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Comparative effectiveness of autologous blood-derived products, shock-wave therapy and corticosteroids for treatment of plantar fasciitis: a network meta-analysis.

AbstractOBJECTIVE:
To compare the efficacy of autologous blood-derived products (ABPs), CSs and shock-wave (SW) therapy in the treatment of plantar fasciitis.
METHODS:
Electronic databases were searched for studies that compared ABPs, CSs and SW therapy for the treatment of plantar fasciitis, published up to June 2014. The primary and secondary outcomes were reduction in visual analogue scale (VAS) score at 3 and 6 months and odds ratio of treatment success, respectively. Groups were compared by traditional pair-wise meta-analysis and by network meta-analysis.
RESULTS:
Seven randomized controlled trials and three quasi-experimental studies that included 604 patients were enrolled. Pair-wise meta-analysis indicated a trend favouring ABPs over CSs regarding VAS reduction at 3 months; this benefit was significant in a subgroup analysis of platelet-rich plasma (PRP) vs CSs. There were no significant between-group differences in VAS reduction at 6 months and in treatment success. Network meta-analysis showed that ABPs had the highest probability of being the best treatment at 3 months, but ABPs were slightly inferior to SW for VAS reduction at 6 months. Although SW therapy had the highest likelihood of treatment success, the between-group differences in probabilities were less remarkable than those for pain reduction at 3 and 6 months.
CONCLUSION:
ABPs, followed by CSs, were best in providing relief from pain at 3 months. SW therapy and ABPs had similar probabilities of providing pain relief at 6 months, and were better than CSs at that time. Subgroup analysis indicated that an ABP regimen consisting of platelet-rich plasma improves treatment efficacy.
AuthorsMing-Yen Hsiao, Chen-Yu Hung, Ke-Vin Chang, Kuo-Liong Chien, Yu-Kang Tu, Tyng-Guey Wang
JournalRheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 54 Issue 9 Pg. 1735-43 (Sep 2015) ISSN: 1462-0332 [Electronic] England
PMID25848072 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
Copyright© The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected].
Chemical References
  • Adrenal Cortex Hormones
  • Blood Proteins
Topics
  • Adrenal Cortex Hormones (therapeutic use)
  • Adult
  • Blood Proteins (therapeutic use)
  • Blood Transfusion, Autologous
  • Comparative Effectiveness Research
  • Fasciitis, Plantar (therapy)
  • Female
  • High-Energy Shock Waves (therapeutic use)
  • Humans
  • Male
  • Middle Aged
  • Platelet-Rich Plasma
  • Randomized Controlled Trials as Topic
  • Time Factors
  • Treatment Outcome
  • Visual Analog Scale

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