No significant short-term difference on pain & function between photo-activated PRP and HA .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(21):11 BMC Musculoskelet Disord. 2016 Feb 9;17(1):6723 patients with mild-moderate knee osteoarthritis were randomized to three weekly intra-articular injections of either hyaluronic acid (HA; Synvisc Hylan G-F 20) or photo-activated platelet-rich plasma (PRP). The purpose of this study was to compare pain and functional outcome between the two groups at 4 and 12 week follow-up after the last injection. Efficacy outcomes included a visual analog scale (VAS) for pain, the Knee Injury and Osteoarthritis Outcome Scale (KOOS), the Knee Quality of Life 26-Item questionnaire (KQoL-26), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and functional performance tests. Findings demonstrated no significant differences between groups at either 4 or 12 week follow-up for any outcome measures. Nonetheless, as this was a pilot study, the trial was underpowered to accurately assess comparative efficacy between treatment options.
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)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
2/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
Injection therapies have been increasingly prominent within research regarding treatment of knee osteoarthritis, with numerous randomized controlled trials investigating the efficacy of various products. Of these, popular topics include viscosupplementation with hyaluronic acid, and platelet rich plasma. Specifically regarding PRP, the use of photo-activation has been suggested to possibly heighten efficacy. Nevertheless, there are no RCTs evaluating the use of photo-activated PRP in knee osteoarthritis.
Quelle était la principale question de recherche ?
Are there any significant differences in effect on pain or function between intra-articular injections of photo-activated platelet-rich plasma and hyaluronic acid in patients with knee osteoarthritis, assessed over 3 month follow-up?
- There were no significant differences in VAS pain scores between the PRP group and the HA group at either 4 weeks (MD 1.90 [-13..80, 17.60]; p=0.79) or 12 weeks (MD 18.81 [-0.62, 38.24]; p=0.06).
- There were no significant differences in KOOS scores between the PRP group and the HA group for any subscale at 4 and 12 weeks(Symptoms, Pain, Function, Sport, QoL) (all p>0.05).
- There were no significant differences in KQoL-26 scores between the PRP group and the HA group for any subscale at 4 and 12 weeks (Physical, Activity, Emotional) (all p>0.05).
- There were no significant differences in the results of functional performance tests between the PRP group and the HA group at 4 and 12 weeks (all p>0.05).
De quoi dois-je me souvenir en priorité ?
In the treatment of mild-moderate knee osteoarthritis, there were no significant differences in results at 4 and 12 week follow-up between three weekly intra-articular injections of photo-activated platelet-rich plasma and hyaluronic acid.
Comment cela affectera-t-il les soins prodigués à mes patients ?
The findings of this study suggest that short-term effects are similar between photo-activated platelet-rich plasma and hyaluronic acid injection therapies for symptomatic management and functional outcome in patients with mild-moderate knee osteoarthritis. Whether either therapy is truly efficacious in the treatment of this patient population is still unknown, given the mixed previous evidence of hyaluronic acid products in knee osteoarthritis treatment, the lack of placebo-controlled group in the current study, and the pilot nature of the trial. Therefore, additional randomized, placebo-controlled trials are necessary to more accurately quantify and compare the effects of these injection options in patients with knee osteoarthritis.
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