Effectiveness of extracorporeal shock wave therapy for frozen shoulder: A Meta-analysis

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BACKGROUND: There is a lack of evidence about the application of extracorporeal shock wave therapy (ESWT) in frozen shoulder contracture syndrome. OBJECTIVE: To systematically assess the effectiveness of ESWT for frozen shoulder. METHODS: A computer-based online search of PubMed, ScienceDirect, The Cochrane Library, Embase, Web of knowledge, CNKI, WanFang and CqVip databases was performed for articles related to ESWT for frozen shoulder published before May 10, 2016. Randomized controlled trials or randomized controlled crossover trials were screened. The Meta-analysis was conducted using RevMan 5.0 software, and publication bias was assessed by Berg and Egger tests on Stata11.0 software. The continuous variables were expressed as standard mean difference (SMD) and 95% confidence interval (CI), and binary variables were expressed as odds ratio (OR) and 95% CI. RESULTS AND CONCLUSION: Eleven trials were enrolled involving 816 participants. ESWT could effectively alleviate shoulder pain (P < 0.05, IS=54%). When excluded the trials of which control groups were medical interventions, the direction of the outcome did not change. ESWT was beneficial for the participants in terms of range of motion except extension, the changes in shoulder flexion (P < 0.05, I²=28%), shoulder abduction (P < 0.000 01, I²=17%), shoulder internal rotation (P < 0.05, IS=0%), shoulder external rotation (P < 0.05, IS=43%). However, there is no evidence of the effectiveness of ESWT versus control (conventional therapy) for improving the range of shoulder extension. ESWT could increase the efficiency of treating frozen shoulder (P < 0.05, I²=0.0%) and efficacy of curing frozen shoulder (P < 0.05, I²=0.0%) compared with other interventions, and with no significant difference in the drop rate. These results indicate that ESWT can effectively alleviate the pain of frozen shoulder, expand the range of shoulder flexion, abduction, internal and external rotation, as well as improve the therapeutic efficiency and cure rate in the treatment of frozen shoulder. © 2017 by Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.

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... The existing evidence and findings of this systematic review reveal that ESWT effectively accelerates the healing activity of the frozen shoulder (56). Further, ESWT is beneficial as it is cost-effective, non-invasive, safe, has fewer side effects, and it requires fewer visits without any need for hospitalization (57). The findings of a meta-analysis demonstrate that ESWT expands the range of flexion, internal and external rotation of the shoulder and enhances therapeutic efficiency and cure rate in treating and managing the frozen shoulder (58). ...
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