A new and accurate predictive model for the efficacy of extracorporeal shock wave therapy in managing patients with chronic plantar fasciitis

Publication date: Available online 17 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mengchen Yin, Ni Chen, Quan Huang, Anastasia Sulindro Marla, Junming Ma, Jie Ye, Wen Mo
ObjectivesTo identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis.DesignRandomized controlled, prospective study.SettingOutpatient of local medical center settings.ParticipantsPatients treated for symptomatic chronic plantar fasciitis between 2014 and 2016 (N=278).InterventionsESWT was performed by the principal authors to treat chronic plantar fasciitis. ESWT was administered in 3 sessions, with an interval of 2 weeks (±4 days). In the low, moderate and high-intensity group, 2400 impulses total of ESWT with an energy flux density of 0.2mJ/mm², 0.4mJ/mm², 0.6mJ/mm² respectively (a rate of 8 impulses per second) were appliedMain outcome measuresThe demographic and clinical characteristics independent variables were patient age, gender, BMI, affected side, duration of symptoms, Roles and Maudsley score, VAS when taking first steps in the morning, oedema, bone spurs and intensity grade of ESWT. A minimal reduction of 50% in the VAS was considered as minimum clinically successful therapy (MCST). The correlations between the achievement of MCST and independent variables were analyzed. The statistically significant factors identifies were further analyzed by multivariate logistic regression, and the predictive model was established.ResultsThe success rate of ESWT was 66.9%. Univariate analysis found that VAS when taking first steps in the morning, oedema and the presence of heel spur in X-ray significantly affected the outcome of the treatment. Logistic regression draw the equation: MCST=[1+e^{(0.011+42.807∗heel spur+0.109∗ Oedema+5.395∗VAS)}]^-1.The sensitivity of predictive factors was 96.77%, 87.63% and 86.02%, respectively. The specificity 45.65%, 42.39% and 85.87%, respectively. The AUC was 0.751, 0.650 and 0.859, respectively. Youden index was 0.4243, 0.3003 and 0.7189, respectively. Hosmer-Lemeshow test showed a good fitting of the predictive model with an overall accuracy of 89.6%.ConclusionsThe study establishes a new and accurate predictive model for the efficacy of ESWT in managing patients with chronic plantar fasciitis. The use of these parameters, in the form of a predictive model for ESWT efficacy, has the potential to improve decision-making in the application of ESWT.



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