Hitchman et al. 2023
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Hitchman L, Totty J, Smith GE, Carradice D, Twiddy M, Iglesias C, Russell D, Chetter IC. Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review. 2023 Aug;20(6):2303-2320.
Design: Systematic Review Methods: Databases were searched for trials comparing ESWT plus standard care to standard care alone or sham ESWT in participants with DFUs. The Cochrane Risk of Bias 2 tool and GRADE approach was used to assess bias and certainty. All trials must have reported an objective measure of ulcer healing to be eligible for inclusion. Results: • 6 trials consisting of 471 participants were included. • Time to ulcer healing, proportion of healed ulcers and reduction in ulcer size was most likely improved in patients treated with ESWT compared with standard ulcer care alone (GRADE: low certainty). • Patients treated with ESWT were more likely to heal at 20 weeks post- ESWT compared with those treated with standard ulcer care alone (GRADE: low certainty). • Adverse events did not differ between ESWT and standard care alone (GRADE: low certainty) • No trials assessed the quality of life or cost effectiveness of the ESWT compared to standard care alone.
Key message: ESWT remains a promising new treatment but the translation into routine clinical practice is still limited by the low certainty of evidence surrounding its effectiveness, case selection and optimum dose.
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