What type of study is this?

This is a Meta-Analysis study (also classified as: Systematic Review).

August 18, 2025Open Access

Comparison of extracorporeal shockwave therapy, ultrasound therapy, and corticosteroid injections for treatment of lateral epicondylitis: an umbrella review of meta-analyses

PZPengcheng ZhuGeely (China)PTPengyue TangCentral South University JSJingyue SuWenzhou Medical University

Puntos clave

Extracorporeal shockwave therapy significantly reduces pain in lateral epicondylitis compared to corticosteroid injections, ultrasound therapy, and placebo.
Visual analogue scale measurements indicate that shockwave therapy reduces pain more effectively than other treatments, with a mean difference of -1.42 after one-month follow-up.
Quality assessment of nine meta-analyses reveals five rated high quality, informing the reliability of the findings on effectiveness and pain relief.
Evidence classification analysis indicates significant overlap in primary studies, emphasizing the strength of the conclusions drawn.

Resumen

The purpose of this study was to assess the methodological quality of meta-analyses (MAs) and resolve evidence inconsistencies by quantifying overlap in primary studies, thereby providing enhanced evidence on the efficacy of extracorporeal shockwave therapy (ESWT) versus placebo, ultrasound therapy, and corticosteroid injections for lateral epicondylitis. We conducted searches in four databases: PubMed, Embase, Cochrane Library, and Web of Science, until August 2024. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) graded the quality and reliability of the MAs, and the quality of outcomes was graded by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Graphical Representation of Overlap for OVErviews (GROOVE) was applied to analyze overlap and classified the resulting evidence into four categories (I-IV) on the basis of evidence classification criteria. A total of nine MAs were included for analysis: five had a high AMSTAR 2 rating, three had a moderate AMSTAR 2 rating, and one had a low AMSTAR 2 rating. GROOVE analysis revealed substantial overlap, informing evidence classification. ESWT can effectively reduce the pain assessed by the visual analogue scale (VAS) compared with placebo (MD = -0.68; 95% CI -1.06, -0.3; P = 0.0004; I2 = 75%). Compared with ultrasound therapy, ESWT has a significantly large reduction in the level of pain after the treatment at 1-month follow-up (MD = -1.42; 95% CI -2.14, -0.7; P = 0.0001; I2 = 92%) and 3-month follow-up (MD = -1.65; 95% CI -1.81, -1.49; P < 0.00001; I2 = 98%). ESWT is better than corticosteroid injection when calculating the pooled effect size of VAS (SMD = 1.13, 95% Cl 0.72, 1.55; P < 0.00001; I2 = 0). ESWT also has a significant difference in the rate of 50% reduction in pain (RR = 1.38; 95% CI 1.09, 1.75; P = 0.008; I2 = 41%). However, compared with placebo, it has no clinically important difference of grip strength (MD = 3.33; 95% CI 0.93, 5.73; P = 0.007; I2 = 30%), and the pain score of Thomsen test (MD = -3.22; 95% CI -14.06, 7.62; P = 0.56; I2 = 69%). ESWT has a significant difference in reducing pain evaluation and relief of pain symptoms, and the effect is better than ultrasound therapy and corticosteroid injections. CRD42024586419.

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