title: Extracorporeal shock wave therapy as an adjunct wound treatment: a systematic review of the literature.
abstract: Standard care procedures for complex wounds are sometimes supported and reinforced by physical treatment modalities such as extracorporeal shock wave therapy (ESWT). To evaluate available evidence of ESWT effectiveness in humans, a systematic review of the literature was conducted using MEDLINE, PubMed, Scopus, EBSCOhost, and PEDro databases. Of the 393 articles found, 13 met the publication date (year 2000-2013), study type (clinical study), language (English only), and abstract availability (yes) criteria. The 13 studies (n = 919 patients with wounds of varying etiologies) included seven randomized controlled trials that were evaluated using Cochrane Collaboration Group standards. Only studies with randomization, well prepared inclusion/exclusion criteria protocol, written in English, and full version available were analyzed. An additional six publications reporting results of other clinical studies including a total of 523patients were identified and summarized. ESWT was most commonly applied once or twice a week using used low or medium energy, focused or defocused generator heads (energy range 0.03 to 0.25 mJ/mm2; usually 0.1 mJ/mm2), and electrohydraulic or electromagnetic sources. Few safety concerns were reported, and in the controlled clinical studies statistically significant differences in rates of wound closure were reported compared to a variety of standard topical treatment modalities, sham ESWT treatment, and hyperbaric oxygen therapy. Based on this analysis, ESWT can be characterized as noninvasive, mostly painless, and safe. Controlled, randomized, multicenter, blind clinical trials still are required to evaluate the efficacy and cost-effectiveness of ESWT compared to sham control, other adjunctive treatments, and commonly used moisture-retentive dressings. In the future, ESWT may play an important role in wound care once evidence-based practice guidelines are developed.
authors.affiliation: Department of Nervous System Diseases, University of Medicine in Wroclaw, Wroclaw, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Dymarek
authors.affiliation: Institute of Public Higher Professional Medical School, Opole, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Halski
authors.affiliation: Department of Gynecology and Obstetrics, University of Medicine in Wroclaw, Wroclaw, Poland.
authors.forename: Kuba
authors.initials: K
authors.lastname: Ptaszkowski
authors.affiliation: Department of Physiotherapy, University of Medicine in Wroclaw, Wroclaw, Poland.
authors.forename: Lucyna
authors.initials: L
authors.lastname: Slupska
authors.affiliation: Department of Nervous System Diseases, University of Medicine in Wroclaw, Wroclaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Rosinczuk
authors.affiliation: Trustee of the European Pressure Advisory Panel; and Department of Physiotherapy Basics, Academy School of Physical Education, Katowice, Poland; email: j.taradaj@awf.katowice.pl.
authors.forename: Jakub
authors.initials: J
authors.lastname: Taradaj
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods* / Q000706:statistics & numerical data; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D023421:Models, Animal; D016896:Treatment Outcome; D014945:Wound Healing; D014947:Wounds and Injuries / Q000628:therapy*