THE EFFECTIVENESS OF SHOCKWAVE THERAPY IN THE TREATMENT OF ADULT PATIENT WITH CHRONIC PLANTER FASCIITIS: A SYSTEMATIC REVIEW.

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Background Plantar fasciitis (PF) is a highly prevalent musculoskeletal condition affecting the lower limbs. Both extracorporeal shock wave therapy (ESWT), and radial extracorporeal shock wave therapy (rESWT) therapy seem effective, safe, non-invasive treatment methods for PF. The lack of systematic reviews (SR) means the question of whether ESWT and rESWT are equivalent in pain control for PF in adults remains unanswered. Therefore, this SR assesses the effectiveness of SWT in treating and achieving a reduction in PF in adult patients. Methods An SR research design was adopted, adhering to the PRISMA guidelines. PubMed, CINAHL, Cochrane Library, Scopus, Web of Science, MEDLINE (via OVID) and Embase (via OVID) databases were searched for all relevant studies from January 2000. A PRISMA flow diagram was used to provide a visual summary and to screen the process and so remove irrelevant articles. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Retrospective Cohort Studies and randomized controlled trials (RCTs) were employed to appraise the included studies. The primary outcome measure was allocated to include a visual analogue scale (VAS) score, a Roles and Maudsley (RM) score paired with the Foot Function Index-pain subscale (FFI-PS); secondary outcomes included the AOFAS, RM, and the SF-12 Global Health Rating Scale. Results In total, 1,590 studies were identified. After eliminating irrelevant articles using JBI Critical Appraisal Checklist, only 12 studies that met inclusion criteria were included for this SR. The total number of participants in this SR was 1,258: 67% were females (845) and 33% were males (413) of the ages: 38.9 ±6.4 to 59.9 ± 4.7. The sample sizes across all the studies ranged from 40-246 participants. The studies revealed that SWT (ESWT, rESWT) is efficacious and safe for managing chronic PF by effectively reducing the pain amongst adults through a multitude of high-quality RCTs that can be used in double-blind-RCTs, single-blind-RCTs, and retrospective cohort studies. The findings show that applying a lower pulse variable frequency of treatment (from 1,300 to 2,000 pulses) at an energy density of (0.02 to 0.3 mJ/mm2) repeatedly was highly effective. It was also argued that a minimum of three sessions, with a 1-week interval between them, can improve pain and function. Conclusion: ESWT and rESWT offer an effective, safe, non-invasive management of chronic PF that effectively reduces the pain amongst adults. Therefore, SWT is probably a safe treatment for PF, as there are no complications that require a 2-year follow-up. However, long-term complications remain unidentified. Future research (e.g., RCTs) is needed to explore the impacts of the long-term outcomes of ESWT and rESWT for the treatment of different age groups with chronic PF. Therefore, more high-quality studies are required with a larger sample size and any complications or side effects, particularly regarding pain during treatment. Keywords: Plantar fasciitis (PF), shock wave therapy, systematic review (SR)

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