FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3042829821> ?p ?o ?g. }

• W3042829821 endingPage "280" @default.
• W3042829821 startingPage "278" @default.
• W3042829821 abstract "Proximal suspensory desmitis (PSD) is a commonly diagnosed condition affecting a range of equine populations, but most commonly seen in mature sports horses (Dyson 1994). Previous studies have shown that the percentage of those horses affected returning to their previous level of work varies greatly with conservative management (40%) or surgical treatment (70–87%) (Norvall et al. 2015). Which limb is affected also plays a significant role with up to 90% of forelimb injuries returning to work compared to only 40% of hindlimb injuries (Dyson 1994). Extracorporeal shockwave therapy ECSWT and radial pressure wave therapy (RPWT) have been advocated for the management of many tendon and ligament disorders, such as superficial flexor tendinitis (Kersh et al. 2018) and PSD (Caminoto et al. 2005) based on results in experimental research models. The exact mechanism by which ECSWT or RPWT exerts their effect within tendon and ligaments is not known. One theory is that it relates to induction of analgesia from the effect on sensory nerves (Bolt et al. 2004). Experimental studies have, however, also demonstrated deleterious effects on tendon explant cultures (Bosch et al. 2007). The relevance of this in the clinical situation is not known. ECSWT and RPWT are both included in this critically appraised topic (CAT) to enable a larger body of literature to be used. Multiple theories regarding the mechanisms and relative efficacy of the two methods are offered in the literature, with many suggesting ECSWT to be superior. However, large meta-analyses within human rehabilitation literature have concluded the modalities are equally as efficacious for the management of tendon and ligament disorders, and that the majority of available ECSWT devices generate waveforms rather than true shockwaves (Schmitz 2015). This study aims to evaluate the literature relevant to functional outcomes following the use of ECSWT or RPWT in PSD in horses. Does RPWT or ECSWT improve the return to function in horses with proximal suspensory desmitis? Population- Horses with proximal suspensory desmitis Intervention- Extracorporeal shockwave therapy or radial pressure wave therapy Control- Horses with PSD managed conservatively Outcome- return to previous athletic activity The first paper from Löffeld et al. (2002) was a prospective clinical trial of 61 horses with proximal suspensory desmitis. Horses included in the trial met the following criteria: (i) diagnosis of chronic proximal suspensory desmitis >3 months duration, (ii) previous unsuccessful treatment with systemic or local anti-inflammatories and (iii) no systemic or other orthopaedic disease. Thirty horses with chronic PSD were compared to 31 control cases. Within the paper, it is not detailed as to whether the cases were forelimb or hindlimb cases. Cases were prospectively enrolled to be part of the treatment or control group; no details within the paper are found as to the randomisation process. The control group included horses treated by corticosteroids injected around the proximal suspensory ligament, blistering or field rest. The blistering process was not detailed in the paper as to the method used or if the method was consistent throughout. Similarly, the injection site, corticosteroid used or total volume injected are not clearly stated. The ECSWT group were treated with 2000 impulses at 2.5 bar with a frequency of 8 Hz for three sessions with a 2- to 4-week interval. Both groups were subject to the same ascending exercise programme beginning with 20 min of hand walking increasing up to short periods of trot. Cases treated with ECSWT alongside the exercise programme had increased rates of return to previous activity level with 71% compared to 50% of the control group being in full work at 6 months. The control group in this study was not homogenous and subject to different treatment protocols. Overall this leaves us unable to draw strong conclusions to the benefits of the pressure wave treatment applied to this population compared with the control group. Following this Crowe et al. (2004) reported 65 horses with chronic forelimb or hindlimb PSD seen at two UK referral centres. Their inclusion criteria were as follows: (i) lameness present for greater than 3 months; (ii) a positive response to local anaesthesia of the deep branch of the lateral plantar or palmar metacarpal nerve; where a positive response was defined as abolishment of lameness or substantial improvement; (iii) a negative response to intra-articular anaesthesia of the tarsometatarsal or middle carpal joint; (iv)ultrasonographic evidence of proximal suspensory desmitis. Of the 65 cases, 20 cases had forelimb PSD, 43 had hindlimb PSD and two cases had both forelimb and hindlimb PSD. Cases were additionally assessed for lameness grade and ultrasonographic appearance of lesions at the beginning and end of treatment. All horses were subject to the same treatment protocol; radial pressure wave therapy (2000 impulses at 10 Hz) given at 2-week intervals for 3 treatments followed by an ascending exercise programme. Horses then had a further lameness examination at 6 months. Fifty horses were reassessed by the author, 8 horses by the referring vet and the final 2 horses’ results were obtained via telephone consultation with the owner. Of the 19 forelimb cases re-examined by the authors, 10 (53%) were in full work at 6 months, and for the 43 hindlimb cases, 18 (41%) were in full work. These results were then compared with the results of a previous series of cases of acute hindlimb PSD seen at one of the clinics where they found 18–21% in full work at 6 months and a previous series of cases of chronic PSD where 0/11 cases were in full work at 6 months (Dyson 1994). The authors concluded that for chronic PSD in the forelimb and hindlimb, RPWT resulted in more horses being in work at 6 months compared to that of a controlled exercise program alone. The control populations were not contemporaneous and the outcomes for forelimb PSD cases were compared with those in a previous series of hindlimb cases. Forelimb PSD cases are reported to respond better to conservative management than hindlimb PSD so it becomes difficult to draw firm conclusions from these results. Lischer et al. (2006) reported a retrospective series of 52 cases seen between 1999 and 2003. Their inclusion criteria were as follows: (i) improvement by one AAEP lameness grade in response to palmar metacarpal or deep branch of the lateral plantar nerve anaesthesia; (ii) negative or mild improvement to intraarticular anaesthesia of the tarsometatarsal joint. This mild improvement was not defined by the authors. Within the group of the 52 horses, 34 forelimbs had PSD (1 bilateral) and 22 hindlimbs had PSD (3 bilateral). Cases were assessed for lameness grade, ultrasonographic appearance of the lesions and radiographic assessment of any sceloris at the origin of the suspensory ligament (graded from mild to moderate). Radiographs were taken to exclude other pathologies, but it is not stated by the authors whether cases were excluded if they had concomitant orthopaedic problems. Ultrasonographic evidence of proximal suspensory desmitis was not a prerequisite for inclusion in this study. The affected limbs were then subject to the same ECSWT protocol of 2000 impulses at 240 Hz over three treatments spaced 2 weeks apart followed by an ascending exercise programme. The lameness was then reassessed at weeks 3, 6, 12, 26 and 52 post-treatment. Of the forelimb PSD cases, mean lameness grade at 26 weeks was improved from 1.8/5.0 to 0.5/5.0 with 61.0% in full work. For hindlimb PSD cases, mean lameness grade was improved from 1.95/5.0 to 1.29/5.0 with 40.8% in full work at 26 weeks. These results were compared to the 13% in full work at 6 months previously reported with rest and rehabilitation alone (Dyson 1994). A degree of interobserver error may be present with assessment performed by more than one individual. This paper has no contemporaneous control group(s) and relies on comparisons with the previous literature. There is lack of blinding of assessors leading to treatment bias and lack of contemporaneous control groups. A more recent paper by Norvall et al. (2015) compared the outcome and time to return to work for horses with hindlimb PSD that were treated either surgically with neurectomy and fasciotomy or with ECSWT. This study is the only one of those described to compare ECSWT to surgical management rather than to conservative management. The inculsion criteria were as follows: (i) improvement of lameness to deep branch of the lateral plantar nerve analgesia; (ii) ultrasonographic findings consistent with PSD. Seventy-five horses with hindlimb proximal suspensory desmitis were included in the study. Initially, 41 horses were treated surgically, and 34 cases with ECSWT. Of the 41 surgically treated cases, 24 horses (58%) returned to their previous level of work with a mean time to return to work of 10.1 months. Twenty of the 34 cases (59%) treated with ECSWT returned to their previous level of work with a mean time to return to work of 7.4 months. The authors claimed their results indicated that within this study ECSWT resulted in a faster return to work with success rates similar to that of surgical treatment of PSD. Fifteen horses remained lame following their initial treatment and were then treated with the other modality. Seven of these horses returned to their previous level of work following both treatments. Previously reported results of surgical treatment with neurectomy and fasciotomy reported 44% of horses with concurrent lameness issues to be in work at one year, compared to 77% of horses where PSD was the sole complaint (Dyson and Murray, 2012). Within this paper, it is not discussed if there were any concurrent lameness problems, however, both treatment groups results fall within these ranges. The limitations of the study by Norvall et al. (2015) include lack of randomisation of treatment groups; however, it is less subject to interobserver error and provides a more straightforward account of the prognosis to inform owners. The question this paper asked (Does RPT or ECSWT improve the return to function in horses with proximal suspensory desmitis?) is not able to be unequivocally answered based on the literature reviewed. Studies published to date on ECSWT and PSD mostly comprise retrospective case series, with only one prospective case-control study. The follow-up within all the studies is of limited duration (between 6 months and one year), providing little information on the long-term prognosis for horses with PSD. Outcome measures are not standardised not assessors blinded as to treatment. Inclusion criteria were often limited to clinical investigation without diagnostic imaging which may influence the population studied and means improvement in appearance on imaging could not be incorporated into outcome measures. There are two studies supporting an improved outcome with either ECSWT or RPT over rest and rehabilitation alone, but both studies had significant weaknesses that make drawing any firm conclusion impossible. None of the case series included indicated a worse functional outcome for horses treated with ECSWT or RPT compared to other regimes. Further prospective randomised case-control studies would be required to fully elucidate the impact of ECSWT and RPWT. It would be helpful to standardise both the inclusion criteria and outcome measures for future studies. No conflicts of interest have been declared. Not applicable. None." @default.
• W3042829821 created "2020-07-23" @default.
• W3042829821 creator A5001383154 @default.
• W3042829821 date "2020-07-16" @default.
• W3042829821 modified "2023-10-13" @default.
• W3042829821 title "Does extracorporeal shockwave therapy or radial pressure wave therapy improve return to function over conservative and/or surgical management in horses with proximal suspensory desmitis?" @default.
• W3042829821 cites W1514239796 @default.
• W3042829821 cites W1944496461 @default.
• W3042829821 cites W1986562201 @default.
• W3042829821 cites W1988329195 @default.
• W3042829821 cites W2014152843 @default.
• W3042829821 cites W2017935441 @default.
• W3042829821 cites W2041047715 @default.
• W3042829821 cites W2507493036 @default.
• W3042829821 cites W2883898635 @default.
• W3042829821 doi "https://doi.org/10.1111/eve.13352" @default.
• W3042829821 hasPublicationYear "2020" @default.
• W3042829821 type Work @default.
• W3042829821 sameAs 3042829821 @default.
• W3042829821 citedByCount "1" @default.
• W3042829821 countsByYear W30428298212022 @default.
• W3042829821 crossrefType "journal-article" @default.
• W3042829821 hasAuthorship W3042829821A5001383154 @default.
• W3042829821 hasBestOaLocation W30428298211 @default.
• W3042829821 hasConcept C141071460 @default.
• W3042829821 hasConcept C2777572544 @default.
• W3042829821 hasConcept C2779915274 @default.
• W3042829821 hasConcept C2780904754 @default.
• W3042829821 hasConcept C3019249673 @default.
• W3042829821 hasConcept C3019396726 @default.
• W3042829821 hasConcept C71924100 @default.
• W3042829821 hasConceptScore W3042829821C141071460 @default.
• W3042829821 hasConceptScore W3042829821C2777572544 @default.
• W3042829821 hasConceptScore W3042829821C2779915274 @default.
• W3042829821 hasConceptScore W3042829821C2780904754 @default.
• W3042829821 hasConceptScore W3042829821C3019249673 @default.
• W3042829821 hasConceptScore W3042829821C3019396726 @default.
• W3042829821 hasConceptScore W3042829821C71924100 @default.
• W3042829821 hasIssue "5" @default.
• W3042829821 hasLocation W30428298211 @default.
• W3042829821 hasOpenAccess W3042829821 @default.
• W3042829821 hasPrimaryLocation W30428298211 @default.
• W3042829821 hasRelatedWork W2012440261 @default.
• W3042829821 hasRelatedWork W2014543782 @default.
• W3042829821 hasRelatedWork W2040447569 @default.
• W3042829821 hasRelatedWork W2050657432 @default.
• W3042829821 hasRelatedWork W2402876051 @default.
• W3042829821 hasRelatedWork W2467471573 @default.
• W3042829821 hasRelatedWork W2607400854 @default.
• W3042829821 hasRelatedWork W2989971081 @default.
• W3042829821 hasRelatedWork W3033044226 @default.
• W3042829821 hasRelatedWork W4285509580 @default.
• W3042829821 hasVolume "33" @default.
• W3042829821 isParatext "false" @default.
• W3042829821 isRetracted "false" @default.
• W3042829821 magId "3042829821" @default.
• W3042829821 workType "article" @default.