Wang

Extracorporeal shockwave therapy may be better than hyperbaric oxygen for healing diabetic ulcers.

1. Some poor evidence that ESWT may be effective in stimulating healing of diabetic ulcers.

Citation/s:1.Wang CJ, Kuo YR, Wu RW, Liu RT, Hsu CS, Wang FS, Yang KD. Extracorporeal shockwave treatment for chronic diabetic foot ulcers. J Surg Res. 2009 Mar;152(1):96-103. doi: 10.1016/j.jss.2008.01.026. Epub 2008 Mar7
Lead author's name and fax: Chin-Jen Wang : w281211@cgmh.org.tw

Three-part Clinical Question:For adult patients with chronic diabetic ulcers, does the use of extracorporeal shockwave therapy (ESWT) compared to hyperbaric oxygen, result in improved healing?
Search Terms: ESWT; diabetic ulcer; blood flow

The Study:Non-blinded non-randomised trial without intention-to-treat.
The Study Patients: Recurrent diabetic ulcers of at least 3 months duration. Sepsis and gangrene excluded.
Control group (N = 36; 34 analysed): ESWT 300  + 100/cm2 impulses of shockwave at 0.11 mJ/cm2 energy flux density evenly applied to the ulcer surface once every 2 wk for a total of three treatments in 6 weeks. Repeat course if not complete healing.
Experimental group (N = 38; 36 analysed): 100% oxygen breathing at 2.5 ATA for 90 minutes daily, five days each week to a total of 20 sessions.

The Evidence:

 

Outcome

Time to Outcome

ESWT

HBOT

Relative risk reduction

Absolute risk reduction

NNT

Complete healing

End of treatment

0.31

0.21

31%

0.10

11

95% CIs:

-34% to 96%

-0.10 to 0.29

NNT = 3 to INF; NNH = 10 to INF

>50% healing

End of treatment

0.58

0.47

19%

0.11

9

95% CIs:

-20% to 57%

-0.12 to 0.34

NNT = 3 to INF; NNH = 9 to INF

 

Measure

ESWT Group

HBOT Group

Difference

95% CI

Mean

SD

Mean

SD

Laser doppler blood flow after treatment (no units)

0.75

0.19

0.58

0.11

0.17

0.16 to 0.18

 

Comments:

1. Not a truly randomised study - allocation by day of referral.
2. Four patients excluded for poor compliance after randomisation
3. All patients had standard wound care in both arms. No measure of any ulcer hypoxia (e'g. PtcO2)
4. Note ESWT course potentially 12 weeks, HBOT course four weeks, so comparisons are not made at the same time in each group. Longer term outcomes not known.                                                                                                                                                    5. 
Proportions for healing were reported as statistically significantly different in favour of ESWT.

Appraised by: Darren Foo & Mike Bennett m.bennett@unsw.edu.au; Monday, 6 July 2020
Kill or Update By: July 2022  

 

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