Article

OBJECTIVE: To 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. DESIGN: Randomized,
controlled, prospective study. SETTING: Outpatient of local medical center
settings. PARTICIPANTS: Patients treated for symptomatic chronic plantar
fasciitis between 2014 and 2016 (N=278). INTERVENTIONS: ESWT was performed by the
principal authors to treat chronic plantar fasciitis. ESWT was administered in 3
sessions, with an interval of 2 weeks (+/-4d). In the low-, moderate-, and
high-intensity groups, 2400 impulses total of ESWT with an energy flux density of
0.2, 0.4, and 0.6mJ/mm(2), respectively (a rate of 8 impulses per second), were
applied. MAIN OUTCOME MEASURES: The independent variables were patient age, sex,
body mass index, affected side, duration of symptoms, Roles and Maudsley score,
visual analog scale (VAS) score when taking first steps in the morning, edema,
bone spurs, and intensity grade of ESWT. A minimal reduction of 50% in the VAS
score was considered as minimum clinically successful therapy. The correlations
between the achievement of minimum clinically successful therapy and independent
variables were analyzed. The statistically significant factors identified were
further analyzed by multivariate logistic regression, and the predictive model
was established. RESULTS:
The success rate of ESWT was 66.9%. Univariate analysis
found that VAS score when taking first steps in the morning, edema, and the
presence of heel spur in radiograph significantly affected the outcome of the
treatment. Logistic regression drew the equation: minimum clinically successful
therapy=(1+e([.011+42.807xheel spur+.109xedema+5.395xVAS)(score]))(-1).The
sensitivity of the predictive factors was 96.77%, 87.63%,
and 86.02%,
respectively. The specificity of the predictive factors was 45.65%, 42.39%, and
85.87%, respectively. The area under the curve of the predictive factors was
.751, .650, and .859, respectively. The Youden index was .4243, .3003, and .7189,
respectively. The Hosmer-Lemeshow test showed a good fitting of the predictive
model, with an overall accuracy of 89.6%. CONCLUSIONS:
This 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.
CI - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS