OBJECTIVESThe aim of this study was to provide an evidence-based overview of the effectiveness of (conservative and surgical) interventions for the 4 specific pain disorders of the handtrigger ...finger, primary Raynaudʼs phenomenon, Dupuytren disease, and De Quervainʼs disease. This information can help clinicians in the selection of interventions in daily practice, and may give direction to future research.
METHODSRelevant review publications and randomized clinical trials (RCTs) in PubMed were searched. Data extraction and quality assessment were performed. To summarize the results of the included reviews and RCTs, a best-evidence synthesis was used.
RESULTSFor primary Raynaudʼs phenomenon (1 review, 20 RCTs), we found strong evidence for calcium channel blockers and moderate evidence for laser therapy. Limited evidence was found for Ketanserin, Prozasin, Buflomedil, transdermal glyceryl trinitrate patches, Ginkgo biloba, and behavioral treatment with temperature feedback. Other interventions did not show clear favorable treatment effects. For Trigger finger one very small RCT was found that showed limited evidence for steroid injection. For Dupuytren disease (4 RCTs) limited evidence was found in favor of use of staples versus sutures in the Dupuytrenʼs surgery, and for intermittent compression on the postoperative hand after surgery. For other interventions no clear positive effects could be demonstrated. For De Quervainʼs disease (2 RCTs), we found no efficacy of Nimesulide as addition to a Triamcinolone injection, and no clear differences between a corticosteroid injection and a splint in pregnant patients or patients breast-feeding.
DISCUSSIONWell-designed and well-conducted RCTs are clearly needed in this field.
OBJECTIVE:To provide an evidence-based overview of the effectiveness of interventions for 4 nontraumatic painful disorders sharing the anatomic region of the elbowcubital tunnel syndrome, radial ...tunnel syndrome, elbow instability, and olecranon bursitis.
METHODS:The Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched to identify relevant reviews and randomized clinical trials (RCTs). Two reviewers independently extracted data and assessed the quality of the methodology. A best-evidence synthesis was used to summarize the results.
RESULTS:One systematic review and 6 RCTs were included. For the surgical treatment of cubital tunnel syndrome (1 review, 3 RCTs), comparing simple decompression with anterior ulnar nerve transposition, no evidence was found in favor of either one of these. Limited evidence was found in favor of medial epicondylectomy versus anterior transposition and for early postoperative therapy versus immobilization. No evidence was found for the effect of local steroid injection in addition to splinting. No RCTs were found for radial tunnel syndrome. For olecranon bursitis (1 RCT), limited evidence for effectiveness was found for methylprednisolone acetate injection plus naproxen. Concerning elbow instability, including 2 RCTs, one showed that nonsurgical treatment resulted in similar results compared with surgery, whereas the other found limited evidence for the effectiveness in favor of early mobilization versus 3 weeks of immobilization after surgery.
DISCUSSION:In this review no, or at best, limited evidence was found for the effectiveness of nonsurgical and surgical interventions to treat painful cubital tunnel syndrome, radial tunnel syndrome, elbow instability, or olecranon bursitis. Well-designed and well-conducted RCTs are clearly needed in this field.
Pompe disease is an inherited metabolic, neuromuscular disorder. With the introduction of enzyme replacement therapy skeletal muscle and respiratory function can be stabilized or improved. Additional ...physiotherapy to advance physical functioning of patients might be beneficial, but evidence and guidelines are lacking.
In order to get an insight into current practices of referral and treatment, and perceived benefit, we performed a survey among 88 Dutch adult Pompe patients and 31 physiotherapists.
Sixty percent of patients were ever referred for physiotherapy, whereas currently less than 40% receive physiotherapy. Approximately 50% of patients were referred for loss of muscle strength; while 74% received muscle strengthening exercises, often combined with aerobic endurance training. In 47% of patients the intervention did not match the referral reason. More than two-thirds of patients and physiotherapists perceived physiotherapy as beneficial, and the majority highlighted the need for guidance.
Physiotherapeutic care can be improved by tailoring interventions to referral reasons and treatment objectives. More high quality studies are urgently needed to assess which interventions are most useful in this patient group.
► 41% of patients with Pompe disease were never referred for physiotherapy. ► More patients could be referred; evidence and guidelines are needed to support this. ► Treatment objective and intervention are often not in line with the referral reason. ► Tailoring intervention to referral reason and objective may improve physiotherapy care.
To present an evidence-based overview of the effectiveness of oral pain medication and corticosteroid injections to treat carpal tunnel syndrome (CTS).
The Cochrane Library, PubMed, Embase, CINAHL, ...and Physiotherapy Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs).
Two reviewers independently applied the inclusion criteria to select potential studies.
Two reviewers independently extracted the data on pain (visual analog scale), function or recovery, and assessed the methodologic quality.
A best-evidence synthesis was performed to summarize the results of the included studies. Four reviews and 9 RCTs were included. For oral pain medication, strong and moderate evidence was found for the effectiveness of oral steroids versus placebo in the short term. Moderate evidence was found in favor of oral steroids versus splinting in the short term. No evidence was found for the effectiveness of oral steroids in the long term. For corticosteroid injections, strong evidence was found in favor of a corticosteroid injection versus a placebo injection and moderate evidence was found in favor of corticosteroid injection versus oral steroids in the short term. Also, in the short term, moderate evidence was found in favor of a local versus a systematic corticosteroid injection. Higher doses of corticosteroid injections seem to be more effective in the midterm; however, the benefits of corticosteroid injections were not maintained in the long term.
The reviewed evidence supports that oral steroids and corticosteroid injections benefit patient with CTS particularly in the short term. Although a higher dose of steroid injections seems to be more effective in the midterm, the benefits of oral pain medication and corticosteroid injections were not maintained in the long term.
To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions for carpal tunnel syndrome (CTS).
The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were ...searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016.
Two reviewers independently applied the inclusion criteria to select potential studies.
Two reviewers independently extracted the data and assessed the methodologic quality.
A best-evidence synthesis was performed to summarize the results. Four systematic reviews and 33 RCTs were included. Surgery versus nonsurgical interventions, timing of surgery, and various surgical techniques and postoperative interventions were studied. Corticosteroid injection was more effective than surgery (strong evidence, short-term). Surgery was more effective than splinting or anti-inflammatory drugs plus hand therapy (moderate evidence, midterm and long-term). Manual therapy was more effective than surgical treatment (moderate evidence, short-term and midterm). Within surgery, corticosteroid irrigation of the median nerve before skin closure as additive to CTS release or the direct vision plus tunneling technique was more effective than standard open CTS release (moderate evidence, short-term). Furthermore, short was more effective than long bulky dressings, and a sensory retraining program was more effective than no program after surgery (moderate evidence, short-term). For all other interventions only conflicting, limited, or no evidence was found.
Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the short-term, midterm, and/or long-term to treat CTS. However there is strong evidence that a local corticosteroid injection is more effective than surgery in the short-term, and moderate evidence that manual therapy is more effective than surgery in the short-term and midterm. There is no unequivocal evidence that suggests one surgical treatment is more effective than the other. Postsurgical, a short- (2-3 days) favored a long-duration (9-14 days) bulky dressing and a sensory retraining program seems to be more effective than no program in short-term. More research regarding the optimal timing of surgery for CTS is needed.
To systematically review the literature on the effectiveness of low-level laser therapy for patients with carpal tunnel syndrome.
The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy ...Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016.
Two reviewers independently applied the inclusion criteria to select potential studies.
Two reviewers independently extracted the data and assessed the methodologic quality.
A best-evidence synthesis was performed to summarize the results of the 2 systematic reviews and 17 RCTs that were included. Strong evidence was found for the effectiveness of low-level laser therapy compared with placebo treatment in the very short term (0 to ≤5wk). After 5 weeks, the positive effects of low-level laser therapy on pain, function, or recovery diminished over time (moderate and conflicting evidence were found at 7- and 12-wk follow-up, respectively).
In the very short term, low-level laser therapy is more effective as a single intervention than placebo low-level laser therapy in patients with carpal tunnel syndrome, after which the positive effects of low-level laser therapy tend to subside. Evidence in the midterm and long term is sparse.
Abstract Huisstede BM, Randsdorp MS, Coert JH, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments—a systematic review. Objective To present an ...evidence-based overview of the effectiveness of surgical and postsurgical interventions to treat carpal tunnel syndrome (CTS). Data Sources The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs). Study Selection Two reviewers independently applied the inclusion criteria to select potential studies. Data Extraction Two reviewers independently extracted the data and assessed the methodologic quality. Data Synthesis A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 25 RCTs were included. Moderate evidence was found in favor of surgical treatment compared with splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term, and for the effectiveness of corticosteroid irrigation of the median nerve before skin closure as additive to carpal tunnel release in the short term. Limited evidence was found in favor of a double-incision technique compared with the standard incision technique. Also, limited evidence was found in favor of a mini-open technique assisted by a Knifelight instrument compared with a standard open release at 19 months of follow-up. However, in the short term and at 30 months of follow-up, no significant differences were found between the mini-open technique assisted by a Knifelight instrument compared with a standard open release. Many studies compared different surgical interventions, but no evidence was found in favor of any one of them. No RCTs explored the optimal timing strategy for surgery. No evidence was found for the efficacy of various presurgical or postsurgical treatment programs, including splinting. Conclusions Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term to treat CTS. However, there is no unequivocal evidence that suggests one surgical treatment is more effective than the other. More research is needed to study conservative to surgical treatment in which also should be taken into account the optimal timing of surgery. Future research should also concentrate on optimal presurgical and postsurgical treatment programs.
Abstract Gebremariam L, Hay EM, Koes BW, Huisstede BM. Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review. Objective To provide an ...evidence-based overview of the effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome. Data Sources The Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched. Study Selection Two reviewers independently selected relevant systematic reviews and randomized controlled trials (RCTs). Data Extraction Two reviewers independently extracted data and assessed the methodologic quality. Data Synthesis If pooling of data was not possible, a best-evidence synthesis was used to summarize the results. Results One review and 5 RCTs reporting on various surgical techniques, and postsurgical interventions were included. Moderate evidence was found in favor of adding platelet-leukocyte gel versus open subacromial decompression. No evidence was found for the superiority of subacromial decompression versus conservative treatment in the short, mid, and long term or in favor of 1 surgical technique when compared with another. Limited evidence was found in favor of early activation after arthroscopic decompression in the short and long term. Conclusions This review shows that there is no evidence that surgical treatment is superior to conservative treatment or that1 particular surgical technique is superior to another. Because of possibly lower risks for complications, conservative treatment may be preferred. When choosing for surgery, arthroscopic decompression may be preferred because of the less invasive character of the procedure.
Abstract Objective To present an evidence-based overview of the effectiveness of pharmaceutical interventions, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, and other ...injections, used to treat the subacromial impingement syndrome (SIS). An overview can help physicians select the most appropriate pharmaceutical intervention, and it can identify gaps in scientific knowledge. Data Sources The Cochrane Library, PubMed, Embase, PEDro, and CINAHL databases. Study Selection Two reviewers independently selected relevant reviews and randomized clinical trials. Data Extraction Two reviewers independently extracted the data and assessed the methodologic quality. Data Synthesis A best evidence synthesis was used to summarize the results. Three reviews and 5 randomized clinical trials were included. Although we found limited evidence for effectiveness in favor of 2 sessions with corticosteroid injections versus 1 session, for the effectiveness of corticosteroid injections versus placebo, nonsteroidal anti-inflammatory drugs, or acupuncture, only conflicting and no evidence for effectiveness was found. Moderate evidence was found in favor of immediate release oral ibuprofen compared with sustained-released ibuprofen in the short-term. Also, moderate evidence for effectiveness was found in favor of glyceryltrinitrate patches versus placebo patches in the short-term and mid term. Furthermore, injections with disodium ethylene diamine tetraacetic acid plus ultrasound with ethylene diamine tetraacetic acid gel were more effective (moderate evidence) than was placebo treatment in the short- and long-term. Conclusions This article presents an overview of the effectiveness of pharmaceutical interventions for SIS. Some treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn.
Prospective cohort study.
To evaluate whether the DASH is not only a valid and responsive instrument to measure patients with shoulder, arm, and hand complaints, but also to evaluate patients with ...neck complaints.
The DASH has shown to be a valid and responsive questionnaire to evaluate disability in patients with shoulder, arm, and hand complaints. However, patients with shoulder, arm, or hand complaints frequently report neck complaints as well. Therefore, a valid and responsive questionnaire designed for the whole upper extremity, including the neck, would be very useful and practical in upper-extremity research.
Six hundred seventy-nine patients visiting their general practitioner with a new episode of nontraumatic complaints of the neck and upper extremity were evaluated by use of questionnaires at baseline and at 6-months follow-up. Six (sub)groups were formulated according to the location of complaints, including a subgroup with complaints in the shoulder-arm-hand region only and a group with complaints of the neck only. Disability (DASH), general health SF-12 (physical and mental component), severity, and persistence of complaints were assessed. Construct validity, floor and ceiling effects, and responsiveness were studied. RESULTS.: Correlations between the DASH and the other measures within the 6 (sub)groups at baseline (construct validity), for the change scores at 6-months follow-up (responsiveness), and the responsiveness ratios were classified as acceptable. No floor and ceiling effects were found.
The DASH performed well with regard to the a priori hypotheses. This study has shown acceptable validity and responsiveness of the DASH for use in patients with nontraumatic neck complaints in addition to shoulder, arm, and hand complaints. We would caution against using the DASH in patients with neck complaints only, since fewer of the hypotheses could be confirmed in this subgroup.
