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PODIATRY  2004

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Subject:

Re: ESWT

From:

Joel Radford <[log in to unmask]>

Reply-To:

A group for the academic discussion of current issues in podiatry <[log in to unmask]>

Date:

Tue, 26 Oct 2004 13:03:24 +1000

Content-Type:

text/plain

Parts/Attachments:

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text/plain (107 lines)

Reply

Reply

Hi Dieter,

I finally have had a chance to look at the full text of the very recent
Ogden study (Journal of Bone and Joint Surgery, October, Vol 86, No 10,
2216-2228)

I've only looked at the results from the randomised trial presented as
obviously this provides higher evidence than the phase 1 and non-randomised
trials.  I've also only looked at the outcomes at 3 months as the follow-up
at 12 months demonstrates an almost 50% drop out rate and allows
participants to choose whether they want to continue treatment.  I haven't
judged the quality of the trial either (blinding etc), only looked at the
results.

Successful treatment, according to criteria set by the authors, was achieved
in 67 participants in the intervention group and 42 participants in the
placebo group.  Mailbasers can judge for themselves whether this a wonderful
success rate or not.

Unfortunately, the actual differences between groups in VAS scores for
"morning heel-pain" and "pain during activity" demonstrate results of
questionable clinical importance, 8.5mm and 1.6mm respectively.  Currently
it appears that you need to achieve a change of at least 9mm (some authors
report 16mm) on the VAS before the patients even notice that their pain has
changed.  Therefore, this difference between groups may not even be
noticeable for patients.

The largest difference on the VAS was for the physician assessment of heel
pain 20.2.  However I'm never keen on pain measurements that involve a
clinician, I prefer to know what the patient thinks on their own.  I'm also
unsure how reliable this measurement of pain would be?

Interestingly, no standard deviations (let alone confidence intervals) were
provided so we cannot know how precise these measurements were.  Also, SF-36
data was collected but results not reported from what I could see - strange!
Oh, and there was a vested interest for some of the authors involved in the
trial if anyone wanted to know.

I wish the results were better for all those hopeful to add ESWT to their
arsenal for plantar fasciitis, but at this stage the outset is still not so
good.

Cheers,

Joel.




-----Original Message-----
From: A group for the academic discussion of current issues in podiatry
[mailto:[log in to unmask]] On Behalf Of Dieter
Sent: Thursday, October 14, 2004 7:18 AM
To: [log in to unmask]
Subject: Re: ESWT

Joel,

But there IS good evidence in favour of ESTW - but the right treatment needs
to be matched to the right patient group. You seem to not accept this
tenent.

I have posted evidence twice but you have not taken this into account.
Unfortunately I do not have librabry access to search for other papers at
this time. If you are interested there is more to be found in the links I
have provided.

The way I see it the jury is still out on it but I found enough evidence
that suggests to me that it is a worthwhile addition, in the managment of
recalcitrant heel pain. To re-iterate, the worst outcome is the patient is
no better. The best outcome: the patient is saved from potentially harmful
surgery. I have not followed the ankle manipulation thread but would suggest
the same philosophy applies.

If you have closed your mind to this it is your perogative - nonetheless I
appreciate your input and observations about the Buchbinder study.

I would be interested to hear from anyone else who is using the equipment
right now.

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