FARES method leads to less pain and quicker reduction of anterior shoulder dislocation .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):220 Injury. 2012 Jul;43(7):1066-70. Epub 2012 Feb 12160 patients with acute anterior shoulder dislocation were randomized to either receive treatment using the FARES (fast, reliable and safe) method or the Eachempati external rotation method. The results indicate that both the FARES and Eachempati methods are safe and effective; however, the FARES method resulted in quicker reductions and decreased pain. Additionally, fewer attempts were needed to achieve reduction. The FARES method should be recommended for reduction of anterior dislocation of the shoulder.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
2/4
Randomization
2/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Acute anterior dislocations of the shoulder are a frequently encountered emergency issue. There are many techniques used to reduce acute anterior shoulder dislocation, two of the newest techniques are; the Fast, Reliable and Safe (FARES) method and the Eachempati method. Although both are proven to be more effective than older methods, there have been no studies comparing these two new techniques.
Qual era a principal questão de investigação?
Are FARES and Eachempati external rotation methods safe, efficacious and reliable for the reduction of anterior shoulder dislocation and are there differences in outcome between these two methods?
- No patients had any post-reduction complications.
- 76/80 (95%) of patients in the FARES method group compared to 73/80 (91.25%) of patients in the Eachempati external rotation group achieved successful reduction of their shoulder dislocation. This was not a statistically significant difference (p=0.53, Fisher's exact test).
- There was a significant difference between groups in favour of the FARES method with respect to the speed of reduction (p<0.0001), pain felt during reduction (p<0.0001), and the number of attempts taken during reduction (p<0.0001).
De que é que me devo lembrar mais?
Both the FARES and the Eeachempati method are safe and effective in reduction of anterior shoulder dislocation; however, the FARES method resulted in an increased speed of reduction, less pain, and this method resulted in a lower number of attempts to achieve reduction.
Como é que isto afectará o tratamento dos meus doentes?
This study supports the use of the FARES method in the reduction of acute glenohumeral dislocation, as it results in quicker reductions, less pain and fewer attempts required (compared with the Eachempati method). Future studies should compare the FARES methods to various other reduction techniques.
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