Network meta-analysis evaluating injection treatments for plantar fasciopathy

Study Type: N/A
OE Level of Evidence: 1
Journal Level of Evidence: N/A
22 randomized controlled trials were included in this network meta-analysis, that included over 10 injectable treatments, to evaluate comparative efficacy for the management of plantar faciopathy. The primary outcome of this study was pain relief. At 0-2 month Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: European Research Council
Conflicts: None disclosed
Why was this study needed now?
Plantar fasciopathy is a common condition that can cause significant pain and disability. First-line treatments typically consist of weight loss, activity limitation, orthotics, and exercises. If these initial treatments are unsuccessful, several options are available including physiotherapy, immobilization, and injection therapies. There are currently ten different injection therapies available for the treatment of plantar fasciopathy, and while these treatments have been investigated in randomized controlled trials, a synthesis of research to determine the comparative efficacy of these treatments has not been conducted.
What was the principal research question?
What is the comparative efficacy of different injection therapies for plantar fasciopathy?
Data Source: MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were search for relevant studies published from inception until July 11, 2015. Trial registries were also searched from unpublished data and trials currently in progress. A hand search of reference lists was also conducted to identify any additional articles missed in the electronic databases.
Index Terms: Provided in the supplemental information of the network meta-analysis
Study Selection: Study selection was conducted by two independent authors. Eligible articles were identified by title and abstract screening, followed by a full-text review to determine final inclusion. Randomized controlled trials that compared the effects of at least two different injectable therapies in adult patients with plantar faciopathy were included. Disagreements in study selection were resolved by discussion.
Data Extraction: Data extraction was conducted by two independent reviewers, and discrepancies were resolved by discussion. If more than one condition was being investigated in an included study, only the information pertaining to the treatment of plantar faciopathy was extracted. The primary outcomes were pain relief and pain intensity measured using a questionnaire or by subscales of composite instruments. Secondary outcomes extracted included composite questionnaires that measured functional disability and health-related quality of life outcomes.
Data Synthesis: A pair-wise meta-analysis was conducted using Review Manager to determine an estimate of the direct effect for each comparison. Heterogeneity was assessed using the Q statistic and a significance level was set to 0.05. Differences were reported as standardized mean differences (SMD) with 95% confidence intervals and converted back to mean differences for some outcomes. Network meta-analysis was performed using STATA. SMDs and 95% confidence intervals were reported, and a p value was set at 0.05. Additionally, treatment ranking was performed using SUrface under the Cumulative RAnking curve (SUCRA) statistic. A minimally clinically important difference of -9 mm on a VAS scale was used for clinical interpretation.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.