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)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
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
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
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.
¿Cuál era la pregunta principal de la investigación?
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?
¿Cuáles fueron los hallazgos importantes?
- 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).
¿Qué es lo que más debo recordar?
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.
¿Cómo afectará esto al cuidado de mis pacientes?
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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