Author: Li X1, Zhang L2, Gu S1, Sun J1, Qin Z3, Yue J4, Zhong Y5, Ding N2, Gao R6
Affiliation: <sup>1</sup>Department of Orthopedic and Trauma Surgery, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
<sup>2</sup>Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany.
<sup>3</sup>Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
<sup>4</sup>Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
<sup>5</sup>Institute of Biophysics, Chinese Academy of Science, Beijing, China.
<sup>6</sup>Institute of Clinical Pharmacology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
Conference/Journal: Medicine (Baltimore).
Date published: 2018 Oct
Other:
Volume ID: 97 , Issue ID: 43 , Pages: e12819 , Special Notes: doi: 10.1097/MD.0000000000012819. , Word Count: 303
BACKGROUND: Plantar fasciitis is one of the most common causes of adult heel pain. The aim of this study is to comprehensively compare the effectiveness of various therapies for plantar fasciitis using network meta-analysis.
METHODS: Studies were comprehensively searched on Embase, MEDLINE via PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) up to December 4, 2017. Randomized controlled trials that used extracorporeal shock wave therapy, ultrasound, ultrasound-guided pulsed radiofrequency treatment (UG-PRF), intracorporeal pneumatic shock therapy (IPST), low-level laser therapy (LLLT), and noninvasive interactive neurostimulation (NIN) for the treatment of plantar fasciitis were included. The primary outcome is change in pain relief. Risk of bias was assessed using the Cochrane risk of bias tool. Quality assessment was performed using the GRADE system.
RESULTS: Nineteen trials with 1676 patients with plantar fasciitis plantar fasciitis were included. In the pair-wise meta-analysis, radial extracorporeal shock wave therapy (RSW), LLLT, and IPST showed a significant pooled reduction in the visual analogue scale (VAS) compared with placebo at 0 to 6 weeks [mean difference (MD) = 6.60, 95% confidence interval (CI): (6.04, -7.16); MD = 2.34, 95% CI: (1.60, 3.08); MD = 2.24, 95% CI: (1.44, 3.04), respectively]. Compared with placebo, UG-PRF [MD = 2.31, 95% CI: (1.26, 3.36)] and high-intensity focused extracorporeal shock wave (H-FSW) [MD = 0.82, 95% CI: (0.20, 1.45)] showed superior pain-relieving effects at 2 to 4 months; UG-PRF [MD = 1.11, 95% CI: (0.07, 2.15)] and IPST [MD = 4.92, 95% CI: (4.11, 5.73)] showed superior effects at 6 to 12 months. In the network meta-analysis, only RSW induced significant pain reduction compared with placebo at 0 to 6 weeks [MD = 3.67, 95% CI: (0.31, 6.9)]. No significant differences were found for the 2 to 4-month and 6 to 12-month periods because of the wide 95% CIs.
CONCLUSIONS: We recommend treating plantar fasciitis with RSW. The commonly used ultrasound and focused extracorporeal shock wave (FSW) therapies can be considered as alternative treatment candidates. IPST, NIN, and LLLT may potentially be better alternatives, although their superiority should be confirmed by additional comprehensive evidence.PROSPERO registration number: PROSPERO (CRD42015017353).
PMID: 30412072 DOI: 10.1097/MD.0000000000012819