{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T16:43:13Z","timestamp":1792341793692,"version":"4.4.0"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"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>Objectives<\/jats:title>\n                    <jats:p>To investigate the clinical and ultrasonographic changes associated with radial extracorporeal shock wave therapy (rESWT) in women with lipedema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective, single-arm study included 40 women with lipedema who completed six sessions of rESWT administered twice weekly to the index lower limb. Treatment consisted of 3000\u20136000 impulses at 15\u00a0Hz and 3\u20134\u00a0bar. Participants were evaluated at baseline (T0), immediately after treatment (T1), and at 4-week follow-up (T2). Outcomes included visual analog scale (VAS) pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, pressure pain threshold (PPT), limb circumference, subcutaneous fat thickness (SCFT), and tissue echogenicity. Patient Global Impression of Change (PGIC) was assessed at T1 and T2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      VAS scores decreased from 8.45 at T0 to 5.45 at T1 and 4.17 at T2, while PROMIS scores decreased from 25.3 to 16.2 and 14.3, respectively (both\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001). PPT increased significantly at all four evaluated sites (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001). Calf and thigh circumferences decreased significantly over time (both\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001). Medial calf SCFT decreased from 16.5 to 15.2 and 15.1\u00a0mm, and medial thigh SCFT from 21.0 to 18.2 and 18.1\u00a0mm (both\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001). Median tissue echogenicity decreased from 3 at baseline to 2 at both post-treatment assessments (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001). PGIC scores also improved between T1 and T2 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Six sessions of rESWT were associated with improvements in pain, quality of life, mechanical pain sensitivity, limb circumference, and ultrasonographic tissue characteristics in women with lipedema, with most improvements maintained at 4-week follow-up. These findings support further evaluation of rESWT as an adjunctive conservative treatment for lipedema in controlled studies with longer follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov, NCT07683559.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02683555261499797","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T14:58:51Z","timestamp":1792162731000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and ultrasonographic effects of extracorporeal shock wave therapy in patients with lipedema: A prospective study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0997-7013","authenticated-orcid":false,"given":"Elif","family":"\u00d6zyi\u011fit","sequence":"first","affiliation":[{"name":"Kanuni Sultan S\u00fcleyman Training and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilek","family":"\u00dcn O\u011fuzhanas\u0131lt\u00fcrk","sequence":"additional","affiliation":[{"name":"Kanuni Sultan S\u00fcleyman Training and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6mer","family":"\u00d6zyi\u011fit","sequence":"additional","affiliation":[{"name":"Istanbul Atlas University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mert","family":"Zure","sequence":"additional","affiliation":[{"name":"Kanuni Sultan S\u00fcleyman Training and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-34-5-1243"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/aps.2011.153"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/02683555211015887"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/ddg.15513"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/02683555211002340"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13648"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/oby.22778"},{"key":"e_1_3_5_9_2","first-page":"220","article-title":"An overview of shock wave therapy in musculoskeletal disorders","volume":"26","author":"Wang CJ","year":"2003","unstructured":"Wang CJ. An overview of shock wave therapy in musculoskeletal disorders. Chang Gung Med J 2003; 26: 220\u2013232.","journal-title":"Chang Gung Med J"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-475X.2012.00796.x"},{"key":"e_1_3_5_11_2","first-page":"33","article-title":"The biological effects of extracorporeal shock wave therapy (ESWT) on tendon tissue","volume":"2","author":"Notarnicola A","year":"2012","unstructured":"Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (ESWT) on tendon tissue. Muscles Ligaments Tendons J 2012; 2: 33\u201337.","journal-title":"Muscles Ligaments Tendons J"},{"key":"e_1_3_5_12_2","first-page":"396","article-title":"Lipedema\u2014Pathogenesis, diagnosis, and treatment options","volume":"117","author":"Kruppa P","year":"2020","unstructured":"Kruppa P, Georgiou I, Biermann N, et al. Lipedema\u2014Pathogenesis, diagnosis, and treatment options. Dtsch Arztebl Int 2020; 117: 396\u2013403. https:\/\/doi.org\/10.3238\/arztebl.2020.0396","journal-title":"Dtsch Arztebl Int"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.2458\/lymph.5872"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.011"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmpt.2003.11.003"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/02683555261451555"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/8747461"},{"key":"e_1_3_5_18_2","first-page":"323","article-title":"Extracorporeal shockwaves as regenerative therapy in orthopedic traumatology: a narrative review from basic research to clinical practice","volume":"30","author":"D\u2019Agostino MCD","year":"2016","unstructured":"D\u2019Agostino MCD, Frairia R, Romeo P, et al. Extracorporeal shockwaves as regenerative therapy in orthopedic traumatology: a narrative review from basic research to clinical practice. 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