PDF(Pubmed)
Abstract：
There is a plethora of treatment options for patients with de Quervain tenosynovitis (DQT), but there are limited data on their effectiveness and no definitive management guidelines.
To assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines.
Medline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022.
All randomized clinical trials assessing the effectiveness of any intervention for the management of DQT.
This study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome.
Pairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses.
A total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function.
This network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.
To assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines.
Medline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022.
All randomized clinical trials assessing the effectiveness of any intervention for the management of DQT.
This study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome.
Pairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses.
A total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function.
This network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.
摘要：
■对于齿状腱鞘炎（DQT）患者，有很多治疗选择，但是关于其有效性的数据有限，没有明确的管理指南。
■评估和比较与DQT可用治疗方案相关的有效性，以指导肌肉骨骼从业者并告知指南。
■Medline，Embase,PubMed,CochraneCentral,Scopus,OpenGrey.欧盟，和WorldCat.org被搜索发表的研究，和世界卫生组织国际临床试验注册平台，ClinicalTrials.gov,欧盟临床试验注册，并在ISRCTN注册中心搜索了从开始到2022年8月未发表和正在进行的研究.
■所有评估任何干预措施对DQT管理的有效性的随机临床试验。
■这项研究在PROSPERO上进行了前瞻性注册，并根据系统审查和荟萃分析的首选报告项目进行并报告了扩展声明，以报告系统审查报告，其中包含了医疗保健干预的网络荟萃分析（PRISMA-NMA）和运动中的PRISMA，康复,运动医学和运动科学（PERSIST）指导。偏差工具的Cochrane风险和建议的分级，评估,发展,和评估工具用于每个结果的偏倚风险和证据确定性评估。
使用视觉模拟量表（VAS）对患者报告的疼痛以及使用手臂快速残疾的功能进行了成对和网络荟萃分析。肩膀,和手（Q-DASH）规模。对成对荟萃分析计算了其95%CI的平均差异(MD)。
■共30项研究，共1663名患者（平均[SD]年龄，46[7]年；80%女性)被包括在内，其中19项研究纳入定量分析.从成对的荟萃分析中，基于适度确定性的证据，在皮质类固醇注射（CSI）中添加拇指固定3至4周与统计学相关，但在短期内没有临床显着功能益处（MD，10.5[95%CI，6.8-14.1]点）和中期（MD，9.4[95%CI，7.0-11.9]点）。在网络荟萃分析中，包括超声引导下CSI在内的干预措施在疼痛方面排名第一.固定拇指的CSI是对短期和中期功能最有效的干预措施的可能性最高。
■该网络荟萃分析发现，在CSI中添加短时间的拇指刺固定与统计学相关，但在临床上没有显着的短期和中期益处。这些发现表明，对DQT患者应考虑给予CSI，然后进行3至4周的固定治疗。
■评估和比较与DQT可用治疗方案相关的有效性，以指导肌肉骨骼从业者并告知指南。
■Medline，Embase,PubMed,CochraneCentral,Scopus,OpenGrey.欧盟，和WorldCat.org被搜索发表的研究，和世界卫生组织国际临床试验注册平台，ClinicalTrials.gov,欧盟临床试验注册，并在ISRCTN注册中心搜索了从开始到2022年8月未发表和正在进行的研究.
■所有评估任何干预措施对DQT管理的有效性的随机临床试验。
■这项研究在PROSPERO上进行了前瞻性注册，并根据系统审查和荟萃分析的首选报告项目进行并报告了扩展声明，以报告系统审查报告，其中包含了医疗保健干预的网络荟萃分析（PRISMA-NMA）和运动中的PRISMA，康复,运动医学和运动科学（PERSIST）指导。偏差工具的Cochrane风险和建议的分级，评估,发展,和评估工具用于每个结果的偏倚风险和证据确定性评估。
使用视觉模拟量表（VAS）对患者报告的疼痛以及使用手臂快速残疾的功能进行了成对和网络荟萃分析。肩膀,和手（Q-DASH）规模。对成对荟萃分析计算了其95%CI的平均差异(MD)。
■共30项研究，共1663名患者（平均[SD]年龄，46[7]年；80%女性)被包括在内，其中19项研究纳入定量分析.从成对的荟萃分析中，基于适度确定性的证据，在皮质类固醇注射（CSI）中添加拇指固定3至4周与统计学相关，但在短期内没有临床显着功能益处（MD，10.5[95%CI，6.8-14.1]点）和中期（MD，9.4[95%CI，7.0-11.9]点）。在网络荟萃分析中，包括超声引导下CSI在内的干预措施在疼痛方面排名第一.固定拇指的CSI是对短期和中期功能最有效的干预措施的可能性最高。
■该网络荟萃分析发现，在CSI中添加短时间的拇指刺固定与统计学相关，但在临床上没有显着的短期和中期益处。这些发现表明，对DQT患者应考虑给予CSI，然后进行3至4周的固定治疗。
