Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis

BackgroundOur 2012 review on therapeutic interventions for acute hamstring injuries found a lack of high-quality studies. The publication of new studies warranted an update.ObjectivesTo update and reanalyse the efficacy of conservative treatments for hamstring injury.Data sourcesPubMed, EMBASE, Web...

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Veröffentlicht in:British journal of sports medicine 2015-09, Vol.49 (18), p.1197-1205
Hauptverfasser: Pas, Haiko IMFL, Reurink, Gustaaf, Tol, Johannes L, Weir, Adam, Winters, Marinus, Moen, Maarten H
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container_end_page 1205
container_issue 18
container_start_page 1197
container_title British journal of sports medicine
container_volume 49
creator Pas, Haiko IMFL
Reurink, Gustaaf
Tol, Johannes L
Weir, Adam
Winters, Marinus
Moen, Maarten H
description BackgroundOur 2012 review on therapeutic interventions for acute hamstring injuries found a lack of high-quality studies. The publication of new studies warranted an update.ObjectivesTo update and reanalyse the efficacy of conservative treatments for hamstring injury.Data sourcesPubMed, EMBASE, Web of Science, Cochrane library, CINAHL and SPORTDiscus were searched till mid-February 2015.Study eligibility criteriaRandomised controlled trials (RCTs) on the effect of conservative interventions versus a control group or other intervention for hamstring injuries (HI) were included.Data analysisThe search results were screened independently by two authors. Risk of bias assessment was performed using a modified Downs and Black scale with a maximum score of 28. Meta-analysis was performed, where possible.Main results10 RCTs (526 participants), including 6 new RCTs, were identified. Two RCTs were of good/excellent quality, the rest were fair or poor (median Downs and Black score 16 (IQR 9)). Meta-analysis of two studies on rehabilitation (lengthening) exercises showed a significantly reduced time to return to play (HR 3.22 (95% CI 2.17 to 4.77), p
doi_str_mv 10.1136/bjsports-2015-094879
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The publication of new studies warranted an update.ObjectivesTo update and reanalyse the efficacy of conservative treatments for hamstring injury.Data sourcesPubMed, EMBASE, Web of Science, Cochrane library, CINAHL and SPORTDiscus were searched till mid-February 2015.Study eligibility criteriaRandomised controlled trials (RCTs) on the effect of conservative interventions versus a control group or other intervention for hamstring injuries (HI) were included.Data analysisThe search results were screened independently by two authors. Risk of bias assessment was performed using a modified Downs and Black scale with a maximum score of 28. Meta-analysis was performed, where possible.Main results10 RCTs (526 participants), including 6 new RCTs, were identified. Two RCTs were of good/excellent quality, the rest were fair or poor (median Downs and Black score 16 (IQR 9)). Meta-analysis of two studies on rehabilitation (lengthening) exercises showed a significantly reduced time to return to play (HR 3.22 (95% CI 2.17 to 4.77), p&lt;0.0001) but no difference in risk of re-injury. Meta-analysis of three studies investigating platelet-rich plasma (PRP) showed no effect when compared to control (HR 1.03 (95% CI 0.87 to 1.22), p=0.73). Limited evidence was found that progressive agility and trunk stability training may reduce re-injury rates.ConclusionsMeta-analysis showed superior efficacy for rehabilitation exercises. PRP injection had no effect on acute hamstring injury. Limited evidence was found that agility and trunk stabilisation may reduce re-injury rates. The limitations identified in the majority of RCTs should improve the design of new hamstring RCTs.</description><identifier>ISSN: 0306-3674</identifier><identifier>EISSN: 1473-0480</identifier><identifier>DOI: 10.1136/bjsports-2015-094879</identifier><identifier>PMID: 26198389</identifier><language>eng</language><publisher>England: BMJ Publishing Group</publisher><subject>Adult ; Athletic Injuries - rehabilitation ; Bias ; Blood platelets ; Citation indexes ; Decision making ; Effectiveness ; Exercise ; Exercise Therapy - methods ; Female ; Humans ; Injections, Intramuscular ; Injuries ; Intervention ; Male ; Meta-analysis ; Muscle Stretching Exercises - methods ; Muscle, Skeletal - injuries ; Patient satisfaction ; Physical therapy ; Plasma ; Platelet-Rich Plasma ; Quality ; Randomized Controlled Trials as Topic ; Rehabilitation ; Return to Sport ; Sports injuries ; Studies ; Systematic review ; Therapists ; Young Adult</subject><ispartof>British journal of sports medicine, 2015-09, Vol.49 (18), p.1197-1205</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright BMJ Publishing Group Sep 2015</rights><rights>Copyright: 2015 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b515t-227fc7074453738e5f63c25c01d16531b664c681260b4f3dfcda96e3c8e808373</citedby><cites>FETCH-LOGICAL-b515t-227fc7074453738e5f63c25c01d16531b664c681260b4f3dfcda96e3c8e808373</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bjsm.bmj.com/content/49/18/1197.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://bjsm.bmj.com/content/49/18/1197.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77343,77374</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26198389$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pas, Haiko IMFL</creatorcontrib><creatorcontrib>Reurink, Gustaaf</creatorcontrib><creatorcontrib>Tol, Johannes L</creatorcontrib><creatorcontrib>Weir, Adam</creatorcontrib><creatorcontrib>Winters, Marinus</creatorcontrib><creatorcontrib>Moen, Maarten H</creatorcontrib><title>Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis</title><title>British journal of sports medicine</title><addtitle>Br J Sports Med</addtitle><description>BackgroundOur 2012 review on therapeutic interventions for acute hamstring injuries found a lack of high-quality studies. The publication of new studies warranted an update.ObjectivesTo update and reanalyse the efficacy of conservative treatments for hamstring injury.Data sourcesPubMed, EMBASE, Web of Science, Cochrane library, CINAHL and SPORTDiscus were searched till mid-February 2015.Study eligibility criteriaRandomised controlled trials (RCTs) on the effect of conservative interventions versus a control group or other intervention for hamstring injuries (HI) were included.Data analysisThe search results were screened independently by two authors. Risk of bias assessment was performed using a modified Downs and Black scale with a maximum score of 28. Meta-analysis was performed, where possible.Main results10 RCTs (526 participants), including 6 new RCTs, were identified. Two RCTs were of good/excellent quality, the rest were fair or poor (median Downs and Black score 16 (IQR 9)). Meta-analysis of two studies on rehabilitation (lengthening) exercises showed a significantly reduced time to return to play (HR 3.22 (95% CI 2.17 to 4.77), p&lt;0.0001) but no difference in risk of re-injury. Meta-analysis of three studies investigating platelet-rich plasma (PRP) showed no effect when compared to control (HR 1.03 (95% CI 0.87 to 1.22), p=0.73). Limited evidence was found that progressive agility and trunk stability training may reduce re-injury rates.ConclusionsMeta-analysis showed superior efficacy for rehabilitation exercises. PRP injection had no effect on acute hamstring injury. Limited evidence was found that agility and trunk stabilisation may reduce re-injury rates. 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The publication of new studies warranted an update.ObjectivesTo update and reanalyse the efficacy of conservative treatments for hamstring injury.Data sourcesPubMed, EMBASE, Web of Science, Cochrane library, CINAHL and SPORTDiscus were searched till mid-February 2015.Study eligibility criteriaRandomised controlled trials (RCTs) on the effect of conservative interventions versus a control group or other intervention for hamstring injuries (HI) were included.Data analysisThe search results were screened independently by two authors. Risk of bias assessment was performed using a modified Downs and Black scale with a maximum score of 28. Meta-analysis was performed, where possible.Main results10 RCTs (526 participants), including 6 new RCTs, were identified. Two RCTs were of good/excellent quality, the rest were fair or poor (median Downs and Black score 16 (IQR 9)). Meta-analysis of two studies on rehabilitation (lengthening) exercises showed a significantly reduced time to return to play (HR 3.22 (95% CI 2.17 to 4.77), p&lt;0.0001) but no difference in risk of re-injury. Meta-analysis of three studies investigating platelet-rich plasma (PRP) showed no effect when compared to control (HR 1.03 (95% CI 0.87 to 1.22), p=0.73). Limited evidence was found that progressive agility and trunk stability training may reduce re-injury rates.ConclusionsMeta-analysis showed superior efficacy for rehabilitation exercises. PRP injection had no effect on acute hamstring injury. Limited evidence was found that agility and trunk stabilisation may reduce re-injury rates. The limitations identified in the majority of RCTs should improve the design of new hamstring RCTs.</abstract><cop>England</cop><pub>BMJ Publishing Group</pub><pmid>26198389</pmid><doi>10.1136/bjsports-2015-094879</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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source MEDLINE; BMJ Journals - NESLi2
subjects Adult
Athletic Injuries - rehabilitation
Bias
Blood platelets
Citation indexes
Decision making
Effectiveness
Exercise
Exercise Therapy - methods
Female
Humans
Injections, Intramuscular
Injuries
Intervention
Male
Meta-analysis
Muscle Stretching Exercises - methods
Muscle, Skeletal - injuries
Patient satisfaction
Physical therapy
Plasma
Platelet-Rich Plasma
Quality
Randomized Controlled Trials as Topic
Rehabilitation
Return to Sport
Sports injuries
Studies
Systematic review
Therapists
Young Adult
title Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis
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