I was recently at a conference where some of the physicians were speaking highly about shock wave therapy. Many of these physicians were in a similar field of medicine as myself, and trying to help people with their pain. This was not the first time I had heard of this modality in the sports medicine and pain management arenas. I finally decided to take matters into my own hands, and put some of the information about extracorporeal shock wave therapy (ESWT) into Treatment Scores in order to see the actual net treatment benefit of this modality for treating pain. I first started out with a search for generalized pain and ESWT. This search was way too broad and gave me hundreds of articles to look through. I then narrowed my search down many times, until I landed on plantar fasciitis and ESWT. I decided to use 2 different articles.
As I put these studies about plantar fasciitis and ESWT into the Treatment Scores system, I knew right away that this treatment was not going to score very well. First of all, pain is not a visual symptom, and thus can only be measured subjectively. That being said, unless a person's pain is completely gone, the pain level, subjectively, rarely tends to decrease substantially. This is partially due to factors that play a role in a person's pain such as chronicity of pain, mental state at the time of visit, external stressors in the person's life, etc.As you can see below, in the two studies evaluating ESWT and it's effect on plantar fasciitis, the treatment grade for ESWT is only a "D" for both studies, despite having slightly different overall scores.
The above studies were actually good studies. The reason the treatment grades were so low is due to the combination of only a 20-30% improvement in pain levels, the small patient population treated, and the short follow up time.
As the future of Treatment Score progresses, we will be able to compare multiple treatments for a single disease and a single treatment for multiple different issues. Treatment Scores allows us to assign a Treatment Grade to a variety of different modalities and diseases, and place them on similar playing fields. It allows use to compare big studies to small studies, good studies to poor studies and more. As time moves forward, this advancement in grading the different aspects of each study will help us to better understand and compare different treatments for different diseases. See the disclaimers below.
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