Table 3.
GRADE evidence profile of the effect of corticosteroid injection on pain
| Quality assessment | Summary of findings | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Comparison | No. of trials | Limitations | Inconsistency | Indirectness | Imprecision | Publication bias | Participants | Effect size (95% CI)a |
GRADE | |
| Corticosteroid injection | Comparator | |||||||||
| Corticosteroid injection vs placebo injection | ||||||||||
| Short term | 4 [20, 24, 44, 46] | No serious limitations | Serious inconsistencyb | No serious indirectness | Serious imprecisionc | Undetected | 132 | 123 |
-0.98 (−2.06, 0.11)f |
Moderate |
| Medium term | 4 [20, 24, 44, 46] | No serious limitations | Serious inconsistencyb | No serious indirectness | Serious imprecisionc | Undetected | 126 | 122 |
-0.86 (− 1.90, 0.19)f |
Moderate |
| Corticosteroid injection vs physical therapy | ||||||||||
| Short term | 2 [25, 52] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | Serious imprecisione | Undetected | 49 | 50 |
-1.07 (−2.75, 0.60)f |
Very low |
| Medium term | 3 [25, 37, 52] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | No serious imprecision | Undetected | 80 | 79 |
-0.74 (− 1.51, 0.03)f |
Low |
| Longer term | 2 [25, 37] | Very serious limitationsd | No serious inconsistency | No serious indirectness | Serious imprecisionc | Undetected | 52 | 51 |
0.00 (−0.39, 0.38) |
Very low |
| Corticosteroid injection vs foot orthoses | ||||||||||
| Short term | 3 [40, 61, 64] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | No serious imprecision | Undetected | 92 | 99 |
−0.91 (−1.69, − 0.13)f |
Low |
| Medium term | 3 [40, 61, 64] | Very serious limitationsd | Serious inconsistencyb | Serious indirectnessg | Serious imprecisionc | Undetected | 72 | 79 |
−0.17 (− 1.30, 0.97) |
Very low |
| Corticosteroid injection vs dry needling | ||||||||||
| Short term | 2 [51, 59] | Very serious limitationsd | Very serious inconsistencyb | No serious indirectness | Serious imprecisionc | Undetected | 81 | 81 |
−0.86 (−3.70, 1.97)f |
Very low |
| Longer term | 2 [51, 59] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | No serious imprecision | Undetected | 81 | 81 | 1.45 (0.70, 2.19)f | Low |
| Corticosteroid injection vs extracorporeal shockwave therapy | ||||||||||
| Short term | 8 [29, 33, 34, 41, 45, 54, 56, 58] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | No serious imprecision | Undetected | 269 | 265 |
−0.32 (−0.77, 0.12) |
Very low |
| Medium term | 10 [29, 30, 33, 34, 41, 45, 50, 54, 58, 63] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | Serious imprecisionc | Undetected | 354 | 354 |
−0.05 (−0.60, 0.49) |
Very low |
| Longer term | 5 [30, 33, 34, 50, 58] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | No serious imprecision | Undetected | 202 | 211 |
0.45 (−0.09, 0.99) |
Very low |
| Corticosteroid injection vs laser therapy | ||||||||||
| Short term | 2 [65, 66] | Very serious limitationsd | No serious inconsistency | Serious indirectnessg | Serious imprecisionc | Undetected | 50 | 44 |
−0.20 (−0.61, 0.20) |
Very low |
| Corticosteroid injection vs autologous blood injection | ||||||||||
| Short term | 4 [22, 38, 42, 62] | Very serious limitationsd | No serious inconsistency | No serious indirectness | No serious imprecision | Undetected | 126 | 131 |
−0.56 (−0.86, − 0.26) |
Low |
| Medium term | 4 [22, 38, 42, 62] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | Serious imprecisionc | Undetected | 126 | 131 |
−0.31 (−0.83, 0.21) |
Very low |
| Longer term | 4 [22, 39, 42, 62] | Very serious limitationsd | No serious inconsistency | No serious indirectness | Serious imprecisionc | Undetected | 128 | 134 |
−0.05 (−0.31, 0.21) |
Very low |
| Corticosteroid injection vs platelet-rich plasma injection | ||||||||||
| Short term | 8 [21, 35, 36, 44, 49, 57, 58, 60] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | Serious imprecisionc | Undetected | 202 | 203 |
−0.16 (−0.70, 0.38) |
Very low |
| Medium term | 7 [21, 35, 36, 44, 57, 58, 60] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | Serious imprecisionc | Undetected | 187 | 188 |
0.32 (−0.19, 0.83) |
Very low |
| Longer term | 6 [21, 35, 36, 57, 58, 60] | Very serious limitationsd | Serious inconsistencyb | Serious indirectnessh | No serious imprecision | Undetected | 162 | 163 | 0.61 (0.30, 1.06) | Very low |
| Corticosteroid injection vs botulinum toxin-A injection | ||||||||||
| Short term | 2 [27, 28] | Very serious limitationsd | Serious inconsistencyb | No serious indirectness | Serious imprecisione | Undetected | 45 | 45 |
0.67 (−0.04, 1.38) |
Very low |
Abbreviations: CI Confidence interval, GRADE Grading Recommendations Assessment, Development and Evaluation
a Negative values indicate that the effect size (SMD) favours corticosteroid injection
b Rated down 1 level for consistency as there was significant heterogeneity (i.e. I2 greater than 40%)
c Rated down 1 level as the upper and lower boundaries of the confidence intervals represent different conclusions
d All participants for this outcome were from trials rated at high risk of bias
e The total sample for this outcome is less than 100
f Rated up 1 level due to large effect size
g The interventions differed between studies
h Outcome measures were obtained at significantly different time points