The role of extra-corporeal shockwave therapy (ESWT) plus rehabilitation for patients with chronic greater trochanteric pain syndrome (GTPS): A case series assessing effects on pain, sleep quality, activity and functioning

Background: Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain, most commonly affecting female patients aged 40–60, and which can have a significant impact on patients’ quality of life. Extra-corporeal shockwave therapy (ESWT) alongside a structured rehabilitation programme has been shown in previous research studies to have a significant improvement in patient's levels of pain, although it is unclear if this then leads to improved level of global functioning or activity. This case series examines the change in a range of patient reported outcome measures following shockwave therapy as well as the frequency of self-reported side-effects. Methods: Patients undergoing ESWT for GTPS were identified from case logs from a single NHS clinic. Patients completed a range of validated patient-rated outcome measures at baseline and at subsequent follow-up appointments. These include measures of pain, and measures of local hip functioning (Oxford Hip Score – OHS, Non-Arthritic Hip Score – NAHS), global functioning (EQ-5D-5L), sleep quality (Pittsburgh Sleep Quality Index – PSQI), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale – HADS), and activity levels (International Physical Activity Questionnaire – IPAQ). Results: Forty-five patients who completed ESWT for GTPS were identified; with a median follow-up duration of 189 days. Side-effect incidence was low, with <10% reporting bruising, and no patients withdrew due to side-effects. ‘Average’ and ‘worst’ self-reported pain values improved significantly from baseline at all time-periods studied; 6.3/10 and 8.2/10 to 3.8/10 and 5.4/10 at 3 months, respectively, correlating to an improvement of about a third. At 3 months 63% of patients were either satisfied or very satisfied, and 70% would recommend the procedure, these figures increased at 6 months. Sleep quality, measures of local hip functioning, and depressive symptoms all improved consistently across different time-points; however, activity levels and global health markers showed less evidence of improvement. Conclusions: ESWT is known to be effective in patients with greater trochanteric pain alongside a structured rehabilitation programme, and this case series is in keeping with the available evidence. This series demonstrates benefits across different areas of functioning. In this series, even though pain decreased, physical activity levels did not increase. As staying active has numerous health benefits further targeted intervention to address this alongside the reduction of pain may be required for optimal health outcomes.