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Paul Gurnett. MCSP. SRP.
Chartered and State Registered Physiotherapist.
----- Original Message -----
From: "Patrick Zerr" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, August 28, 2002 4:51 AM
Subject: Re: Shock Wave Therapy
> I would like to know what the parameters are fore ESWT versus US. I would
> also like to know what the cost of this treatment is versus the reimbursed
> rate any therapists are getting.
> Patrick Zerr
> www.apluspt.com
> The easiest way to prepare for the National PT Exam!
> www.summitpt.com
> Summit Physical Therapy; Tempe, Arizona
> ----- Original Message -----
> From: <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Tuesday, August 27, 2002 1:00 PM
> Subject: Shock Wave Therapy
>
>
> > For those who may not heard of a relatively new form of physical
therapy,
> > here is some information on what has come to be known as "shock wave
> > therapy". Shock wave therapy (ESWT) for treating musculoskeletal
injuries
> > involves the application of mechanical vibration in the form of pulsed
> > acoustic (sound) waves. Since the 1990s reports of benefit of ESWT in
the
> > treatment of tendon disorders have been appearing in the literature.
Here
> is
> > a selection of abstracts on this topic:
> >
> > -----------
> >
> > J Bone Joint Surg Am 2002 Mar; 84-A(3):335-41
> >
> > Evaluation of low-energy extracorporeal shock-wave application for
> treatment
> > of chronic plantar fasciitis.
> >
> > Rompe JD, Schoellner C, Nafe B.
> >
> > BACKGROUND: Although the application of low-energy extracorporeal shock
> waves
> > to treat musculoskeletal disorders is controversial, there has been some
> > limited, short-term evidence of its effectiveness for the treatment of
> > chronic plantar fasciitis.
> >
> > METHODS: From 1993 to 1995, a prospective, two-tailed, randomized,
> > controlled, observer-blinded pilot trial was performed to assess whether
> > three applications of 1000 impulses of low-energy shock waves (Group I)
> led
> > to a superior clinical outcome when compared with three applications of
> ten
> > impulses of low-energy shock waves (Group II) in patients with
intractable
> > plantar heel pain. The sample size was 112. The main outcome measure was
> > patient satisfaction according to a four-step score (excellent, good,
> > acceptable, and poor) at six months. Secondary outcome measures were
> patient
> > satisfaction according to the four-step score at five years and the
> severity
> > of pain on manual pressure, at night, and at rest as well as the ability
> to
> > walk without pain at six months and five years.
> >
> > RESULTS: At six months, the rate of good and excellent outcomes
according
> to
> > the four-step score was significantly (47%) better in Group I than in
> Group
> > II. As assessed on a visual analog scale, the score for pain caused by
> manual
> > pressure at six months had decreased to 19 points, from 77 points before
> > treatment, in Group I, whereas in Group II the ratings before treatment
> and
> > at six months were 79 and 77 points. In Group I, twenty-five of
forty-nine
> > patients were able to walk completely without pain at six months
compared
> > with zero of forty-eight patients in Group II. By five years, the
> difference
> > in the rates of good and excellent outcomes according to the four-step
> score
> > was only 11% in favor of Group I because of a high rate of good and
> excellent
> > results from subsequent surgery in Group II; the score for pain caused
by
> > manual pressure had decreased to 9 points in Group I and to 29 points in
> > Group II. At five years, five (13%) of thirty-eight patients in Group I
> had
> > undergone an operation of the heel compared with twenty-three (58%) of
> forty
> > patients in Group II.
> >
> > CONCLUSIONS: Three treatments with 1000 impulses of low-energy shock
waves
> > appear to be an effective therapy for plantar fasciitis and may help the
> > patient to avoid surgery for recalcitrant heel pain. In contrast, three
> > applications of ten impulses did not improve symptoms substantially.
> >
> > -------------
> >
> > Cochrane Database Syst Rev 2002;(1):CD003524
> >
> > Shock wave therapy for lateral elbow pain.
> >
> > Buchbinder R, Green S, White M, Barnsley L, Smidt N, Assendelft WJ.
> >
> > BACKGROUND: This review is one in a series of reviews of interventions
for
> > lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common
> > condition causing pain in the elbow and forearm and lack of strength and
> > function of the elbow and wrist. Shock wave therapy (ESWT) involves the
> > application of single pulsed acoustic wave. Since the 1990's reports of
> > benefit of ESWT in the treatment of tendon disorders have been appearing
> in
> > the literature. A systematic review published in the German language
> appeared
> > in 2000 (Boddeker 2000)
> >
> > OBJECTIVES: To determine the effectiveness and safety of ESWT in the
> > treatment of adults with lateral elbow pain. SEARCH STRATEGY:
> Comprehensive
> > electronic searches of MEDLINE, CINAHL, EMBASE and SCISEARCH were
combined
> > with searches of the Cochrane Clinical Trails Registrar and the
> > Musculoskeletal Review Group's specialist trial database. Identified
> keywords
> > and authors were searched again in an effort to identify as many trials
as
> > possible.
> >
> > SELECTION CRITERIA: Two independent reviewers assessed all identified
> trials
> > against pre-determined inclusion criteria. Randomised and pseudo
> randomised
> > trials in all languages were evaluated for inclusion in the review
> provided
> > they described individuals with lateral elbow pain and were comparing
the
> use
> > of ESWT as a treatment strategy.
> >
> > DATA COLLECTION AND ANALYSIS: For continuous variables means and
standard
> > deviations were extracted or imputed to allow the analysis of weighted
> mean
> > difference. Weighted mean difference using a random effects model was
> > selected when outcomes were measured on standard scales. A fixed effects
> > model was used to interpret results and assess heterogeneity. For binary
> data
> > numbers of events and total population were analysed and interpreted as
> > relative risk.
> >
> > MAIN RESULTS: Two trials of ESWT versus placebo are included in this
> review
> > (Rompe 1996, Haake 2001). Both trials included similar study populations
> > consisting of participants with chronic symptoms who had failed other
> > conservative treatment. The frequency of ESWT application and the doses
> and
> > techniques used were similar in both trials. The first trial
demonstrated
> > highly significant differences in favour of ESWT whereas the second
trial
> > found no benefits of ESWT over placebo. When the data from the two
trials
> > were pooled, the benefits observed in the first trial were no longer
> > statistically significant. The relative risk for treatment failure
> (defined
> > as Roles-Maudsley score of 4) of ESWT over placebo was 0.40 (95% CI,
0.08
> to
> > 1.91) at six weeks and 0.44 (95% CI, 0.09 to 2.17) at one year. After 6
> > weeks, there was no statistically significant improvement in pain at
rest
> > [WMD pain out of 100 = - 11.40 (95% CI, -26.10 to 3.30)], pain with
> resisted
> > wrist extension [WMD pain out of 100 = -16.20 (95% CI, -47.75 to 15.36)]
> or
> > pain with resisted middle finger extension [WMD pain out of 100
> = -20.51(95%
> > CI, -56.57 to 15.56)]. Results after 12 or 24 weeks were similar.
> >
> > REVIEWER'S CONCLUSIONS: The two trials included in this review yielded
> > conflicting results. Further trials are needed to clarify the value of
> ESWT
> > for lateral elbow pain.
> >
> > ----------------
> >
> > Z Orthop Ihre Grenzgeb 2002 May-Jun;140(3):267-74
> >
> > [Musculoskeletal shock wave therapy - current database of clinical
> research]
> >
> > Rompe JD, Buch M, Gerdesmeyer L, Haake M, Loew M, Maier M, Heine J
> >
> > During the past decade application of extracorporal shock waves became
an
> > established procedure for the treatment of various musculoskeletal
> diseases
> > in Germany. Upt to now the positive results of prospective randomised
> > controlled trials have been published for the treatment of plantar
> fasciitis,
> > lateral elbow epicondylitis (tennis elbow), and of calcifying tendinitis
> of
> > the rotator cuff. Most recently, contradicting results of prospective
> > randomised placebo-controlled trials with adequate sample size
calculation
> > have been reported. The goal of this review is to present information
> about
> > the current cinical database on extracorporeal shock wave tratement
> (ESWT).
> >
> > -------------------
> >
> > Clin Orthop 2001 Jun;(387):72-82
> >
> > Shock wave therapy versus conventional surgery in the treatment of
> calcifying
> > tendinitis of the shoulder.
> >
> > Rompe JD, Zoellner J, Nafe B.
> >
> > A prospective quasirandomized study was performed to compare the effects
> of
> > surgical extirpation (Group I, 29 patients) with the outcome after
> > high-energy extracorporeal shock wave therapy (Group II, 50 patients;
> 3,000
> > impulses of an energy flux density of 0.6 mJ/mm2) in patients with a
> chronic
> > calcifying tendinitis in the supraspinatus tendon. Symptoms and
> demographic
> > data of the two groups were comparable. According to the University of
> > California Los Angeles Rating System, the mean score in Group I was 30
> points
> > with 75% good or excellent results after 12 months, and 32 points with
90%
> > good or excellent results after 24 months.
> >
> > Radiologically, there was no calcific deposit in 85% of the patients
after
> 1
> > year. In Group II, the mean score was 28 points with 60% good or
excellent
> > results after 12 months, and 29 points with 64% good or excellent
results
> > after 2 years. Radiologically, complete elimination of the deposit was
> > observed in 47% of the patients after 1 year. Clinically, according to
the
> > University of California Los Angeles score, there was no significant
> > difference between both groups at 1 year. At 2 years, there was a
> > significantly better result in Group II. Both groups then were
subdivided
> > into patients who had a homogenous deposit as seen on radiographs and
> > patients who had an inhomogenous deposit before treatment.
> >
> > Surgery was superior compared with high-energy shock wave therapy for
> > patients with homogenous deposits. For patients with inhomogenous
> deposits,
> > high-energy extracorporeal shock wave therapy was equivalent to surgery
> and
> > should be given priority because of its noninvasiveness.
> >
> > --------------------
> >
> > Arch Orthop Trauma Surg 2002 May;122(4):222-8
> >
> > Side-effects of extracorporeal shock wave therapy (ESWT) in the
treatment
> of
> > tennis elbow.
> >
> > Haake M, Boddeker IR, Decker T, et al
> >
> > Apart from a few observational reports, there are no studies on the
> > side-effects of extracorporeal shock wave therapy (ESWT) in the
treatment
> of
> > insertion tendopathies. Within the framework of a randomised,
> > placebo-controlled, single-blind, multicentre study to test the
> effectiveness
> > of ESWT in the case of lateral epicondylitis (LE), side-effects were
> > systematically recorded. A total of 272 patients from 15 centres was
> > allocated at random to active ESWT (3 x 2000 pulses, energy flux density
> > ED(+) 0.04 to 0.22 mJ/mm(2) under local anaesthesia) or placebo ESWT. In
> all,
> > 399 ESWT and 402 placebo treatments were analysed.
> >
> > More side-effects were documented in the ESWT group (OR = 4.3, CI =
[2.9;
> > 6.3]) than in the placebo group. Most frequently, transitory reddening
of
> the
> > skin (21.1%), pain (4.8%) and small haematomas (3.0%) were found.
Migraine
> > was registered in four and syncopes in three instances after ESWT. ESWT
> for
> > LE with an energy flux density of ED(+) 0.04 to 0.22 mJ/mm(2) is a
> treatment
> > method which has very few side-effects. The possibility of migraine
being
> > triggered by ESWT and the risk of a syncope should be taken into account
> in
> > the future. No physical shock wave parameters could be definitely
> identified
> > as the cause of the side-effects observed.
> >
> > ------------------
> >
> > Clin Orthop 2001 Jun;(387):102-11
> >
> > High-energy extracorporeal shock wave treatment of nonunions.
> >
> > Rompe JD, Rosendahl T, Schollner C, Theis C.
> >
> > Forty-three consecutive patients who did not have healing of tibial or
> > femoral diaphyseal and metaphyseal fractures and osteotomies for at
least
> 9
> > months after injury or surgery were examined prospectively for use of
> > high-energy extracorporeal shock waves. Former treatment modalities
> (cast,
> > external fixator, plate osteosynthesis, limitation of weightbearing)
> > remained unchanged. In all cases a 99mTechnetium dicarboxyphosphonate
> > regional two-phase bone scintigraphy was performed before one treatment
> with
> > 3,000 impulses of an energy flux density of 0.6 mJ/mm2. Radiologic and
> > clinical followups were done at 4-week intervals starting 8 weeks after
> shock
> > wave treatment. The success criterion was bridging of all four cortices
> in
> > the anteroposterior and lateral radiographic views, in oblique views,
or
> by
> > conventional tomography.
> >
> > An independent observer described bony consolidation in 31 of 43 cases
> (72%)
> > after an average of 4 months (range, 2-7 months). Twenty-nine of 35
> (82.9%)
> > patients with a positive bone scan had healing of the pseudarthrosis
> > compared with two of eight (25%) patients with a negative bone scan. Six
> of
> > these eight patients with negative scans were heavy smokers. No
> complications
> > were observed.
> >
> > High-energy shock wave therapy seemed to be an effective noninvasive
tool
> > for stimulation of bone healing in properly selected patients with a
> > diaphyseal or metaphyseal nonunion of the femur or tibia. Additional
> > controlled studies are mandatory.
> >
> > --------------------
> >
> > Dr Mel C Siff
> > Denver, USA
> > http://groups.yahoo.com/group/Supertraining/
> >
>
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