Extracorporeal shock wave therapy for treating foot ulcers in people with diabetes: A systematic review and meta-analysis of randomized controlled trials

Abstract Objective Extracorporeal shock wave therapy (ESWT) as a new adjuvant therapy showed a potential capability to promote diabetic foot ulcer (DFU) healing. The purpose of this study was to assess the efficacy and safety of ESWT on the healing of DFU. Methods The Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine and the reference lists were searched for studies published up to December 2018. Randomized controlled trials (RCTs) of any design including ESWT for DFU patients with were included. Two reviewers extracted data including the wound surface area (WSA), the percentage of re-epithelialization, the population of complete cure and unchanged and other related outcomes. Results Eight RCTs (339 participants) were included. ESWT was found associated with a greater reduction of WSA by 1.54 cm 2 , and increase of re-epithelialization by 26.31%. A greater population of complete cure was found at the end of treatment (risk ratio (RR) =2.22, 95% confidence interval (CI): 1.46-3.40), however, there was no statistically significant difference at the end of follow-up ( p =0.052). It can also reduce treatment inefficiency by 4.8-fold (95% CI: 0.12-0.37). In addition, ESWT also showed a higher superiority than HBOT at the population of complete cure and unchanged ulcer (RR=1.83, 95% CI: 1.14-2.94 and RR=0.25, 95% CI: 0.13-0.48, respectively). Conclusion ESWT is a feasible adjuvant treatment for DFU. It can effectively improve the complete cure rate, shorten the healing period of DFU, and significantly reduce the treatment ineffectiveness. This can provide new therapeutic ideas for clinical practice of intractable and recurrent DFU.