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?
Were the criteria used for assessing the validity of the included studies reported?
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?
How would you rate the scientific quality of this evidence?
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.
4/4
Introduction
3/4
Accessing Data
3/4
Analysing Data
4/4
Results
3/4
Discussion
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 ?
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.
Quelle était la principale question de recherche ?
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.
De quoi dois-je me souvenir en priorité ?
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.
Comment cela affectera-t-il les soins prodigués à mes patients ?
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.
AVIS DE NON-RESPONSABILITÉ
Le contenu de cette page est fourni à titre d'information uniquement et n'est pas destiné à remplacer un avis médical, un diagnostic ou un traitement professionnel. Si vous avez besoin d'un traitement médical, demandez toujours l'avis de votre médecin ou rendez-vous au service des urgences le plus proche. Les opinions, croyances et points de vue exprimés par les individus sur le contenu de cette page ne reflètent pas les opinions, croyances et points de vue d'OrthoEvidence.
0 de 4 articles mensuels GRATUITS débloqués
