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Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial


Methodology: 3/5          
Usefulness: 1/5
McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB.
BMJ. 2012 May 22;344:e3260.


This double-blind RCT found that there was a reduction in a 100-point pain score at 4 weeks for plantar fasciitis patients whose feet were injected with 4mg dexamethasone compared to normal saline placebo  (10.9 points, 95% CI 1.4 to 20.4; P=0.03).  JC attendees agreed that this study did not show any clinically-significant pain or function improvement with dexamethasone injections although the therapy may be useful for cases resistant to more conservative therapy. 
By: Dr. Aseem Bishnoi
(Presented February 2013)

Epi Lesson – Use of Continuous Data as Primary Outcome
Beware of studies that compare the effectiveness of interventions by using continuous data outcomes, such as pain scales (1-100), oxygen saturation values, and minutes to pain relief. These kinds of data can produce statistically significant differences between groups with relatively small sample sizes but often give you little information about clinical importance. Far better and almost always the norm are outcome measures given as proportions or percentages, such as % of patients who achieve: 20 points improvement in pain, an oxygen saturation of 90%, pain relief in less than 2 hours, or survival.  
By: Dr. Ian Stiell

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