Efficacy of Extracorporeal Shockwave Therapy in the Management of Chronic Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis

Abstract

Introduction: This study will explore the effectiveness of current extracorporeal shockwave therapies in ulcer healing in diabetic foot disease compared to the standard of care. Methods: The systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. The electronic databases WoS, EMBASE, MEDLINE Complete, CINAHL Complete, Academic Search Ultimate, AMED-The Allied and Complementary Medicine Database, Scopus and PubMed searched for the outcome rate of complete ulcer healing. The risk of bias assessment was conducted using the tool recommended by the Cochrane Collaboration (Robvis Tool). Statistical analysis included the individual and combined result of the studies, heterogeneity test, the effect size, sensitivity analysis, and publication bias tests. Results: Eight randomized controlled trials (RCTs) with a total of 672 patients were included in this study. This meta-analysis showed a higher rate of complete ulcer healing in groups receiving extracorporeal shockwave therapies (OR = 2.747 [1.965, 3.841], p < 0.01, I2 =0.02) compared to control groups. Conclusions: In conclusion, the results of this meta-analysis show that extracorporeal shockwave therapies, when used as an adjunctive treatment, demonstrate significantly higher ulcer healing rates compared to standard of care. Extracorporeal shockwave therapies should be taken into account as a valuable adjunct to standard care for diabetic foot ulcer treatment.