{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:44:36Z","timestamp":1792205076949,"version":"4.4.0"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Phlebology"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lipedema is an adipose disorder associated with multiple impairments. Conservative treatments remain the mainstay of management, yet evidence regarding the effects of physical therapies on clinical, imaging, and body composition outcomes is limited. Radial extracorporeal shock wave therapy (rESWT) has been proposed as a non-invasive therapeutic option, although its impact is not fully established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a prospective, longitudinal, within-patient study conducted in women with clinically diagnosed lipedema. One lower limb was treated with radial extracorporeal shock wave therapy (rESWT), whereas the contralateral limb served as an internal control. A total of 16 patients were initially assessed, of whom 12 completed the full follow-up and were included in the final analysis. rESWT was applied over six sessions (two sessions per week) using standardized parameters. Clinical outcomes (LEFS, EQ-5D, SF-36 Physical Function, and IPAQ) were assessed at baseline, 6\u00a0weeks, and 3\u00a0months. Ultrasound and elastography were used to evaluate subcutaneous tissue thickness and stiffness at predefined leg and thigh sites, while segmental bioimpedance analysis assessed body composition and fluid distribution. Longitudinal changes were analyzed using mixed-effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant improvements were observed in functional capacity, quality of life, and physical activity levels at both 6\u00a0weeks and 3\u00a0months compared with baseline (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .05). In contrast, no statistically significant changes were detected in ultrasound-derived tissue thickness, elastography measurements, or bioimpedance parameters over time, and no significant differences were detected between treated and control limbs within the constraints of the available sample size.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>rESWT was associated with meaningful clinical and functional improvements in patients with lipedema, despite the absence of detectable changes in tissue thickness, stiffness, or body composition. These findings suggest that the benefits of rESWT may be mediated through symptom modulation and functional adaptation rather than structural tissue modification, supporting its role as part of conservative, symptom-oriented treatment strategies in lipedema.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02683555261451555","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T09:35:36Z","timestamp":1778492136000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical, ultrasound, elastography and bioimpedance changes after radial extracorporeal shock wave therapy in patients with lipedema: A prospective within-patient study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1748-8050","authenticated-orcid":false,"given":"Manuel","family":"Novo Rigueiro","sequence":"first","affiliation":[{"name":"\u00c1lvaro Cunqueiro University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mart\u00edn","family":"Bravo Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Clinical University Hospital of Santiago de Compostela"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Prado Mora\u00f1a","sequence":"additional","affiliation":[{"name":"Clinical University Hospital of Santiago de Compostela"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0312-8734","authenticated-orcid":false,"given":"Alberto","family":"Pena Dubra","sequence":"additional","affiliation":[{"name":"Clinical University Hospital of Santiago de Compostela"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Villarroel Comesa\u00f1a","sequence":"additional","affiliation":[{"name":"Clinical University Hospital of Santiago de Compostela"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Navarro N\u00fa\u00f1ez","sequence":"additional","affiliation":[{"name":"Clinical University Hospital of Le\u00f3n"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bibiana","family":"Villamayor Blanco","sequence":"additional","affiliation":[{"name":"Clinical University Hospital of Santiago de Compostela"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Novo Veleiro","sequence":"additional","affiliation":[{"name":"Clinical University Hospital of Santiago de Compostela"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-34-5-1243"},{"key":"e_1_3_7_3_2","first-page":"321","article-title":"Lipedema: an overview of its clinical manifestations, diagnosis and treatment","volume":"17","author":"Forner-Cordero I","year":"2012","unstructured":"Forner-Cordero I, Szolnoky G, Forner-Cordero A, et al. 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Aesthetic Surg J 2006; 26: 536\u2013542.","journal-title":"Aesthetic Surg J"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.7150\/thno.18650"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2004.06.004"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2009.55"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2012.05.008"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.niox.2004.12.005"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-475X.2012.00796.x"},{"key":"e_1_3_7_20_2","first-page":"1451","article-title":"Extracorporeal shockwave therapy (ESWT) reduces pain and improves function in chronic soft tissue conditions","volume":"36","author":"Knobloch K","year":"2008","unstructured":"Knobloch K, Kraemer R, Jagodzinski M, et al. Extracorporeal shockwave therapy (ESWT) reduces pain and improves function in chronic soft tissue conditions. 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Horm Mol Biol Clin Invest 2018; 33(1): 20170076. https:\/\/doi.org\/10.1515\/hmbci-2017-0076","journal-title":"Horm Mol Biol Clin Invest"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/02683555251343155"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2012-091961"},{"issue":"6","key":"e_1_3_7_26_2","first-page":"133","article-title":"Extracorporeal shockwave therapy for plantar fasciitis and other musculoskeletal conditions: clinical outcomes and mechanisms","volume":"32","author":"Notarnicola A","year":"2018","unstructured":"Notarnicola A, Maccagnano G, Tafuri S, et al. Extracorporeal shockwave therapy for plantar fasciitis and other musculoskeletal conditions: clinical outcomes and mechanisms. 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