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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

A Bayesian network meta-analysis: Comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome

Zeitschrift:
BMC Musculoskeletal Disorders > Ausgabe 1/2015
Autoren:
Po-Cheng Chen, Ching-Hui Chuang, Yu-Kang Tu, Chyi-Huey Bai, Chieh-Feng Chen, Mei- Yun Liaw
Wichtige Hinweise
An erratum to this article can be found at http://​dx.​doi.​org/​10.​1186/​s12891-015-0850-5.
An erratum to this article is available at http://​dx.​doi.​org/​10.​1186/​s12891-015-0850-5.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

All authors approved the final manuscript. Y-KT had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: P-CC, Y-KT, C-HB, C-HC.
Acquisition, analysis, or interpretation of data: P-CC, C-HC, C-HB
Drafting of the manuscript: P-CC, C-HC
Critical revision of the manuscript for important intellectual content: C-HC, Y-KT, C-HB, C-FC.
Statistical analysis: P-CC, C-HC , Y-KT.
Administrative, technical, or material support: C-FC.
Study supervision: Y-KT, C-HB.

Abstract

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.
Literatur
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