A comparison of different energy densities of extracorporeal shock wave therapy (ESWT) for the management of chronic heel pain

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A comparison of different energy densities of extracorporeal shock wave therapy (ESWT) for the management of chronic heel pain

 

Author: Chow, Hoi-wan Intonia
Title: A comparison of different energy densities of extracorporeal shock wave therapy (ESWT) for the management of chronic heel pain
Degree: M.Sc.
Year: 2004
Subject: Hong Kong Polytechnic University -- Dissertations
Extracorporeal shock wave therapy
Heel bone -- Wounds and injuries -- Treatment
Pain -- Treatment
Department: Dept. of Rehabilitation Sciences
Pages: x, 84 leaves : ill. (some col.) ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1762048
URI: http://theses.lib.polyu.edu.hk/handle/200/2825
Abstract: Extracorporeal shock wave therapy (ESWT) is getting more popular in the management of chronic musculoskeletal disorders. It has been shown to produce high success rate in pain relief and functional restoration for managing heel pain in recent studies. However, the existing treatment parameters used were based on rough estimates that remain empirical. This study examined the treatment effectiveness of ESWT with different energy densities, as compared to a control group, for the management of chronic heel pain. A single-blinded randomized controlled study design was used. Forty-nine patients suffered from heel pain for more than three months were recruited. Their mean age was 50.94 years old and they were divided into three groups. The "fixed" energy density group received 1000 impulses of ESWT with the mean energy density at 0.09mJ/mm2. The "maximum tolerable" energy density group received 1000 impulses of ESWT with the mean energy density ranged from 0.10 to 0.14m.J/mm2. The control group received 30 impulses of ESWT with energy density fixed at 0.03mJ/mm2. ESWT were administrated at 3 Hz and given at weekly interval for three consecutive weeks. A follow-up was scheduled three weeks after the last treatment, The outcome measures were assessed on Week 1, Week 2, Week 3 and Follow-up before applying ESWT. The intensity of pain on tension and palpation were assessed by Visual Analogue Scale (VAS). Foot Function Index (FFI) and maximum tolerable walking/standing duration were evaluated. Repeated measures analysis of variance (ANOVA) was used for data analysis. After three weeks of ESWT treatment, the "maximum tolerable" energy density group showed significantly greater pain reduction and improvement of functional performance as compared to the "fixed" energy density and control groups. There were significant between-group differences for pain on tension (p=0.00l by Week 2, P=0.000 by Week 3 and Follow-up), pain on palpation (p=0.000 by Week 2, Week 3 and Follow-up) and the maximum tolerable walking/standing duration (p=0.022 by Week 2, p=0.000 by Week 3 and Follow-up). By Week 3, there was 66% cumulative reduction of pain on tension in the "maximum tolerable" energy density group, as compared to 45% in the "fixed" energy density group. Moreover, there was 65% cumulative reduction of pain on palpation in the "maximum tolerable" energy density group, as compared to 32% in the "fixed" energy density group. By Week 3, there was 112% cumulative increase in the maximum tolerable walking/standing duration in the "maximum tolerable" energy density group, as compared to 45% in the "fixed" energy density group. There were also significant between-group differences for the FFI scores of the pain subscale (p=0.000 by Week 3 and Follow-up), disability subscale (p=0.011 by Week 3, p=0.000 by Follow-up) and activity limitation subscale (p=0.016 by Week 3, p=0.000 by Follow-up). By Week 3, there was 48% cumulative reduction of FFI score for the pain subscale in the "maximum tolerable" energy density group, as compared to 14% in the "fixed" energy density group. Moreover, there was 46% cumulative reduction of FFI score for the disability subscale in the "maximum tolerable" energy density group, as compared to 10% in the "fixed" energy density group. By Week 3, there was 58% cumulative reduction of FFI score for the activity limitation subscale in the "maximum tolerable" energy density group, as compared to 16% in the "fixed" energy density group. All treatment effects were maintained at least up to the follow-up session for both the "fixed" and "maximum tolerable" energy density groups. For the control group, there was no significant change in any of the outcome measures across treatment sessions (all p>0.05). ESWT administrated with "maximum tolerable" energy density was more effective in managing chronic heel pain than ESWT with "fixed" energy density. Three sessions of 1000 impulses of ESWT with medium "maximum tolerable" energy density significantly reduced the intensity of heel pain, improved the walking tolerance and functional performance of the patients. The therapeutic effects achieved by three sessions of ESWT could be maintained at least up to the three-week follow-up session.

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