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Chronic low back pain (CLBP) is a key cause of disability, often resulting in persistent pain and impaired physical function. Extracorporeal shock wave therapy (ESWT) has emerged as a noninvasive treatment option, but its comparative efficacy alone and in combination with conventional physical therapy (CPT) remains uncertain.
Combining extracorporeal shock wave therapy with conventional physical therapy provides the greatest improvements in pain relief and functional recovery for chronic low back pain.
Chronic low back pain (CLBP) is a key cause of disability, often resulting in persistent pain and impaired physical function. Extracorporeal shock wave therapy (ESWT) has emerged as a noninvasive treatment option, but its comparative efficacy alone and in combination with conventional physical therapy (CPT) remains uncertain. This study evaluated the relative potency of these treatment strategies for pain reduction and functional improvement in CLBP.
A frequentist network meta-analysis was performed using Stata/MP 18. PubMed, Web of Science, Embase, and the Cochrane Library were searched to identify randomized controlled trials comparing ESWT, CPT, ESWT combined with CPT, or sham ESWT in CLBP-affected adults. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment using RoB 2.0, while evidence certainty was evaluated using grading of recommendations, assessment, development, and evaluation (GRADE). Treatment rankings were estimated via surface under the cumulative ranking curve (SUCRA) values.
In total, 14 randomized controlled trials (RCTs) reported pain outcomes using the visual analog scale (VAS) or numeric rating scale (NRS), while eight trials assessed functional outcomes using the Oswestry Disability Index (ODI). Lower scores indicated better outcomes. Combination therapy (ESWT + CPT) ranked highest for both pain relief (SUCRA: 96.0%) and functional improvement (SUCRA: 99.3%), followed by ESWT alone, CPT alone, and sham ESWT.
Compared with sham ESWT, combination therapy reduced pain (standardized mean difference [SMD] = −1.70) and was also superior to CPT alone (SMD = −0.88). ESWT alone also illustrated greater pain reduction than sham ESWT (SMD = −1.22). For functional outcomes, combination therapy attained better improvements than ESWT alone (mean difference [MD] = −3.60), sham ESWT (MD = −7.60), and CPT alone (MD = −5.29). ESWT monotherapy improved pain but did not demonstrate significant functional benefits.
Combined ESWT with CPT provided the greatest improvements in pain relief and functional recovery in CLBP. ESWT alone reduced pain but did not improve function. Further high-quality trials are warranted to validate these outcomes.
Frontiers in Physiology
Efficacy of extracorporeal shock wave therapy combined with conventional physical therapy for chronic low back pain: a systematic review and network meta-analysis of randomized controlled trials
Zhengtong Qiao et al.
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