HAND & WRIST
Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2019;7(3):23 BMC Musculoskelet Disord. 2018 Feb 13;19(1):4941 women with carpal tunnel syndrome were randomized to 8 weeks of nightly splinting with or without the addition of a single injection of platelet-rich plasma. Patients were followed up after 10 weeks from the beginning of treatment for results related to pain, outcome on the Boston Carpal Tunnel Questionnaire, and electrophysiological measures of peak latency of sensory nerve action potential (PL-SNAP) and onset latency of the compound muscle action potential (OL-CMAP). Results demonstrated no significant differences between the PRP group and the control group for any of the outcome measures assessed.
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)?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
4/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/5
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
The interest in platelet-rich plasma in the management of various orthopaedic and musculoskeletal surgeries and conditions have increased considerably in the past decades. Nonetheless, its efficacy in the management of individuals with carpal tunnel syndrome has not been previously tested.
Was war die wichtigste Forschungsfrage?
In women with carpal tunnel syndrome, does the addition of a single platelet-rich plasma injection to 8 weeks of splint wear have a significant effect on pain, function, or electrophysiological measures at 10 weeks after treatment initiation, as compared to 8 weeks of splint wear alone?
Was waren die wichtigsten Ergebnisse?
- Reduction in VAS pain after 10 weeks did not significantly differ between the PRP group (-2.76+/-2.4) and the control group (-2.90+/-2.1) (p=0.845).
- Reduction in BCTQ Symptom Severity score after 10 weeks did not significantly differ between the PRP group (-0.72+/-0.7) and the control group (-0.70+/-0.3) (p=0.922). Reduction in BCTQ Functional score after 10 weeks also did not significantly differ between the PRP group (-0.63+/-0.8) and the control group (-0.86+/-0.5) (p=0.289).
- Reduction in PL-SNAP after 10 weeks did not significantly differ between the PRP group (-0.17+/-0.2) and the control group (-0.15+/-0.2) (p=0.820).
- Reduction in OL-CMAP after 10 weeks did not significantly differ between the PRP group (-0.04+/-0.2) and the control group (-0.09+/-0.1) (p=0.410).
Was sollte ich mir besonders merken?
In the treatment of women with carpal tunnel syndrome, the addition of a single injection of platelet-rich plasma to 8 weeks of nightly splinting did not have a significant effect on change in pain, function, or electrophysiological measures over 10 weeks when compared to patients managed with nightly splinting alone.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
The results of this study suggest that a single platelet-rich plasma injection does not add any significant benefit to nightly splinting treatment for women with mild-to-moderate carpal tunnel syndrome. Given the small evidence base on the use of PRP in carpal tunnel syndrome treatment, additional randomized controlled trials should be considered.
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