Pengcheng Zhu, Peiyuan Tang, Jingyue Su, Yixin Yang, Shengwu Yang, Chunwu Zhang, Wenfeng Xiao, Yang Zhou, Yusheng Li, Zhenhan Deng
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A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) graded the quality and reliability of the MAs, and the quality of outcomes was graded by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Graphical Representation of Overlap for OVErviews (GROOVE) was applied to analyze overlap and classified the resulting evidence into four categories (I-IV) on the basis of evidence classification criteria.</p><p><strong>Results: </strong>A total of nine MAs were included for analysis: five had a high AMSTAR 2 rating, three had a moderate AMSTAR 2 rating, and one had a low AMSTAR 2 rating. GROOVE analysis revealed substantial overlap, informing evidence classification. ESWT can effectively reduce the pain assessed by the visual analogue scale (VAS) compared with placebo (MD = -0.68; 95% CI -1.06, -0.3; P = 0.0004; I<sup>2</sup> = 75%). Compared with ultrasound therapy, ESWT has a significantly large reduction in the level of pain after the treatment at 1-month follow-up (MD = -1.42; 95% CI -2.14, -0.7; P = 0.0001; I<sup>2</sup> = 92%) and 3-month follow-up (MD = -1.65; 95% CI -1.81, -1.49; P < 0.00001; I<sup>2</sup> = 98%). ESWT is better than corticosteroid injection when calculating the pooled effect size of VAS (SMD = 1.13, 95% Cl 0.72, 1.55; P < 0.00001; I<sup>2</sup> = 0). ESWT also has a significant difference in the rate of 50% reduction in pain (RR = 1.38; 95% CI 1.09, 1.75; P = 0.008; I<sup>2</sup> = 41%). However, compared with placebo, it has no clinically important difference of grip strength (MD = 3.33; 95% CI 0.93, 5.73; P = 0.007; I<sup>2</sup> = 30%), and the pain score of Thomsen test (MD = -3.22; 95% CI -14.06, 7.62; P = 0.56; I<sup>2</sup> = 69%).</p><p><strong>Conclusions: </strong>ESWT has a significant difference in reducing pain evaluation and relief of pain symptoms, and the effect is better than ultrasound therapy and corticosteroid injections.</p><p><strong>Level of evidence i: </strong></p><p><strong>This protocol has been registered in the prospero database: </strong>CRD42024586419.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"55"},"PeriodicalIF":3.7000,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361003/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparison of extracorporeal shockwave therapy, ultrasound therapy, and corticosteroid injections for treatment of lateral epicondylitis: an umbrella review of meta-analyses.\",\"authors\":\"Pengcheng Zhu, Peiyuan Tang, Jingyue Su, Yixin Yang, Shengwu Yang, Chunwu Zhang, Wenfeng Xiao, Yang Zhou, Yusheng Li, Zhenhan Deng\",\"doi\":\"10.1186/s10195-025-00871-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The purpose of this study was to assess the methodological quality of meta-analyses (MAs) and resolve evidence inconsistencies by quantifying overlap in primary studies, thereby providing enhanced evidence on the efficacy of extracorporeal shockwave therapy (ESWT) versus placebo, ultrasound therapy, and corticosteroid injections for lateral epicondylitis.</p><p><strong>Methods: </strong>We conducted searches in four databases: PubMed, Embase, Cochrane Library, and Web of Science, until August 2024. 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Compared with ultrasound therapy, ESWT has a significantly large reduction in the level of pain after the treatment at 1-month follow-up (MD = -1.42; 95% CI -2.14, -0.7; P = 0.0001; I<sup>2</sup> = 92%) and 3-month follow-up (MD = -1.65; 95% CI -1.81, -1.49; P < 0.00001; I<sup>2</sup> = 98%). ESWT is better than corticosteroid injection when calculating the pooled effect size of VAS (SMD = 1.13, 95% Cl 0.72, 1.55; P < 0.00001; I<sup>2</sup> = 0). ESWT also has a significant difference in the rate of 50% reduction in pain (RR = 1.38; 95% CI 1.09, 1.75; P = 0.008; I<sup>2</sup> = 41%). 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引用次数: 0
摘要
背景：本研究的目的是评估meta分析（MAs）的方法学质量，并通过量化初步研究的重叠来解决证据不一致的问题，从而为体外冲击波治疗（ESWT）与安慰剂、超声治疗和皮质类固醇注射治疗外侧上髁炎的疗效提供更有力的证据。方法：我们检索了PubMed、Embase、Cochrane Library和Web of Science四个数据库，检索时间截止到2024年8月。本综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。评估系统评价的测量工具2 （AMSTAR 2）对MAs的质量和可靠性进行了分级，结果的质量通过建议评估、发展和评价分级（GRADE）进行了分级。应用GROOVE （Graphical Representation of Overlap for OVErviews）对重叠进行分析，并根据证据分类标准将得到的证据分为四类（I-IV）。结果：共有9个MAs被纳入分析：5个具有高AMSTAR 2评级，3个具有中等AMSTAR 2评级，1个具有低AMSTAR 2评级。GROOVE分析显示大量重叠，为证据分类提供了信息。与安慰剂相比，ESWT可有效减轻视觉模拟量表（VAS）评估的疼痛（MD = -0.68; 95% CI -1.06, -0.3; P = 0.0004; I2 = 75%）。与超声治疗相比，ESWT治疗后1个月随访（MD = -1.42; 95% CI -2.14, -0.7; P = 0.0001; I2 = 92%）和3个月随访（MD = -1.65; 95% CI -1.81, -1.49; P = 98%）疼痛水平明显降低。计算VAS合并效应大小时，ESWT优于皮质类固醇注射（SMD = 1.13, 95% Cl = 0.72, 1.55; P = 0）。ESWT组在疼痛减轻50%的比率上也有显著差异（RR = 1.38; 95% CI 1.09, 1.75; P = 0.008; I2 = 41%）。但与安慰剂相比，握力（MD = 3.33; 95% CI 0.93, 5.73; P = 0.007; I2 = 30%）和Thomsen试验疼痛评分（MD = -3.22; 95% CI -14.06, 7.62; P = 0.56; I2 = 69%）无临床意义差异。结论：ESWT在减轻疼痛评价和缓解疼痛症状方面具有显著差异，且效果优于超声治疗和皮质类固醇注射。证据级别i：该协议已在prospero数据库中注册：CRD42024586419。
Comparison of extracorporeal shockwave therapy, ultrasound therapy, and corticosteroid injections for treatment of lateral epicondylitis: an umbrella review of meta-analyses.
Background: The purpose of this study was to assess the methodological quality of meta-analyses (MAs) and resolve evidence inconsistencies by quantifying overlap in primary studies, thereby providing enhanced evidence on the efficacy of extracorporeal shockwave therapy (ESWT) versus placebo, ultrasound therapy, and corticosteroid injections for lateral epicondylitis.
Methods: We conducted searches in four databases: PubMed, Embase, Cochrane Library, and Web of Science, until August 2024. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) graded the quality and reliability of the MAs, and the quality of outcomes was graded by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Graphical Representation of Overlap for OVErviews (GROOVE) was applied to analyze overlap and classified the resulting evidence into four categories (I-IV) on the basis of evidence classification criteria.
Results: A total of nine MAs were included for analysis: five had a high AMSTAR 2 rating, three had a moderate AMSTAR 2 rating, and one had a low AMSTAR 2 rating. GROOVE analysis revealed substantial overlap, informing evidence classification. ESWT can effectively reduce the pain assessed by the visual analogue scale (VAS) compared with placebo (MD = -0.68; 95% CI -1.06, -0.3; P = 0.0004; I2 = 75%). Compared with ultrasound therapy, ESWT has a significantly large reduction in the level of pain after the treatment at 1-month follow-up (MD = -1.42; 95% CI -2.14, -0.7; P = 0.0001; I2 = 92%) and 3-month follow-up (MD = -1.65; 95% CI -1.81, -1.49; P < 0.00001; I2 = 98%). ESWT is better than corticosteroid injection when calculating the pooled effect size of VAS (SMD = 1.13, 95% Cl 0.72, 1.55; P < 0.00001; I2 = 0). ESWT also has a significant difference in the rate of 50% reduction in pain (RR = 1.38; 95% CI 1.09, 1.75; P = 0.008; I2 = 41%). However, compared with placebo, it has no clinically important difference of grip strength (MD = 3.33; 95% CI 0.93, 5.73; P = 0.007; I2 = 30%), and the pain score of Thomsen test (MD = -3.22; 95% CI -14.06, 7.62; P = 0.56; I2 = 69%).
Conclusions: ESWT has a significant difference in reducing pain evaluation and relief of pain symptoms, and the effect is better than ultrasound therapy and corticosteroid injections.
Level of evidence i:
This protocol has been registered in the prospero database: CRD42024586419.
期刊介绍：
The Journal of Orthopaedics and Traumatology, the official open access peer-reviewed journal of the Italian Society of Orthopaedics and Traumatology, publishes original papers reporting basic or clinical research in the field of orthopaedic and traumatologic surgery, as well as systematic reviews, brief communications, case reports and letters to the Editor. Narrative instructional reviews and commentaries to original articles may be commissioned by Editors from eminent colleagues. The Journal of Orthopaedics and Traumatology aims to be an international forum for the communication and exchange of ideas concerning the various aspects of orthopaedics and musculoskeletal trauma.
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