Ann Rehabil Med.  2015 Aug;39(4):616-623. 10.5535/arm.2015.39.4.616.

The Dose-Related Effects of Extracorporeal Shock Wave Therapy for Knee Osteoarthritis

• Kim JH
• Kim JY
• Choi CM
• Lee JK
• Kee HS
• Jung KI
• Yoon SR

• KMID: 2148233
• DOI: http://doi.org/10.5535/arm.2015.39.4.616

Abstract

OBJECTIVE
To investigate the dose-related effects of extracorporeal shock wave therapy (ESWT) for knee osteoarthritis.
METHODS
Seventy-five subjects were recruited, 60 of which met the inclusion criteria. The patients were randomly classified into two groups: group L, which was a low-energy group (n=30; 1,000 shocks/session; energy flux density [EFD], 0.040 mJ/mm2) and group M, which was a medium-energy group (n=30; 1,000 shocks/session; EFD, 0.093 mJ/mm2). For each group, 1,000 shock waves were delivered to the medial tibial plateau area, once a week, for 3 weeks. The main outcome measures were the visual analogue scale (VAS), the Roles and Maudsley (RM) score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and the Lequesne index. Each assessment was performed at the baseline and at 1, 4, and 12 weeks after ESWT.
RESULTS
In both groups, the VAS, the RM and WOMAC scores, and the Lequesne index were significantly improved over time (p<0.001), and group M showed greater improvement over group L at the 1, 4 and 12 weeks assessments.
CONCLUSION
In this study, medium-energy group (group M) showed greater improvement in regard to relieving pain and restoring functional outcome than the low-energy group (group L). Therefore, EFD can be considered to have significant influence when treating with ESWT for knee osteoarthritis.

Keyword

Osteoarthritis; Knee; High-energy shock waves; Treatment outcome

MeSH Terms

High-Energy Shock Waves
Humans
Knee*
Ontario
Osteoarthritis
Osteoarthritis, Knee*
Outcome Assessment (Health Care)
Shock*
Treatment Outcome

Figure

• 

  Fig. 1 A flow diagram, showing the treatment process and assessment. ESWT, extracorporeal shock wave therapy; EFD, energy flux density.

• 

  Fig. 2 The visual analogue scale (VAS) score at the baseline and 1-, 4-, and 12-week follow-ups after the extracorporeal shock wave therapy in both groups. This figure shows significant improvement for both groups, in the VAS score, for entire period (***p<0.001 for time effect, ***p<0.001 for group-time interaction) and significant differences between the two groups at 1 week and 12 weeks (*p<0.05). Group M, medium-energy (0.093 mJ/mm2) group; group L, low-energy (0.040 mJ/mm2) group.

• 

  Fig. 3 The Roles and Maudsley score at the baseline and 1-, 4-, 12-week follow-ups after the extracorporeal shock wave therapy, in both groups. This figure shows significant improvement for both group in the Roles and Maudsley score over the entire period (***p<0.001 for time effect, ***p<0.05 for group-time interaction) and significant differences between the two groups at 1 week and 4 weeks (*p<0.05). Group M, medium-energy (0.093 mJ/mm2) group; group L, low-energy (0.040 mJ/mm2) group.

• 

  Fig. 4 The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score at the baseline and 1-, 4-, 12-week follow-ups after the extracorporeal shock wave therapy, in both groups. This figure shows significant improvement, for both groups, in WOMAC score over the entire period (***p<0.001 for time effect, ***p<0.001 for group-time interaction), and significant differences between the two groups at 4 weeks and 12 weeks (*p<0.05). Group M, medium-energy (0.093 mJ/ mm2) group; group L: low-energy (0.040 mJ/mm2) group.

• 

  Fig. 5 The Lequesne index at the baseline and 1-, 4-, 12- week follow-ups after extracorporeal shock wave therapy, for both groups. This figure shows significant improvement, for both groups, in the Lequesne index over entire period (***p<0.001 for time effect, ***p<0.001 for grouptime interaction), and significant differences between the two groups at 12 weeks (*p<0.05). Group M, mediumenergy (0.093 mJ/mm2) group; group L: low-energy (0.040 mJ/mm2) group.

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