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Databases were searched for trials comparing ESWT plus standard care to standard care alone in participants with DFUs. Search results were reviewed by two independent reviewers. The Cochrane Risk of Bias 2 tool and GRADE approach was used to assess bias and certainty. The primary outcome was time to healing. The search identified 345 papers after duplicates removed. Six trials consisting of 471 participants were included. There was unclear or high risk of bias across all domains. Time to ulcer healing was probably shorter in patients treated with ESWT compared with standard ulcer care alone (GRADE: low certainty). Patients treated with ESWT were more likely to heal at 20\u2009weeks post\u2010ESWT compared with those treated with standard ulcer care alone (GRADE: low certainty). There was significant heterogeneity. ESWT remains a promising new treatment but the translation into routine clinical practice is still limited by the low certainty of evidence surrounding its effectiveness, case selection and optimum dose.<\/jats:p>","DOI":"10.1111\/iwj.14035","type":"journal-article","created":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T06:26:24Z","timestamp":1670048784000},"page":"2303-2320","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review"],"prefix":"10.1111","volume":"20","author":[{"given":"Louise","family":"Hitchman","sequence":"first","affiliation":[{"name":"Hull York Medical School  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Totty","sequence":"additional","affiliation":[{"name":"Hull York Medical School  York UK"},{"name":"Hull University Teaching Hospitals NHS Trust  Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Hull York Medical School  York UK"},{"name":"Hull University Teaching Hospitals NHS Trust  Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Carradice","sequence":"additional","affiliation":[{"name":"Hull York Medical School  York UK"},{"name":"Hull University Teaching Hospitals NHS Trust  Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Twiddy","sequence":"additional","affiliation":[{"name":"Institute of Clinical and Applied Health Research Hull York Medical School  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Iglesias","sequence":"additional","affiliation":[{"name":"Department of Health Sciences University of York  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Russell","sequence":"additional","affiliation":[{"name":"Leeds University Teaching Hospitals  Leeds UK"},{"name":"University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian C.","family":"Chetter","sequence":"additional","affiliation":[{"name":"Hull York Medical School  York UK"},{"name":"Hull University Teaching Hospitals NHS Trust  Hull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,3]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"DiabetesUK.Diabetes Statistics.2021. 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