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

Po Cheng Chen, Ching Hui Chuang, Yu Kang Tu, Chyi Huey Bai, Chieh Feng Chen, Mei Yun Liaw

Research output: Contribution to journalArticle

14 Citations (Scopus)

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.

Original languageEnglish
Article number363
JournalBMC Musculoskeletal Disorders
Volume16
Issue number1
DOIs
Publication statusPublished - Nov 19 2015

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Carpal Tunnel Syndrome
Adrenal Cortex Hormones
Placebos
Injections
Therapeutics
Network Meta-Analysis
MEDLINE
Meta-Analysis
Hand

Keywords

  • Carpal tunnel syndrome
  • Local corticosteroid injection
  • Network meta-analysis

ASJC Scopus subject areas

  • Rheumatology
  • Orthopedics and Sports Medicine

Cite this

A Bayesian network meta-analysis : Comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome. / Chen, Po Cheng; Chuang, Ching Hui; Tu, Yu Kang; Bai, Chyi Huey; Chen, Chieh Feng; Liaw, Mei Yun.

In: BMC Musculoskeletal Disorders, Vol. 16, No. 1, 363, 19.11.2015.

Research output: Contribution to journalArticle

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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.",
keywords = "Carpal tunnel syndrome, Local corticosteroid injection, Network meta-analysis",
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AU - Chuang, Ching Hui

AU - Tu, Yu Kang

AU - Bai, Chyi Huey

AU - Chen, Chieh Feng

AU - Liaw, Mei Yun

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KW - Carpal tunnel syndrome

KW - Local corticosteroid injection

KW - Network meta-analysis

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