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.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
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Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
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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.
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
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?
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.
Was war die wichtigste Forschungsfrage?
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.
Was sollte ich mir besonders merken?
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.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
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.
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