a thorough history and physical examination. Baseline symptoms evaluation of each participant was assessed using NIH-CPSI score, IPSS, VAS, and IIEF-5 score. Patients were randomized into two groups: a verum treatment group and a placebo treatment group. Patients of verum group in the lithotomy position received a perineally applied ESWT treatment once a week for four weeks with 3000 impulses each. Patients of placebo group received the same therapy head of the same device with a layer of air-filled microspheres to absorb the shock waves. The previously mentioned validated scores were reassessed on regular follow-up visits at one, three, six, and 12 months after the completion of ESWT.Results:A statistically significant improvement was noticed in the mean values of NIH-CPSI, IPSS, VAS, and IIEF-5 of the patients of verum group over the follow-up period with also statistically significant difference between both groups. At the first visit of follow-up after ESWT, 63 (82.8%) patients had ≥6 points decrease in the NIH-CPSI total score, while 13 (17.2%) patients did not. Univariate and multivariate analyses of the clinical characteristics between the responders and non-responders showed that those patients with history of psychological disorders or had higher initial NIH-CPSI score had a significantly lower response rate to ESWT (p = 0.005, 0.02 & p = 0.002, 0.004 respectively). ROC curve of NIH-CPSI score showed that a score of 32 was the cut-off point above which the response to ESWT decreased.Conclusion:ESWT is an effective treatment option for CPPS. Its efficacy remained throughout long-term follow up. High initial NIH-CPSI score and history of psychological problems are significant predictors for it.

Background Knee osteoarthritis (KOA) is the most common degenerative joint disease. It is characterized by pain, stiffness, reduced joint motion, and muscle weakness. It also has the potential for long-term disability. Radial extracorporeal shock wave therapy (rESWT) is a noninvasive therapeutic modality widely used for the treatment of musculoskeletal disorders. However, the role of rESWT in the treatment of knee osteoarthritis remains controversial in previous clinical trials. This trial will investigate the efficacy of rESWT in improving the symptoms, function, and bone metabolic status of participants with knee osteoarthritis. Methods The study is a randomized, double-blind, controlled trial. Thirty participants with knee osteoarthritis will be randomized to receive either rESWT or sham rESWT on the affected knee once per week for 4 weeks. All participants will undergo professional physiotherapy once a week during the treatment period. The primary outcome is the visual analogue scale score for pain. Secondary outcomes include the Western Ontario and McMaster Universities Osteoarthritis Index score, knee range of motion, the 10-m walk test results, and bone metabolism biochemical indicators. Outcomes will be measured at baseline (T0), 5 weeks post-intervention (T1), and 8 weeks post-intervention (T2). Discussion This study will investigate the effects of rESWT on pain, physical function, and bone metabolism biochemical indicators in participants with knee osteoarthritis, which is expected to reduce the pain of participants, improve the function of participants, and improve bone metabolism biochemical indicators. The information obtained will enhance our understanding of rESWT for the treatment of knee osteoarthritis and may be used to standardize clinical treatment protocols for knee osteoarthritis. Trial registration Chinese Clinical Trial Registry ChiCTR2300069997. Registered on 30 March 2023.

ObjectivesTo assess whether radial extracorporeal shock wave therapy (rESWT), sham-rESWT or a standardised exercise programme in combination with advice plus customised foot orthoses is more effective than advice plus customised foot orthoses alone in alleviating heel pain in patients with plantar fasciopathy.Methods200 patients with plantar fasciopathy were included in a four-arm, parallel-group, sham-controlled, observer-blinded, partly patient-blinded trial. At baseline, before randomisation, all patients received advice plus customised foot orthoses. Patients were randomised to rESWT (n=50), sham-rESWT (n=50), exercise (n=50) or advice plus customised foot orthoses alone (n=50). Patients in the rESWT and sham-rESWT groups received three treatments. The exercise programme comprised two exercises performed three times a week for 12 weeks, including eight supervised sessions with a physiotherapist. Patients allocated to advice plus customised foot orthoses did not receive additional treatment. The primary outcome was change in heel pain during activity in the previous week per Numeric Rating Scale (0–10) from baseline to 6-month follow-up. The outcome was collected at baseline, and 3, 6 and 12 months.ResultsThe primary analysis showed no statistically significant between-group differences in mean change in heel pain during activity for rESWT versus advice plus customised foot orthoses (−0.02, 95% CI −1.01 to 0.96), sham-rESWT versus advice plus customised foot orthoses (0.52, 95% CI −0.49 to 1.53) and exercise versus advice plus customised foot orthoses (−0.11, 95% CI −1.11 to 0.89) at 6 months.ConclusionIn patients with plantar fasciopathy, there was no additional benefit of rESWT, sham-rESWT or a standardised exercise programme over advice plus customised foot orthoses in alleviating heel pain.Trial registration number NCT03472989.

Radial extracorporeal shock wave therapy (r-ESWT) is accepted as one of the most effective treatment modalities for plantar fasciitis (PF). Also kinesio taping (KT) applicationis effective for the treatment of PF. However, there is not enough evidence about the effectiveness of the combination of these two modalities in the treatment of PF. This prospective randomized clinical trial was planned to investigate the acute effects of KT application in addition to r-ESWT application on pain, foot function and flexibility. The study was performed on 42 patients with unilateral PF, that were randomly assigned into two groups receiving four sessions of either r-ESWT or r-ESWT+KT treatment once per week. All patients performed home exercises. Patients' pain levels were evaluated via the Visual Analogue Scale (VAS), and foot function via the Foot Function Index (FFI). Flexibility was evaluated through gastro-soleus and plantar fascia flexibility tests. The evaluations were done before and one week after the final treatment. Two Way Analysis of Variance with Repeated Measures and Generalized Estimating Equations (GEE) methods were used in statistical analyses. As a result, rest pain and activity pain decreased in both groups and there is no differences between the groups (respectively p: 0,831; p: 0.331). FFI pain and disability subscores decreased and were also similar between the groups (respectively p: 0.304; p: 0.978). FFI activity limitation subscore decreased in the r-ESWT group more than r-ESWT+KT group (p: 0.002). Night pain, gastro-soleus and plantar fascia flexibility did not change in both goups (respectively p: 0.713; p: 0.413; p: 0.475). Adding KT to r-ESWT application did not create an additional pain relieving effect, on the contrary, resulted in less improvement in activity limitation. This may be related to the fact that KT application to the sole and heel region creates a hard surface on the heel. r-ESWT application may be more beneficial in PF where activity limitation are prominent. The registration number: NCT06516393.

PurposeOver the last decade, penile low-intensity extracorporeal shockwave therapy (LI-ESWT) has emerged as a promising alternative for the treatment of erectile dysfunction (ED). The aim of this trial is to assess the effect of electromagnetic LI-ESWT on the erectile function of vascular phosphodiesterase type 5 inhibitor (PDE5I) refractory ED patients.MethodsRandomized, double-blind, sham-controlled study. 76 patients with vascular PDE5I-refractory ED completed the study. 40 men were treated with LI-ESWT (1 session/week for 4 weeks, 5000 shocks/session, 0.09 mJ/mm2 energy density) and 36 were treated with a sham probe. Baseline and post-treatment (1, 3 and 6 months) evaluations were performed using validated erectile function questionnaires (IIEF-EF, EHS, SEP2, SEP3 and GAQ1). The groups were compared using Mann–Whitney–Wilcoxon and chi-squared tests, with results considered statistically significant at p < 0.05.ResultsAt the 3-month follow-up, median change in IIEF-EF score for active and sham groups was 3.5 (IQR 0–10) and − 0.5 (IQR − 11 to 1), respectively (p < 0.05). Six months after treatment, 52.5% of patients (21/40) in the active group and 27.8% of patients (10/36) in the sham group presented an EHS > 2 (p < 0.05). At the same evaluation, 40.0% (16/40) and 13.9% (5/36) of patients had positive answers to GAQ-1, in the treated and sham groups, respectively (p < 0.05). No adverse events were observed during the study.ConclusionThis study showed that penile electromagnetic shockwave therapy may improve erectile function, to a modest extent, on certain patients that do not respond to PDE5I; making it an alternative for vascular ED patients that reject more invasive therapies.

Coronary heart disease (CHD) affects a large number of patients, and their survival period with the condition is relatively long. Cardiac shock wave therapy (CSWT) is an anti-myocardial ischemic therapy. This study aims to investigate the rehabilitative effects and underlying mechanisms of CSWT combined with exercise rehabilitation in patients undergoing percutaneous coronary intervention (PCI) for CHD. The study was a prospective randomized controlled trial conducted at Yunnan Fuwai Cardiovascular Hospital from 2020 to 2022, enrolling 74 patients who underwent PCI for CHD. They were randomly assigned to two groups: a control group of 37 patients and a study group of 37 patients. The intervention consisted of CSWT combined with exercise rehabilitation. Following the intervention, patients in the study group demonstrated increases in peak oxygen uptake (peak VO2), high-density lipoprotein cholesterol (HDL-C) and other parameters compared to pre-treatment levels. The combination of CSWT and exercise rehabilitation was found to improve myocardial markers, related anti-inflammatory and anti-atherosclerotic indicators in patients with CHD. Moreover, it alleviated myocardial ischemia while enhancing parameters such as oxygen uptake in cardiopulmonary exercise testing (CPET). These findings may offer novel insights into anti-ischemic treatment and cardiac rehabilitation for patients with CHD in future clinical practice.

PurposeThe extracorporeal shockwave lithotripsy (ESWL) remains the most common first line of treatment for renal stones in the pediatric population. The purpose of this study is to evaluate and compare the outcomes of the ESWL and mini-percutaneous nephrolithotomy (mini-PCNL).Patients and methodsA total of 108 patients younger than 12 years of age with 1–2 cm single renal stone (pelvic or calyceal) were randomized into two groups, each containing 54 patients. Patients in group A were subjected to mini-PCNL using 16.5 Fr percutaneous sheath while those in group B underwent ESWL using Dornier Compact Sigma.ResultsThe stone-free rate (SFR) after first session was 88.9% (48 cases) and 55.6% (30 cases) for groups A and B, respectively. The difference is highly statistically significant P = 0.006. Two patients (3.7%) in group A needed 2nd session of PCNL, while 18 patients (33.3%)in group B needed a 2nd session, of theses 18 patients six patients needed a 3rd session of ESWL. After the third session of ESWL and second look PCNL the stone-free rates were 92.59% (50 cases) and 88.89% (48 cases) for groups A and B, respectively, (P = 0.639), which is statistically insignificant. The mean hospital stay and fluoroscopy exposure were significantly longer in the mini-PCNL group. The complication rate in groups A and group B were (22.2%) and (14.8%), respectively, which is statistically insignificant (P = 0.484).ConclusionsAccording to Clavien grade of complications mini-PCNL is a safe procedure, and after three session of ESWL, mini-PCNL has a similar stone-free rate with a lower retreatment rate. However, the mini-PCNL has more radiation exposure, and requires a longer hospital stay.