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W ith great interest we read the article by Ho et al. 1 entitled "Extracorporeal shockwave therapy with a modified technique on tendon and ligament for knee osteoarthritis." This study aimed to investigate the effects of extracorporeal shockwave therapy (ESWT) in patients with knee osteoarthritis. The authors conclude that ESWT has clinical benefits in patients with osteoarthritis. Based on this study, ESWT seems to be a promising technique, yet some questions about the methods applied in this study remain.First, in the power analysis, a total number of at least 20 participants per group is reported to be required for a test power of 80%. A minimal clinically important difference (MCID) of 0.4 on a Likert scale of the Western Ontario and McMaster Universities Osteoarthritis Index is mentioned. Patients answer 24 questions, with a five-degree (0 to 4) Likert scale indicating the severity of their complaints. 2 However, the Western Ontario and McMaster Universities Osteoarthritis Index score is not displayed on a scale from 0 to 4, but as a sum of the individual Likert scores on the questionnaire, which means the Western Ontario and McMaster Universities Osteoarthritis Index can range from 0 to 96. Because the individual scores of the Western Ontario and McMaster Universities Osteoarthritis Index have been summated, the sample size that is calculated for the MCID of 0.4 will not be sufficient. Williams et al. 3 have described an MCID of 8.8 at 2-mo follow-up for a power of 80% in patients with knee osteoarthritis. This value would have been a better MCID for this study as well and would have given a larger number of required patients. 4 The small sample size and MCID used might have prepossessed the study results.

Numerous barriers are experienced by people with overweight and obesity that play a role in the implementation of lifestyle interventions. This systematic review aims to investigate the barriers and facilitators for children and adults with overweight or obesity when implementing lifestyle interventions targeting weight loss in primary care. A systematic review was conducted by searching four databases to identify eligible studies (1969-2022). The Critical Appraisal Skills Program was used to assess the study quality. A total of 28 studies were included, of which 21 focused on adults and seven on children and their parents. Thematic synthesis of the 28 studies included identified nine key themes, of which support, role of the general practitioner, structure of the lifestyle intervention program, logistics, and psychological factors were the most common. This review shows that a strong support system and a personalized lifestyle intervention are essential components for successful implementation. Additional research is needed to identify whether future lifestyle interventions can take these barriers and facilitators into account and still be feasible for losing weight.

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