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2015 ; 16
(ä): 363
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A Bayesian network meta-analysis: Comparing the clinical effectiveness of local
corticosteroid injections using different treatment strategies for carpal tunnel
syndrome
#MMPMID26585378
Chen PC
; Chuang CH
; Tu YK
; Bai CH
; Chen CF
; Liaw M
BMC Musculoskelet Disord
2015[Nov]; 16
(ä): 363
PMID26585378
show ga
BACKGROUND: Local corticosteroid injections are commonly used to improve the
short-term symptomatic severity and the functional status of the hands affected
by carpal tunnel syndrome. We conducted a systematic review and Bayesian
network-meta-analysis to compare the clinical effectiveness of local
corticosteroid injections using different injection approaches. METHODS:
Electronic literature in Cochrane Central Register of Controlled Trials
(CENTRAL), MEDLINE, EMBASE, Web of Science, and other sources were searched to
identify clinical studies comparing different injection approaches with each
other or placebo for carpal tunnel syndrome. Two review authors conducted
selection of studies, data extraction, and assessment of risk of bias
independently. Random-effects models were used to conduct the pairwise
meta-analysis and the Bayesian network meta-analysis. RESULTS: Overall, 10
studies with 633 patients were included in the systematic review. Among the
injection approaches, local corticosteroid injections using the ultrasound-guided
in-plane injection (Ulnar-I) approach was the best treatment strategy for
clinical response (median OR versus placebo 128.30, 95% CrI 9.76 to 2299.00),
change in symptom severity scale (median MD versus placebo -1.16, 95% CrI -1.95
to -0.38) , and change in functional status scale (median MD versus placebo
-0.74, 95% CrI -2.00 to 0.52) at short-term follow-up period in the network
meta-analysis. Local corticosteroid injections using other injection approaches
were better than placebo for clinical response (for the PI approach, median OR
versus placebo 8.85, 95% CrI 3.00 to 33.15; for the DI approach, median OR versus
placebo 7.00, 95% CrI 0.53 to 118.80) , change in symptom severity scale (for the
Ulnar-O approach, median MD versus placebo -0.78, 95% CrI -1.43 to -0.16; for the
PI approach, median MD versus placebo -0.58, 95% CrI -0.95 to -0.22), and change
in functional status scale (for the Ulnar-O approach, median MD versus placebo
-0.63, 95% CrI -1.67 to 0.43; for the PI approach, median MD versus placebo
-0.46, 95% CrI -1.11 to 0.21) at short-term follow-up period. The quality of
studies is good. CONCLUSIONS: According to our analyses, the ultrasound-guided
in-plane injection (Ulnar-I) approach was the most effective treatment among the
injection approaches for carpal tunnel syndrome.