Sports and Exercise Medicine Research and Education Group, University of Malaya, Kuala Lumpur, Malaysia.
Malaysian Health Technology Assessment Section (MaHTAS), Ministry of Health, Kuala Lumpur, Malaysia.
PLoS One. 2021 May 26;16(5):e0252204. doi: 10.1371/journal.pone.0252204. eCollection 2021.
Prolotherapy and other injections, primarily acting on pathways associated with maladaptive tissue repair, are recommended for recalcitrant chronic soft tissue injuries (CSTI). However, selection of injection is challenging due to mixed results. This network meta-analysis (NMA) aimed to compare prolotherapy with other therapies, particularly injections, for CSTI and establish robustness of the results.
Pubmed, Medline, SPORTDiscus and Google scholar were searched from inception to 4th January 2021 for randomised controlled trials (RCTs) involving injection therapies (e.g. blood derivatives, corticosteroid, hyaluronic acid, botulinum toxin) for CSTI. The primary and secondary outcomes were pain and function, respectively, at (or nearest to) 6 months. Effect size (ES) was presented as standardised mean difference with 95% confidence interval (CI). Frequentist random effect NMA was used to generate the overall estimates, subgroup estimates (by region and measurement time point) and sensitivity analyses.
A total of 91 articles (87 RCTs; 5859 participants) involving upper limb (74%), lower limb (23%) and truncal/hip (3%) injuries were included. At all time points, prolotherapy had no statistically significant pain benefits over other therapies. This observation remained unchanged when tested under various assumptions and with exclusion of studies with high risk of bias. Although prolotherapy did not offer statistically significant functional improvement compared to most therapies, its ES was consistently better than non-injections and corticosteroid injection for both outcomes. At selected time points and for selected injuries, prolotherapy demonstrated potentially better pain improvement over placebo (<4 months: shoulder [ES 0.65; 95% CI 0.00 to 1.30]; 4-8 months: elbow [ES 0.91; 95% CI 0.12 to 1.70]; >8 months: shoulder [ES 2.08; 95% CI 1.49, to 2.68]). Injections generally produced greater ES when combined with non-injection therapy.
While clinical outcomes were generally comparable across types of injection therapy, prolotherapy may be used preferentially for selected conditions at selected times.
增生疗法和其他主要作用于适应不良组织修复相关途径的注射疗法被推荐用于治疗难治性慢性软组织损伤（CSTI）。然而，由于结果混杂，注射疗法的选择具有挑战性。本网络荟萃分析（NMA）旨在比较增生疗法与其他疗法（例如血液衍生物、皮质类固醇、透明质酸、肉毒杆菌毒素）治疗 CSTI 的效果，并确定结果的稳健性。
从建库到 2021 年 1 月 4 日，在 Pubmed、Medline、SPORTDiscus 和 Google scholar 上检索了涉及 CSTI 注射治疗（如血液衍生物、皮质类固醇、透明质酸、肉毒杆菌毒素）的随机对照试验（RCT）。主要和次要结局分别为 6 个月时（或最接近 6 个月时）的疼痛和功能。效应量（ES）表示为标准化均数差，置信区间（CI）为 95%。使用频率论随机效应 NMA 生成总体估计值、亚组估计值（按地区和测量时间点）和敏感性分析。
共纳入 91 篇文章（87 篇 RCT；5859 名参与者），涉及上肢（74%）、下肢（23%）和躯干/臀部（3%）损伤。在所有时间点，与其他疗法相比，增生疗法在疼痛方面均无统计学显著益处。在各种假设和排除高偏倚风险的研究后，这一观察结果保持不变。尽管与大多数疗法相比，增生疗法在功能改善方面无统计学显著益处，但与非注射和皮质类固醇注射相比，其 ES 始终更好。在选定的时间点和选定的损伤部位，与安慰剂相比，增生疗法在疼痛改善方面显示出潜在的更好效果（<4 个月：肩部[ES 0.65；95% CI 0.00 至 1.30]；4-8 个月：肘部[ES 0.91；95% CI 0.12 至 1.70]；>8 个月：肩部[ES 2.08；95% CI 1.49 至 2.68]）。注射疗法通常与非注射疗法联合使用时会产生更大的 ES。
尽管各种类型的注射疗法的临床结局总体相似，但在特定时间和特定情况下，增生疗法可能更优先用于特定情况。
