A meta-analysis of randomized controlled trials

Background: The argument on whether extracorporeal shock-wave therapy (ESWT) and corticosteroid injections (CSIs) exert an equivalent pain control or which is the better treatment for plantar fasciitis (PF) in adults remains to be resolved. It is important and necessary to conduct a meta-analysis to make a relatively more credible and overall assessment about which treatment method performs better pain control in treatment of PF in adults. Methods: From the inception to July 2018, the Embase, PubMed, Web of Science, and Cochrane Library electronic databases were searched for all relevant studies. Only randomized controlled trials (RCTs) focusing on comparing ESWT and CSI therapies in PF cases in adults were included. The primary outcome measure was visual analog scale (VAS) reduction, whereas the secondary outcomes included treatment success rate, recurrence rate, function scores, and adverse events. Results:Nine RCTs involving 658 cases were included in this meta-analysis. In the present study, meta-analysis showed that highintensity ESWT had superior pain relief and success rates relative to the CSI group within 3 months, but the ESWT with low intensity was slightly inferior to CSI for efficacy within 3 months. In addition, patients with CSI may tend to increase the need for the analgesic and more adverse events may be associated with the ESWT. However, the ESWT and CSI present similar recurrent rate and functional outcomes. Conclusion: Our analysis showed that the pain relief and success rates were related to energy intensity levels, with the highintensity ESWT had the highest probability of being the best treatment within 3 months, followed by CSI, and low-intensity ESWT. Morehigh-qualityRCTswith long-term follow-up timeare needed to further compare thedifferencesofCSI andESWT for adultswithPF. Abbreviations: CSI = corticosteroid injection, ESWT = extracorporeal shock-wave therapy, PF = plantar fasciitis, RCTs = randomized controlled trials, VAS = visual analog scale.

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