Corticosteroid injection for plantar heel pain: a systematic review and meta-analysis

Whittaker, Glen A.; Munteanu, Shannon E.; Menz, Hylton B.; Bonanno, Daniel R.; Gerrard, James M.; Landorf, Karl B.

doi:10.1186/s12891-019-2749-z

BMC Musculoskeletal Disorders

Table 3 GRADE evidence profile of the effect of corticosteroid injection on pain

From: Corticosteroid injection for plantar heel pain: a systematic review and meta-analysis

Quality assessment							Summary of findings
Comparison	No. of trials	Limitations	Inconsistency	Indirectness	Imprecision	Publication bias	Participants		Effect size (95% CI)^a	GRADE
Comparison	No. of trials	Limitations	Inconsistency	Indirectness	Imprecision	Publication bias	Corticosteroid injection	Comparator	Effect size (95% CI)^a	GRADE
Corticosteroid injection vs placebo injection
Short term	4 [20, 24, 44, 46]	No serious limitations	Serious inconsistency^b	No serious indirectness	Serious imprecision^c	Undetected	132	123	-0.98 (−2.06, 0.11)^f	Moderate
Medium term	4 [20, 24, 44, 46]	No serious limitations	Serious inconsistency^b	No serious indirectness	Serious imprecision^c	Undetected	126	122	-0.86 (− 1.90, 0.19)^f	Moderate
Corticosteroid injection vs physical therapy
Short term	2 [25, 52]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	Serious imprecision^e	Undetected	49	50	-1.07 (−2.75, 0.60)^f	Very low
Medium term	3 [25, 37, 52]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	No serious imprecision	Undetected	80	79	-0.74 (− 1.51, 0.03)^f	Low
Longer term	2 [25, 37]	Very serious limitations^d	No serious inconsistency	No serious indirectness	Serious imprecision^c	Undetected	52	51	0.00 (−0.39, 0.38)	Very low
Corticosteroid injection vs foot orthoses
Short term	3 [40, 61, 64]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	No serious imprecision	Undetected	92	99	−0.91 (−1.69, − 0.13)^f	Low
Medium term	3 [40, 61, 64]	Very serious limitations^d	Serious inconsistency^b	Serious indirectness^g	Serious imprecision^c	Undetected	72	79	−0.17 (− 1.30, 0.97)	Very low
Corticosteroid injection vs dry needling
Short term	2 [51, 59]	Very serious limitations^d	Very serious inconsistency^b	No serious indirectness	Serious imprecision^c	Undetected	81	81	−0.86 (−3.70, 1.97)^f	Very low
Longer term	2 [51, 59]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	No serious imprecision	Undetected	81	81	1.45 (0.70, 2.19)^f	Low
Corticosteroid injection vs extracorporeal shockwave therapy
Short term	8 [29, 33, 34, 41, 45, 54, 56, 58]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	No serious imprecision	Undetected	269	265	−0.32 (−0.77, 0.12)	Very low
Medium term	10 [29, 30, 33, 34, 41, 45, 50, 54, 58, 63]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	Serious imprecision^c	Undetected	354	354	−0.05 (−0.60, 0.49)	Very low
Longer term	5 [30, 33, 34, 50, 58]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	No serious imprecision	Undetected	202	211	0.45 (−0.09, 0.99)	Very low
Corticosteroid injection vs laser therapy
Short term	2 [65, 66]	Very serious limitations^d	No serious inconsistency	Serious indirectness^g	Serious imprecision^c	Undetected	50	44	−0.20 (−0.61, 0.20)	Very low
Corticosteroid injection vs autologous blood injection
Short term	4 [22, 38, 42, 62]	Very serious limitations^d	No serious inconsistency	No serious indirectness	No serious imprecision	Undetected	126	131	−0.56 (−0.86, − 0.26)	Low
Medium term	4 [22, 38, 42, 62]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	Serious imprecision^c	Undetected	126	131	−0.31 (−0.83, 0.21)	Very low
Longer term	4 [22, 39, 42, 62]	Very serious limitations^d	No serious inconsistency	No serious indirectness	Serious imprecision^c	Undetected	128	134	−0.05 (−0.31, 0.21)	Very low
Corticosteroid injection vs platelet-rich plasma injection
Short term	8 [21, 35, 36, 44, 49, 57, 58, 60]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	Serious imprecision^c	Undetected	202	203	−0.16 (−0.70, 0.38)	Very low
Medium term	7 [21, 35, 36, 44, 57, 58, 60]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	Serious imprecision^c	Undetected	187	188	0.32 (−0.19, 0.83)	Very low
Longer term	6 [21, 35, 36, 57, 58, 60]	Very serious limitations^d	Serious inconsistency^b	Serious indirectness^h	No serious imprecision	Undetected	162	163	0.61 (0.30, 1.06)	Very low
Corticosteroid injection vs botulinum toxin-A injection
Short term	2 [27, 28]	Very serious limitations^d	Serious inconsistency^b	No serious indirectness	Serious imprecision^e	Undetected	45	45	0.67 (−0.04, 1.38)	Very low

Abbreviations: CI Confidence interval, GRADE Grading Recommendations Assessment, Development and Evaluation
^a Negative values indicate that the effect size (SMD) favours corticosteroid injection
^b Rated down 1 level for consistency as there was significant heterogeneity (i.e. I² greater than 40%)
^c Rated down 1 level as the upper and lower boundaries of the confidence intervals represent different conclusions
^d All participants for this outcome were from trials rated at high risk of bias
^e The total sample for this outcome is less than 100
^f Rated up 1 level due to large effect size
^g The interventions differed between studies
^h Outcome measures were obtained at significantly different time points

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ISSN: 1471-2474

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