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 4 GRADE evidence profile of the effect of corticosteroid injection on function

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 physical therapy
Short term	2 [25, 52]	Very serious limitations^b	Serious inconsistency^c	No serious indirectness	No serious imprecision	Undetected	49	50	−0.69 (−1.31, − 0.07)	Low
Medium term	2 [25, 52]	Very serious limitations^b	Serious inconsistency^c	No serious indirectness	Serious imprecision^d	Undetected	49	50	−0.55 (− 1.14, 0.03)	Very low
Corticosteroid injection vs foot orthoses
Short term	2 [61, 64]	Very serious limitations^b	Serious inconsistency^c	No serious indirectness	Serious imprecision^d	Undetected	70	73	−0.78 (−1.81, 0.25)	Very low
Corticosteroid injection vs extracorporeal shockwave therapy
Short term	2 [41, 58]	Very serious limitations^b	No serious inconsistency	No serious indirectness	Serious imprecision^d	Undetected	90	86	0.11 (−0.18, 0.41)	Very low
Medium term	2 [41, 58]	Very serious limitations^b	No serious inconsistency	No serious indirectness	Serious imprecision^d	Undetected	90	86	0.21 (−0.08, 0.51)	Very low
Corticosteroid injection vs platelet-rich plasma injection
Short term	3 [21, 36, 58]	Very serious limitations^b	No serious inconsistency	No serious indirectness	No serious imprecision	Undetected	94	93	−0.18 (−0.47, 0.10)	Low
Medium term	3 [21, 36, 58]	Very serious limitations^b	No serious inconsistency	No serious indirectness	Serious imprecision^d	Undetected	94	93	0.10(−0.18, 0.39)	Very low
Longer term	3 [21, 36, 58]	Very serious limitations^b	No serious inconsistency	No serious indirectness	No serious imprecision	Undetected	94	93	0.21 (−0.08, 0.49)	Low
Corticosteroid injection vs botulinum toxin-A injection
Short term	2 [27, 28]	Very serious limitations^b	Serious inconsistency^c	No serious indirectness	Serious imprecision^d	Undetected	45	45	0.76 (−0.24, 1.76)	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 All participants for this outcome were from trials rated at high risk of bias
^c Rated down 1 level for consistency as there was significant heterogeneity (i.e. I² greater than 40%)
^d Rated down 1 level as the upper and lower boundaries of the confidence intervals represent different conclusions

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ISSN: 1471-2474

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