1.
Efficacy of Platelet-Rich Plasma Injection on Range of Motion, Pain, and Disability in Patients with Adhesive Capsulitis: A Systematic Review and Meta-Analysis
Lin HW, Tam KW, Liou TH, Rau CL, Huang SW, Hsu TH
Archives of physical medicine and rehabilitation. 2023
Abstract
OBJECTIVE To investigate the therapeutic effects of platelet-rich plasma (PRP) injection on range of motion (ROM), pain, and disability in patients with adhesive capsulitis (AC). DATA SOURCES The authors performed the literature search in the PubMed, Embase, and Cochrane Library databases in February 2023. STUDY SELECTION Prospective studies comparing the outcomes of PRP with other intervention in patients with AC. DATA EXTRACTION The quality of included randomized trials was assessed using the revised Cochrane Risk of Bias (RoB 2.0) tool. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool was applied to assess the quality of nonrandomized trials. The mean difference (MD) or standardized mean difference (SMD) was determined as the effect size for continuous outcomes, and outcome accuracy was determined using 95% confidence intervals (CIs). DATA SYNTHESIS Fourteen studies involving 1,139 patients were included. Our meta-analysis revealed that PRP injection can significantly improve passive abduction (MD = 3.91, 95% CI: 0.84-6.98), passive flexion (MD = 3,90, 95% CI: 0.15-7.84), and disability (SMD = -0.50, 95% CI: -1.29--0.74) within one month after intervention. Moreover, PRP injection can significantly improve passive abduction (MD = 17.19, 95% CI: 12.38-22.01), passive flexion (MD = 17.74, 95% CI: 9.89-25.59), passive external rotation (MD = 12.95, 95% CI: 10.04-15.87), pain (MD = -8.40, 95% CI: -16.73--0.06), and disability (SMD = -1.02, 95% CI: -1.29--0.74) three months after intervention. PRP injection can also significantly improve pain (MD = -18.98, 95% CI: -24.71 to -13.26), and disability (SMD = -2.01, 95% CI: -3.02 to -1.00) six months after intervention. In addition, no adverse effects of PRP injection were reported. CONCLUSION PRP injection may serve as an effective and safe treatment for patients with AC.
2.
Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
Huang YH, Chen HC, Huang KW, Chen PC, Hu CJ, Tsai CP, Tam KW, Kuan YC
BMC Neurology. 15:39, 2015.. 2015;15:39.
Abstract
BACKGROUND Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial. METHODS We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels. RESULTS We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD]=-1.02, 95% confidence interval [CI]=-2.51 to 0.47), fatigue scores (WMD=0.28, 95% CI -0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity. CONCLUSION The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials.