Background
Methods
Types of studies
Types of participants
Types of Intervention
Types of outcome measures
Search methods for identification of studies
# | Searches |
---|---|
1 | exp Lower Extremity/ |
2 | exp Therapeutics/ |
3 | exp Myofascial Pain Syndromes/ |
4 | exp"Outcome and Process Assessment (Health Care)"/or exp"Quality of Life"/or exp"Outcome Assessment (Health Care)"/or exp Questionnaires/or exp Treatment Outcome |
5 | exp Heel Pain/or exp Pain Assessment/or exp Foot Pain/or exp Musculoskeletal Pain/ |
6 | exp fasciitis/ |
7 | exp methodology/ |
8 | (leg* or calf or calves or foot or feet or ankle* or toe* or plantar fascia or plantar aponeurosis or plantar ligament or area).mp. |
9 | (needl* or acupuncture or inject*) |
10 | (trigger area* or trigger point* or"myofascial trigger point pain" or"myofascial pain components" or taut band). |
11 | (systematic review or"randomised controlled trial" or RCT or qausi experimental or"single subject design" or comparative study) |
12 | VAS or"visual analogue scale" or"visual analysis scale" or"activities of daily living" or"quality of life" or"pressure pain threshold" or algometry |
13 | 9 or 2 |
14 | 6 or 3 or 10 |
15 | 5 or 12 or 4 |
16 | 11 or 7 |
17 | 1 or 8 |
18 | 13 and 14 and 15 and 16 and 17 |
Study selection
Data Extraction
Assessment of methodological quality
Results
Trial | Design | Number allocated to experimental and control groups | Mean age in years (SD) | % Female | Mean duration of disease in months (SD) | Exclusion criteria | Criteria used to identify the MTrP |
---|---|---|---|---|---|---|---|
Tillu and
Gupta
(1998)
| Quasi-experimental (one group) | Experimental = 18 | 49.1 (10.7) | 72.3% | 25.1 (10.7) | History of heel surgery or cortisone injection in last three months | No criteria used |
Imamura
et al.
(1998)
| Quasi-experimental (two groups, non-randomised) | Experimental = 15 (Actual number is unclear but it would appear that 20 were recruited and 5 dropped out) Control = 9 at discharge. | Experimental: 50.0 (12.2) Control: 44.0 (NR) | 89.7% | 27.0 (NR) | NR | MTrP identified via palpation (local tenderness and taut band) |
Perez-Millan
and Foster
(2001)
| Quasi-experimental (one group) | Experimental = 11 | 39.5 (12.7) | 72.8% | 39.0 (5.0) | NR | NR |
Quality of the evidence
Quality Index items | Imamura et al. (1998) | Tillu and Gupta (1998) | Perez Millan and Foster (2001) |
---|---|---|---|
Reporting | |||
1. Study hypothesis/aim/objective | 1 | 1 | 1 |
2. Main outcomes | 1 | 1 | 1 |
3. Characteristics of the participants | 0 | 0 | 0 |
4. Interventions of interest | 0 | 1 | 0 |
5. Distributions of principal confounders in each group | 0 | 0 | 0 |
6. Main findings | 0 | 1 | 1 |
7. Estimates of random variability for main outcomes | 1 | 0 | 1 |
8. All the important adverse events that may be a consequence of intervention | 0 | 0 | 0 |
9. Characteristics of patients lost to follow-up | 0 | 1 | 1 |
10. Actual probability values for main outcomes | 0 | 1 | 0 |
External validity
| |||
11. Were subjects who were asked to participate representative of the entire population from which they were recruited? | 1 | 1 | 0 |
12. Were subjects who were prepared to participate representative of the entire population from which they were recruited? | 0 | 0 | 0 |
13. Were the staff, places, and facilities representative of the treatment the majority of subjects received? | 1 | 0 | 1 |
Internal validity (bias)
| |||
14. Was an attempt made to blind subjects to the intervention they received? | 0 | 0 | 0 |
15. Was an attempt made to blind those measuring main outcomes of the intervention? | 0 | 0 | 0 |
16. If any of the results of the study were based on"data dredging", was this made clear? | 0 | 1 | 1 |
17. Do analyses adjust for different lengths of follow-up? | 0 | 1 | 1 |
18. Were appropriate statistical tests used to assess the main outcomes? | 1 | 1 | 1 |
19. Was compliance with the intervention reliable? | 1 | 1 | 1 |
20. Were main outcome measures reliable and valid? | 0 | 0 | 0 |
Internal validity (selection bias)
| |||
21. Were patients in different intervention groups recruited from the same population? | 0 | 0 | 0 |
22. Were subjects in different intervention groups recruited over the same period of time? | 0 | 0 | 0 |
23. Were subjects randomized to intervention groups? | 0 | 0 | 0 |
24. Was the randomized intervention assignment concealed from both patients and staff until recruitment was complete and irrevocable? | 0 | 0 | 0 |
* 25. Was there adequate adjustment for confounding in the analyses from which main findings were drawn? | x | x | x |
26. Were losses of subjects to follow-up taken into account? | 0 | 1 | 1 |
Power
| |||
* 27. Did the study have sufficient power to detect a clinically important effect where the probability for a difference due to chance was less than 5%? | x | x | x |
Total score (/27)
|
7
|
12
|
11
|
Trial characteristics
Trial | Intervention | Trigger points and Acupuncture points selected for treatment | Outcome measure | Number of treatment sessions per week |
---|---|---|---|---|
Tillu and
Gupta
(1998)
| 25 mm acupuncture needle (diameter unknown) inserted for 15 minutes and stimulated every 5 minutes for 5 sec. Needle was manipulated to produce
de qi. No control group. | (i) Acupuncture points KI.3; BL.60 and SP.6 (ii) Gastrocnemius MTrP and heel MTrP. Specific location of MTrP in the heel and calf not identified. | (i) Visual analogue scale (ii) Verbal pain score Outcome measures recorded at 4 and 6 weeks post baseline. | 4 sessions of acupuncture/1 per week. If symptoms were not resolved after this period, 2 sessions (1 per week) of acupuncture and dry needling were implemented. |
Imamura et al.
(1998)
| 22-25 gauge needle repetitively inserted and withdrawn with injection of 1% lidocaine into the MTrP; plus *standard therapy. Control group received conventional conservative therapy but not outlined in the methods. | Medial head of Gastrocnemius; Soleus; Tibialis posterior; Popliteus; Abductor hallucis; Peroneus Longus and Flexor digitorum brevis | (i) Duration of treatment (ii) Visual analogue scale (iii) Pressure pain threshold Outcome measures recorded at discharge, 6 and 24 months | The number of sessions and times per week varied between the groups |
Perez-Millan
and Foster
(2001)
| 10-120 mm acupuncture needle (0.20-0.25 mm diameter); plus electrostimulator (2-4 Hz) for 20-30 minutes. No control group. | (i) Acupuncture points KI.1, 3, 6; BL.60, 67; GB 44 (ii) MTrPs points in the heel and arch regions | (i) Visual analogue scale (ii) **Foot function index questionnaire Outcome measures recorded at 6 weeks post baseline | 6 sessions/1 per week |
Evidence for the effectiveness of dry needling and/or injections of MTrPs associated with plantar heel pain
Trial | Difference between groups | Differences within groups | ||
---|---|---|---|---|
Tillu and
Gupta
(1998)
| N/A (one group only) | (i) VAS pain: @ 4 weeks (34.7% improvement, p < 0.001) @ 6 weeks (67.9% improvement, p < 0.001) @ 6 weeks vs 4 weeks, (difference 33.2%, p = 0.047) | ||
(ii) Verbal pain score (% of improvement): 40.2 (40.1%) @ 4 weeks and 65.9 (32.8%) @ 6 weeks | ||||
Intervention
|
Control
| |||
Imamura et
al. (1998)
| Duration of treatment (weeks): Significantly less in intervention group (83.9% difference between the groups, p < 0.05) | (i) Mean duration of treatment in weeks (SD) (ii) VAS pain: @ discharge @ 6 months @ 2 years | 3.4 (2.2) 58.4% improvement, p = 0.003 67.1% improvement, p = 0.007 67.1% improvement p = 0.002 | 21.1 (19.5) 54.9% improvement, p < 0.05 values not reported at 6 months values not reported at 12 months |
(iii) PPT (gastrocnemius): @ discharge @ 6 months @ 2 years | 130% increase, p = 0.001 71% increase, p = 0.009 55% increase, p = 0.023 | PPT not reported for control | ||
(iv) PPT (medial calcaneal tubercle) at: @ discharge @ 6 months @ 2 years | 106% increase, p = 0.004 values not reported at 6 months 143% increase, p = 0.007 | PPT not reported for control | ||
Perez-Millan
and Foster
(2001)
| N/A (one group only) | (i) VAS pain: @ 6 weeks (46% improvement, p < 0.001) | ||
(ii) Foot function index questionnaire scores*: significantly less pain for 10 out of 12 |