Supplementary Materials. Comparative Analysis of Extracorporeal Shockwave Therapy (ESWT) as a First-line Intervention for Carpal Tunnel Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials

Introduction: Carpal tunnel syndrome—CTS is one of a few common entrapment neuropathies. In most cases, they result in less than satisfactory results with conservative treatment options. The application of Extracorporeal Shockwave Therapy-ESWT in Carpal Tunnel Syndrome has shown promise as an alternative therapy. This systematic review and meta-analysis aim to assess whether ESWT provides better relief from CTS pain and better clinical outcomes than other conservative interventions, including local corticosteroid injections, physiotherapy, sham therapies, splinting, ultrasound, and laser therapy.Methods: A comprehensive search was conducted in MEDLINE, EMBASE, Web of Science, Scopus, and ScienceDirect databases up to August 2023. Visual Analogue Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) in two groups were measured as mean difference (MD) with 95% confidence interval (CI) using Review Manager 5.4 in a continuous inverse-variance analysis. Subgroup analysis was performed to compare the efficacy of ESWT compared to local corticosteroid injection (LCI), wrist splint, sham rESWT, ultrasound, low-level laser therapy (LLLT), and physiotherapy. Univariate, random model meta-regression was performed to ascertain the influence of study characteristics on the overall estimates. Heterogeneity was calculated using Cochran’s Q test and I2 statistics. Egger’s test and funnel graphs were used to assess publication bias.Result: Fourteen randomized controlled trials (RCTs), comprising 787 patients and 922 wrists, were included. ESWT significantly improved VAS scores, particularly from week 4 to 24 (MD = -2.02, 95% CI -2.77, -1.27, P Conclusion: ESWT resulted in a significant improvement of VAS and BCTQ symptom scores, indicating its efficacy compared to other conservative treatments. Superior outcomes of ESWT in VAS improvement were found from weeks 4 to 24 of follow-up. Keywords: Carpal Tunnel Syndrome; Extracorporeal Shockwave Therapy; Visual Analog Scale.