背景:本系统评价的目的是确定足跟提升对下肢肌肉骨骼疾病的任何比较者的益处和危害。
方法:OvidMEDLINE,OvidAMED,OvidEMCARE,从开始到2024年5月底,搜索了CINAHLPlus和SPORTDiscus。随机化,比较足跟提升与任何其他干预或无治疗的准随机或非随机试验均可纳入.提取了疼痛结果的数据,残疾/功能,参与,参与者总体状况评级,生活质量,综合措施和不良事件。两位作者在主要时间点12周(或次接近)使用GRADE方法独立评估偏倚和证据确定性的风险。
结果:8项试验(n=903),调查中段跟腱病,包括跟骨关节炎和足底足跟痛。高跟鞋被比作运动,超声,冷冻疗法矫形器,伸展,鞋类,活动修改,毡垫和止痛药。没有结果的偏倚风险较低,几乎没有影响(47个中的2个)是临床重要的。低确定性证据(1次试验,n=199)表示疼痛缓解改善(55.7分[95%CI:50.3-61.1],在100毫米视觉模拟量表上)与定制矫形器相比,与跟骨关节炎12周时的脚跟抬起相比。非常低的确定性证据(1次试验,n=62)表示与消炎痛相比,足跟抬起的疼痛和功能得到改善(35.5分[95%CI:21.1-49.9],足功能指数)在12个月时治疗足底足跟痛。
结论:很少有试验评估足跟提升对下肢肌肉骨骼疾病的益处和危害。47个结果中只有两个结果在组间差异中显示出临床意义。然而,由于非常低到低确定性的证据,我们无法对结果充满信心,真正的效果可能大不相同。
背景:PROSPERO注册号CRD42022309644。
BACKGROUND: The objective of this systematic review is to determine the benefits and harms of heel lifts to any comparator for lower limb musculoskeletal conditions.
METHODS: Ovid MEDLINE, Ovid AMED, Ovid EMCARE, CINAHL Plus and SPORTDiscus were searched from inception to the end of May 2024. Randomised, quasi-randomised or non-randomised trials comparing heel lifts to any other intervention or no-treatment were eligible for inclusion. Data was extracted for the outcomes of pain, disability/function, participation, participant rating of overall condition, quality of life, composite measures and adverse events. Two authors independently assessed risk of bias and certainty of evidence using the GRADE approach at the primary time point 12 weeks (or next closest).
RESULTS: Eight trials (n = 903), investigating mid-portion Achilles tendinopathy, calcaneal apophysitis and plantar heel pain were included. Heel lifts were compared to exercise, ultrasound, cryotherapy orthotics, stretching, footwear, activity modification, felt pads and analgesic medication. No outcome was at low risk of bias and few effects (2 out of 47) were clinically important. Low-certainty evidence (1 trial, n = 199) indicates improved pain relief (55.7 points [95% CI: 50.3-61.1], on a 100 mm visual analogue scale) with custom orthotics compared to heel lifts at 12 weeks for calcaneal apophysitis. Very low-certainty evidence (1 trial, n = 62) indicates improved pain and function with heel lifts over indomethacin (35.5 points [95% CI: 21.1-49.9], Foot Function Index) at 12 months for plantar heel pain.
CONCLUSIONS: Few trials have assessed the benefits and harms of heel lifts for lower limb musculoskeletal conditions. Only two outcomes out of 47 showed clinically meaningful between group differences. However, due to very low to low certainty evidence we are unable to be confident in the results and the true effect may be substantially different.
BACKGROUND: PROSPERO registration number CRD42022309644.