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?
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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)?
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Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
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La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
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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
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
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.
Qual era la domanda di ricerca principale?
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.
Che cosa devo ricordare di più?
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.
Come influenzerà l'assistenza ai miei pazienti?
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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