scholarly journals Comparing two dry needling interventions for plantar heel pain: a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038033
Author(s):  
Zaid Al-Boloushi ◽  
Eva Maria Gómez-Trullén ◽  
Mohammad Arian ◽  
Daniel Fernández ◽  
Pablo Herrero ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Treatment Session ◽  
Heel Pain ◽  
Secondary Outcome ◽  
Dry Needling ◽  
Foot Health ◽  
Plantar Heel Pain ◽  
Vas Scores ◽  
Randomised Controlled ◽  
Pain Domain

ObjectivesTo compare the effectiveness of dry needling (DN) versus percutaneous needle electrolysis (PNE) for improving the level of pain, function and quality of life (QoL) of patients suffering from plantar heel pain (PHP) provoked by myofascial trigger points.DesignA prospective, parallel-group, randomised controlled trial with blinded outcome assessment.SettingA single treatment facility in the State of Kuwait.Participants118 participants were screened for eligibility. Of these, 102 participants were enrolled (30 men (49.5±8.9 years) and 72 women (48.1±8.8 years)) and 68 of them completed the trial.InterventionsTwo parallel groups, one study arm received DN and a stretching protocol whereas the other arm received percutaneous needling electrolysis with a stretching protocol.Primary and secondary outcome measuresThe primary outcome measure was the Foot Pain domain of the Foot Health Status Questionnaire, with 13 questions related to foot health-related domains. Secondary outcome measures included the 0–10 numerical rating scale pain visual analogue scale (VAS) scores, performed before and after each treatment session. In addition, QoL was measured using the EuroQoL-5 dimensions. All measurements were taken at baseline, at 4, 8, 12, 26 and 52 weeks.ResultsFoot Pain domain improved at all time points for DN group (p<0.001; 29.7 (17.8 to 41.5)) and percutaneous needling electrolysis group (p<0.001; 32.7 (18.3 to 47.0)), without significant differences between groups. Pain VAS scores decreased at all time points for both DN (p<0.001; −2.6 (−4.0 to −1.2)) and percutaneous needling electrolysis group (p<0.001; −3.0 (−4.5 to −1.6)). QoL improved at 4 weeks for both DN (p<0.01; 0.15 (0.5 to 0.25)) and percutaneous needling electrolysis group (p<0.01; 0.09 (0.01 to 0.17)) and at 8 and 52 weeks for the PNE group (p<0.01; 0.10 (0.02 to 0.18)), with significant differences between groups for the QoL at 52 weeks (p<0.05; 0.10 (0.01 to 0.18)). There were two small haematomas in the PNE group and one in the DN group. No serious adverse events were reported.ConclusionsBoth PNE and DN were effective for PHP management, reducing mean and maximum pain since the first treatment session, with long lasting effects (52 weeks) and significant differences between groups in the case of QoL at 52 weeks in favour of the PNE group.Trial registration numberNCT03236779.

scholarly journals Comparing two dry needling interventions for plantar heel pain: a protocol for a randomized controlled trial

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Zaid Al-Boloushi ◽  
Eva María Gómez-Trullén ◽  
Pablo Bellosta-López ◽  
María Pilar López-Royo ◽  
Daniel Fernández ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Heel Pain ◽  
Dry Needling ◽  
Randomized Controlled ◽  
Plantar Heel Pain

scholarly journals Effectiveness of Trigger Point Dry Needling for Plantar Heel Pain: A Randomized Controlled Trial

2014 ◽  
Vol 94 (8) ◽  
pp. 1083-1094 ◽  
Author(s):  
Matthew P. Cotchett ◽  
Shannon E. Munteanu ◽  
Karl B. Landorf
Keyword(s):  
Randomized Controlled Trial ◽  
Adverse Events ◽  
Trigger Point ◽  
Controlled Trial ◽  
Heel Pain ◽  
Foot Pain ◽  
Dry Needling ◽  
Randomized Controlled ◽  
Plantar Heel Pain ◽  
End Point

Background Plantar heel pain can be managed with dry needling of myofascial trigger points; however, there is only poor-quality evidence supporting its use. Objective The purpose of this study was to evaluate the effectiveness of dry needling for plantar heel pain. Design The study was a parallel-group, participant-blinded, randomized controlled trial. Setting The study was conducted in a university health sciences clinic. Patients Study participants were 84 patients with plantar heel pain of at least 1 month's duration. Intervention Participants were randomly assigned to receive real or sham trigger point dry needling. The intervention consisted of 1 treatment per week for 6 weeks. Participants were followed for 12 weeks. Measurements Primary outcome measures included first-step pain, as measured with a visual analog scale (VAS), and foot pain, as measured with the pain subscale of the Foot Health Status Questionnaire (FHSQ). The primary end point for predicting the effectiveness of dry needling for plantar heel pain was 6 weeks. Results At the primary end point, significant effects favored real dry needling over sham dry needling for pain (adjusted mean difference: VAS first-step pain=−14.4 mm, 95% confidence interval [95% CI]=−23.5 to −5.2; FHSQ foot pain=10.0 points, 95% CI=1.0 to 19.1), although the between-group difference was lower than the minimal important difference. The number needed to treat at 6 weeks was 4 (95% CI=2 to 12). The frequency of minor transitory adverse events was significantly greater in the real dry needling group (70 real dry needling appointments [32%] compared with only 1 sham dry needling appointment [&lt;1%]). Limitations It was not possible to blind the therapist. Conclusion Dry needling provided statistically significant reductions in plantar heel pain, but the magnitude of this effect should be considered against the frequency of minor transitory adverse events.

scholarly journals Autoregulated Heavy Slow Resistance Training Combined with Radial Shockwave Therapy for Plantar Heel Pain: Protocol for a Mixed Methods Pilot Randomised Controlled Trial

2020 ◽  
Author(s):  
Ian Burton
Keyword(s):  
Mixed Methods ◽  
Randomised Controlled Trial ◽  
Resistance Training ◽  
Controlled Trial ◽  
Treatment Protocol ◽  
Heel Pain ◽  
Shockwave Therapy ◽  
Plantar Heel Pain ◽  
Pilot Rct ◽  
Randomised Controlled

Background: Plantar heel pain (PHP) is considered a tendinopathy and it affects up to 10% of the population. Both heavy slow resistance training (HSRT) and extracorporeal shockwave therapy (ESWT) have shown effectiveness for treating PHP in isolation. However more comprehensive exercise protocols and progression methods are needed due to poor long-term outcomes, and better standardization of ESWT protocols are required. Autoregulation of resistance training involves self-selecting exercise dosage based on individual factors. Although autoregulation has proven effective for strength gains in athletes, it has not been investigated in tendinopathy. It is recommended that PHP not be treated by one treatment in isolation, with there being a need to investigate feasibility and effectiveness of combined treatments in PHP. Currently, no studies have investigated autoregulated HSRT combined with ESWT, despite their individual efficacy. The optimal treatment protocol for PHP is unknown, and there is a need to ascertain whether the addition of ESWT to autoregulated HSRT leads to better outcomes compared to either alone. Methods: A three-arm randomised controlled trial (RCT) comparing these groups would be the ideal way to investigate this question, with a pilot RCT testing trial procedures and process evaluation required prior to a definitive RCT. Patients expectations, feasibility and acceptability of combined ESWT and exercise for PHP also remain unknown. Therefore, the addition of qualitative interviews in a mixed methods pilot RCT would help ascertain acceptability and help explain the intervention outcomes.

scholarly journals Cost-Effectiveness of Two Dry Needling Interventions for Plantar Heel Pain: A Secondary Analysis of an RCT

2021 ◽  
Vol 18 (4) ◽  
pp. 1777
Author(s):  
Daniel Fernández ◽  
Zaid Al-Boloushi ◽  
Pablo Bellosta-López ◽  
Pablo Herrero ◽  
Manuel Gómez ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Heel Pain ◽  
Dry Needling ◽  
Cost Effectiveness Ratio ◽  
Plantar Heel Pain ◽  
Life Years

Plantar heel pain is a common cause of foot pain that affects patients’ quality of life and represents a significant cost for the healthcare system. Dry needling and percutaneous needle electrolysis are two minimally invasive treatments that were shown to be effective for the management of plantar heel pain. The aim of our study was to compare these two treatments in terms of health and economic consequences based on the results of a published randomized controlled trial. For this, we evaluated the costs from the point of view of the hospital and we carried out a cost-effectiveness study using quality of life as the main variable according to the Eq-5D-5L questionnaire. The cost of the complete treatment with dry needling (DN) was €178.86, while the percutaneous needle electrolysis (PNE) was €200.90. The quality of life of patients improved and was translated into +0.615 quality-adjusted life years (QALYs) for DN and +0.669 for PNE. PNE presented an average incremental cost-effectiveness ratio (ICER) of €411.34/QALY against DN. These results indicate that PNE had a better cost-effectiveness ratio for the treatment of plantar heel pain than DN.

scholarly journals Metformin reduces 12-month change in body weight among people newly commenced on clozapine: a retrospective naturalistic cohort study

2021 ◽  
Vol 11 ◽  
pp. 204512532110006
Author(s):  
Jessica Spokes ◽  
Samantha Hollingworth ◽  
Karl Winckel ◽  
Steve Kisely ◽  
Andrea Baker ◽  
...  
Keyword(s):  
Cohort Study ◽  
Weight Gain ◽  
Tobacco Smoking ◽  
Digital Health ◽  
Controlled Trial ◽  
Bodyweight Gain ◽  
Metabolic Effects ◽  
Secondary Outcome ◽  
Standard Clinical Practice ◽  
Randomised Controlled

Background: People with schizophrenia have a 15–20-year reduction in life expectancy, driven in part by the metabolic effects of antipsychotics. Clozapine is associated with the highest rates of weight gain. As clozapine remains the most effective antipsychotic for treatment-resistant schizophrenia (TRS), identifying treatments to ameliorate clozapine-induced weight gain (CIWG) is urgently needed to reduce this morality gap. Methods: We retrospectively analysed digital health records of patients with TRS aged 18–65 newly initiated on clozapine at four tertiary hospitals in south-east Queensland from 1 March 2017 to 30 June 2019. Our primary outcome was the effect of metformin on change in percentage bodyweight at 12 months after clozapine initiation, with secondary outcome being proportion with >5% or >7% bodyweight change. We also explored impact on bodyweight change of other variables including sex, tobacco smoking, type 2 diabetes (T2DM), age, clozapine level and dose and clozapine/norclozapine ratio. Results: Among 90 patients initiated on clozapine, metformin use ( n = 48) was associated with a smaller increase in percentage bodyweight (1.32% versus 5.95%, p = 0.031), lower rates of >7% gain in bodyweight (37.8% versus 63.0%, p = 0.025) but not >5% gain in bodyweight. Age below the median (32.0 years) was associated with greater bodyweight gain (5.55% versus 1.22%, p = 0.046). Sex, tobacco smoking, T2DM, clozapine dose and level and clozapine/norclozapine ratio were not associated with differences in change in bodyweight. Conclusion: In this small retrospective cohort study, use of metformin within 12-months of clozapine initiation was associated with a statistically and clinically significant reduction in CIWG. Although there is increasing evidence for the role of metformin to ameliorate bodyweight gain at time of clozapine initiation, our findings need replication and testing in a randomised controlled trial before recommending metformin co-commencement with clozapine as standard clinical practice.

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