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Reply: Shock Wave Therapy for Chronic Achilles Tendon Pain: A Randomized Placebo-controlled Trial

Costa, Matthew1; Shepstone, Lee2; Donell, Simon3; Thomas, Tudor4

Clinical Orthopaedics and Related Research: April 2006 - Volume 445 - Issue - p 277
doi: 10.1097/01.blo.0000203487.36454.b7
SECTION III: REGULAR AND SPECIAL FEATURES: Orthopaedic • Radiology • Pathology Conference: Letters to the Editor
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1Department of Orthopaedics, Warwick Medical School, Coventry, UK; 2The Institute of Health, University of East Anglia, Norwich, UK; 3The Institute of Health, University of East Anglia, Norwich, UK; and 4Department of Orthopaedics, Colchester General Hospital, Colchester, UK

Reply:

We thank Professor Rompe for his interest in our paper.2 We hope that we can address each of his queries in this letter.

Regarding the number and frequency of the shock wave treatment sessions, we are unaware of any trials in which different times between the treatment applications were compared. The senior author and the radiographers who provided the treatment worked together for 8 years to develop the protocol used in our study. Their early experience was published previously.5

Our study was done in 2001, as we stated in the published article.2 The excellent work of Speed et al was not published until 2002,6 therefore, these data were not available when we designed our trial. Regarding the timing of the primary end point, Professor Rompe is correct that our primary outcome measure was recorded 1 month after completion of treatment (4 months after it began). However, the followup was for 1 year which certainly would have included the delayed treatment effect to which he refers. We did not observe such an effect.

We agree that there are several well-designed trials that show a treatment effect for shock wave therapy. As an expert in the field, I am sure that Professor Rompe also is aware of the numerous well-designed trials that have not shown a treatment effect.1,3,4,6 We are pleased to stand by the published conclusions of our trial.2

Matthew Costa, PhD, FRCS (Tr and Orth)

Department of Orthopaedics, Warwick Medical School, Coventry, UK

Lee Shepstone, PhD

The Institute of Health, University of East Anglia, Norwich, UK

Simon Donell, MD

The Institute of Health, University of East Anglia, Norwich, UK

Tudor Thomas, FRCS

Department of Orthopaedics, Colchester General Hospital, Colchester, UK

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References

1. Buchbinder R, Ptasznik R, Gordon J, Buchanan J, Prabaharan V, Forbes A. Ultrasound-guided extracorporeal shock wave therapy for plantar fasciitis: a randomized controlled trial. JAMA. 2002;288: 1364-1372.
2. Costa ML, Shepstone L, Donell ST, Thomas TL. Shock wave therapy for chronic Achilles tendon pain: a randomized placebo-controlled trial. Clin Orthop Relat Res. 2005;440:199-204.
3. Haake M, Buch M, Schoellner C, Goebel F, Vogel M, Mueller I, Hausdorf J, Zamzow K, Schade-Brittinger C, Mueller H-H. Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre study. BMJ. 2003;327:75.
4. Haake M, Konig IR, Decker T, Riedel C, Buch M, Muller HH. Extracorporeal Shock Wave Therapy Clinical Trial Group. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg. 2002;84: 1982-1991.
5. Mandalia V, Thomas TL, Chari R. The analgesic effect of extracorporeal shock wave therapy (ESWT) on tennis elbow, golfer's elbow and plantar fasciitis: a preliminary report. J Orthop Med. 2002;24:13-16.
6. Speed CA, Richards C, Nichols D, Burnet S, Wies JT, Humphreys H, Hazleman BL. Extracorporeal shock-wave therapy for tendonitis of the rotator cuff: a double-blind, randomised, controlled trial. J Bone Joint Surg. 2002;84:509-512.
© 2006 Lippincott Williams & Wilkins, Inc.