Re: ESWT - trials cast doubt on efficacy
Posted by john on 10/10/04 at 14:27
Dieter,
I feel that Buchbinder set out to produce a negative review because her
conclusions far exceeded the results of the study. She made statements
about the effectiveness of high intensity ESWT and duration of symptoms
even though the statements were not tested in her study.
In terms of her NEJM article, Dr. Buchbinder recommended surgery even
though she admitted that the evidence was weak. Dr. Rompe provided a nice
rebuttal to the NEJM article.
I think that there is a dose effect with ESWT and the recent JAMA article
on rotator cuff demonstrates a dosing effect. Buchbinder and others do not
recognize the difference between high intensity and low intensity ESWT,
preferring instead, to group all protocols into one.
Buchbinder's original JAMA article was conducted properly and was high
quality research. My complaint is that it did not study the protocol
approved by the FDA so it's results cannot be used to make conclusions
about the FDA approved protocol. In the US, ESWT is reserved as a treatment
of last result after all other methods fail and before surgery. It would be
improper to take a patient with 6 weeks of symptoms and treat them with
ESWT. Evidently, in Australia, it may be acceptable to use ESWT as a first
line treatment.
Hope this helps to clarify the concerns over Buchbinder and her two
articles.
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