A systematic review with meta-analysis «Wang Y, Wang K, Qin Y, et al. The effect of cortic...»1 compared glucocorticoid + local anesthetic injection with usual care wait and see strategy or placebo in treatment of GTPS and found uncertain impact on short term (4-6 weeks pain). A small randomized controlled study «Nissen MJ, Brulhart L, Faundez A, et al. Glucocort...»2 compared glucocorticoid + local anesthetic injection with placebo in treatment of GTPS and found little to no impact.
On medium term and long term, the impact remained uncertain.
The quality of the evidence is downgraded due to risk of bias, inconsistency and imprecision.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Wang Y, Wang K, Qin Y, et al. The effect of cortic...»1 | SR/MA of RCTs | Adult patients with GTPS. | Glucocorticoid + local anesthetic injection vs. wait and see and usual care or placebo | Short-, medium-, long-term, and extra long-term pain intensity | Moderate |
| «Nissen MJ, Brulhart L, Faundez A, et al. Glucocort...»2 | RCT | Adult patients with GTPS. | Ultrasound-guided glucocorticoid + local anesthetic injection vs. placebo | Short-term pain intensity | Low |
| Reference | Comments |
|---|---|
| «Wang Y, Wang K, Qin Y, et al. The effect of cortic...»1 | Wide inclusion criteria without definition of the outcome measures for the literature
search. Patients with ongoing treatments were not excluded even though studies included
had excluded those patients. Diagnostic criteria for GTPS were not clearly defined
thus varied. Highly limited number of studies involved. Bias of included studies: Allocation concealment and blinding of outcome assessment was not described/mentioned in one study. Blinding was not performed in both. |
| «Nissen MJ, Brulhart L, Faundez A, et al. Glucocort...»2 | Double-blinded study with a successful randomization. All patients participated in the follow-up. No selective outcome reporting or incomplete data. Blinding of outcome assessment was not mentioned. Pain intensity was assessed 30 min after the injection that may have influenced the blinding. Concurrent treatments were requested to be avoided, but usage of pain medication was not screened. Target number of patients was not exceeded. |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (sd) I | Mean (sd) (%) C | Std. Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: very low The quality of evidence is downgraded due to study limitations, inconsistency, indirectness, imprecision. I=intervention; C=comparison; CI=confidence interval |
|||||
| «Wang Y, Wang K, Qin Y, et al. The effect of cortic...»1 | 3 studies, 300 patients (147/153) | 4-6 weeks | NA | NA | -0.45 (-1.06 to 0.17) |
| «Nissen MJ, Brulhart L, Faundez A, et al. Glucocort...»2 | One, 46 patients (21/25) | 4 weeks | NA | NA | Not reported. Reduction of NRS: Intervention group: -1.5 Control group: -2.5 (p=0.23) |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (sd)) I | Mean (sd) C | Std. Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded due to study limitations. One small trial using placebo as control did not measure medium or long-term follow ups. I=intervention; C=comparison; CI=confidence interval |
|||||
| «Wang Y, Wang K, Qin Y, et al. The effect of cortic...»1 | 2 studies, 254 (126/128) | 8 weeks to 3 months | NA | NA | -0.47 (-0.72, -0.22) |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (sd) I | Mean (sd) C | Std. Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded due to study limitations and imprecision. One small trial using placebo as control did not measure medium or long-term follow ups. I=intervention; C=comparison; CI=confidence interval |
|||||
| «Wang Y, Wang K, Qin Y, et al. The effect of cortic...»1 | Comparison A: 2 studies, 254 (126/128) | 6 months | NA | NA | -0.08 (-0.33, 0.16) |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (sd) I | Mean (sd) C | Std. Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded due to study limitations and imprecision. One small trial using placebo as control did not measure medium or long-term follow ups. I=intervention; C=comparison; CI=confidence interval |
|||||
| «Wang Y, Wang K, Qin Y, et al. The effect of cortic...»1 | Comparison A: 2 studies, 254 (126/128) | 12 months | NA | NA | -0.27 (-0.52, -0.02) |