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The Effects of Shock Wave Therapy on the Symptoms and Function of Individuals With Dupuytren Disease: A Systematic Review

PainSci » bibliography » Yazdani et al 2024
updated

Four pages on PainSci cite Yazdani 2024: 1. Does Ultrasound or Shockwave Therapy Work? 2. Dupuytren’s Contracture 3. Shockwaves for Dupuytren’s: vibration therapy for a disease triggered by vibration? 4. STUDY: Vibration therapy for a disease triggered by vibration 

PainSci notes on Yazdani 2024:

Yazdani et al looked at twenty-six trials of shockwave therapy for Dupuytren’s contracture, tossed out twenty, and reviewed the remaining six teeny tiny studies — just 145 patients covered by all of them. But studies don’t have to be big to be worthwhile, and these researchers judged five to be “good” quality, and one “fair.” I think they might have been a bit too generous.

But — good news, everyone! — those six studies of uncertain quality collectively showed “remarkable improvement” in pain and function, as measured by the pain-scale and various disability questionnaires. One study also reported improved grip.

And another reported actual shrinkage of the distinctive bumps and lumps of Dupuytren’s contracture! So maybe shockwave therapy can “melt” contractures somehow? That would be a way bigger deal than merely improving pain and function — that’s changing the course of the disease. If it really does, that’s some crazy physiology, fascinating and important. But I rather doubt it. And so do Yazdani et al, who rated their confidence in that evidence “low.” (Even though it came from a study they rated as “fair”? Seems like a bit of a contradiction there.)

The review concludes (with some slightly stilted English):

Shockwave therapy can lead to significant pain improvement, functional rehabilitation, and patient satisfaction with no adverse effect in the management of Dupuytren disease. Pain may return over time, but not to that severity [sic] before the intervention.

For whatever a small review of a small body of evidence is worth. Reviews are worse than laws and sausages: the more we know about how they’re made, the less we like them (hat tip to Mark Crislip).


Common issues and characteristics relevant to this paper: ?Scientific papers have many common characteristics, flaws, and limitations, and many of these are rarely or never acknowledged in the paper itself, or even by other reviewers. I have reviewed thousands of papers, and described many of these issues literally hundreds of times. Eventually I got sick of repeating myself, and so now I just refer to a list common characteristics, especially flaws. Not every single one of them applies perfectly to every paper, but if something is listed here, it is relevant in some way. Note that in the case of reviews, the issue may apply to the science being reviewed, and not the review itself.

  1. Garbage in, garbage out — not enough good quality data to meaningfully review/analyze.

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To systematically evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, clinical and functional outcomes, and satisfaction of patients with Dupuytren disease.

DATA SOURCES: A thorough search for all the study types published in English was conducted in PubMed, Scopus, Web of Science, and Embase from inception to August 31, 2022.

STUDY SELECTION: Title and abstract and then full-text screening against eligibility criteria was performed independently by 2 reviewers, and a third reviewer achieved consensus.

DATA EXTRACTION: Reviewers identified 26 studies, of which 6 were included in the analysis (145 cases). The methodological quality was assessed using the National Heart, Lung, and Blood Institute and the Joanna Briggs Institute checklists. The certainty of evidence was evaluated using the Grading of Recommendation Assessment, Development, and Evaluation.

DATA SYNTHESIS: Assessments represented a remarkable improvement in the pain and function through the measurements including the visual analog scale, the Disabilities of Arm Shoulder and Hand Questionnaire, the Michigan Hand Outcome Questionnaire, and Mayo Wrist Score. Patients' satisfaction was also favorable using the Roles and Maudsley score. The hand grip strength improvement was noted in one study measured via a Jamar dynamometer. In addition, the ultrasonographic assessment of the nodules revealed a decrease in the size of the nodules in a patient with multiple bilateral nodules after the treatment. The quality of the included studies was good for all studies except for one that was fair. The certainty of evidence was moderate for pain and function and was low for patients' satisfaction and ultrasonographic findings.

CONCLUSIONS: ESWT can lead to significant pain improvement, functional rehabilitation, and patient satisfaction with no adverse effect in the management of Dupuytren disease. Pain may return over time, but not to that severity before the intervention. ESWT-related characteristics and the need for continuation of treatment remain to be fully elucidated in future large clinical trials.

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