Comparing the effects of different physical therapy modalities with physical exercise in improving the walking...

Peripheral vascular disease (PVD) causes significant pain and disability in patients. Current conservative treatment for PVD is often limited to physical exercise. However, several recent studies have investigated the effects of physical therapy modalities in patients with PVD.

This systematic review and network meta-analysis (NMA) aimed to compare the effects of different physical therapy modalities and physical exercise in improving the walking function of patients with PVD.

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, NMA extension. We searched six databases for relevant randomized clinical trials (RCTs) published between 2013-2023. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB2). MetaInsight and R were used to conduct the NMA.

We analyzed 21 studies in the NMA. The results showed that shockwave therapy (SMD = 1.41, 95%CI (0.58, 2.24)) and vacuum therapy (SMD = 0.72, 95%CI (0.16, 1.29)) were effective independently in improving the walking function of patients with PVD. Combined hydrotherapy and exercise programs also performed better than exercise-only programs (SMD = 0.74, 95%CI (0.38, 1.09)). While electrotherapy yielded a significant effect when performed independently (SMD = 1.43, 95%CI (0.53, 2.33)), but was not effective when combined with exercise.

Our findings suggest that shockwave and vacuum therapy can be used as a treatment for patients with PVD who have difficulties participating in physical exercise. Hydrotherapy could assist patients participating in physical exercise programs to achieve better outcomes. This study was registered in the PROSPERO database CRD42023461442.