Ultrasound superior to palpation-guided injection of corticosteroid for plantar fasciitis .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(10):13 PLoS One. 2014 Mar 21;9(3):e92671. doi: 10.1371/journal.pone.0092671. eCollection 20145 randomized control trials containing 149 patients were analyzed in this meta-analysis to determine the efficacy of ultrasound versus palpation-guided corticosteroid injections for plantar fasciitis. Patients who received ultrasound-guided corticosteroid injections had a higher tenderness threshold, thinner plantar fascial thickness, and a lower incidence of hypoechogenicity compared to palpation-guided corticosteroid injections. Other outcomes including pain, the heel tenderness index, response rate, and heel pad thickness were not significantly different between groups.
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يقيّم تقييم معايير الإبلاغ الشفافية التي يبلغ بها المؤلفون عن الخصائص المنهجية والتجريبية للتجربة في المنشور. ينقسم التقييم إلى خمس فئات معروضة أدناه.
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
مؤشر الهشاشة هو أداة تساعد في تفسير النتائج المهمة، وتوفر مقياسًا لقوة النتيجة. ويمثل مؤشر الهشاشة عدد الأحداث المتتالية التي يجب إضافتها إلى نتيجة ثنائية التفرع لجعل النتيجة غير مهمة. يمثل الرقم الصغير نتيجة أضعف ويمثل الرقم الكبير نتيجة أقوى.
لماذا كانت هناك حاجة لهذه الدراسة الآن؟
Approximately 80% of all heel pain in adult patients is caused by plantar fasciitis. Conservative treatments for plantar fasciitis include rest, nonsteroidal anti-inflammatory drugs, stretching, physical therapy, and foot padding. If these fail, patients tend to seek corticosteroid injections as an alternative treatment option. Various randomized control trials have compared ultrasound and palpation-guided corticosteroid injection for the treatment of plantar fasciitis, but the results are conflicting. Therefore, this meta-analysis was needed to determine the efficacy of ultrasound- versus palpation-guided corticosteroid injections.
ما هو سؤال البحث الرئيسي؟
Is the efficacy of ultrasound-guided corticosteroid injections superior to palpation-guided corticosteroid injections for the treatment of plantar fasciitis?
- All 5 RCTs in this meta-analysis reported VAS pain, and found pain was not significantly different between ultrasound-guided and palpation-guided corticosteroid injections (SMD= -0.35, 95%CI (-0.83, 0.14), p=0.16).
- 2 studies reported that ultrasound-guided injections result in a higher tenderness threshold than palpation-guided injections (MD=2.17, 95%CI (1.28, 3.06), p=0.00).
- 2 studies reported the heel tenderness index did not differ significantly between ultrasound- and palpation-guided injections (MD= -0.25, 95%CI (-0.63, 0.13), p=0.20).
- 3 studies (93 patients) revealed that response rate did not differ significantly between groups (RR=1.29, 95%CI (0.94, 1.76), p=0.11).
- 4 studies reported that ultrasound-guided injections resulted in thinner plantar fascial thickness than palpation-guided injections (MD= -0.12, 95%CI (-0.22, -0.01), p=0.03).
- 3 studies reported that ultrasound-guided injections resulted in less hypoechogenicity than palpation-guided injections (RR=0.30, 95%CI (0.12, 0.77), p=0.01).
- 2 studies reported heel pad thickness did not differ significantly between groups (MD=0.62, 95%CI (-1.84, 3.09), p=0.62), meaning no atrophy occurred.
ما الذي يجب أن أتذكره أكثر؟
Patients who received ultrasound-guided corticosteroid injections had a higher tenderness threshold, thinner plantar fascial thickness, and a lower incidence of hypoechogenicity compared to palpation-guided corticosteroid injections. Pain, heel tenderness index, response rate, and heel pad thickness were similar between groups.
كيف سيؤثر ذلك على رعاية مرضاي؟
Based on the presented evidence, an ultrasound-guided injection of corticosteroid appears to be more effective than palpation-guided injections for plantar fasciitis. Additional well designed, high-quality, randomized control trials with larger sample sizes are needed to confirm these results.
تنويه
هذا المحتوى الموجود في هذه الصفحة هو لأغراض إعلامية فقط وليس الغرض منه أن يكون بديلاً عن المشورة الطبية المتخصصة أو التشخيص أو العلاج. إذا كنت بحاجة إلى علاج طبي، اطلب دائمًا مشورة طبيبك أو اذهب إلى أقرب قسم طوارئ إليك. الآراء والمعتقدات ووجهات النظر التي يعبر عنها الأفراد في المحتوى الموجود في هذه الصفحة لا تعكس آراء ومعتقدات ووجهات نظر أورثوإيفيدنس.
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