Twelve RCTs (1,431 participants) scoring 3 or more out of 5 points on the Jadad scale were included in the review.
Success rates: Statistically higher success rates were observed for medium-intensity focused shockwave (OR 1.56, 95% CI 1.23 to 1.96; five RCTs; Ι²=0%) and high-intensity focused shockwave (OR 1.43, 95% CI 1.07 to 1.91; two RCTs; Ι²=60%) compared with placebo. Larger, but statistically non-significant, pooled effects were seen for low-intensity focused shockwave and radial shockwave versus placebo. In the network meta-analysis with Bayesian mixed-treatment comparisons, only radial shockwave showed an increase in success in which the entire credible interval was greater than one (OR 38.26, 95% CrI 2.14 to 202.4). The probability of being ranked best treatment were 82.7% for radial shockwave, 12.3% for low-intensity focused shockwave, 1.7% for medium-intensity focused shockwave, and 3.1% for high-intensity focused shockwave.
Reduction in pain scales: Statistically lower pain visual analogue scale score rates were observed for medium-intensity focused shockwave (-1.21, 95% CI -1.76 to -0.67; two RCTs; Ι²=40%) and high-intensity focused shockwave (-0.33, 95% CI -0.58 to -0.08; two RCTs; Ι²=0%) compared with placebo. Larger, but statistically non-significant, pooled effects were seen for low-intensity focused shockwave and radial shockwave versus placebo. In the network meta-analysis with Bayesian mixed-treatment comparisons, only radial shockwave showed a reduction in pain scores in which the entire credible interval (CrI) was less than zero (-6.09, 95% CrI -8.30 to -3.42). The probability of being ranked best treatment were 91.0% for radial shockwave, 2.8% for low-intensity focused shockwave, 4.2% for medium-intensity focused shockwave, and 1.8% for high-intensity focused shockwave.
Meta-regression showed some correlation between focused shockwave intensity and pain reduction, but not for success.