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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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<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<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><subject>Adult</subject><subject>Athletic Injuries - rehabilitation</subject><subject>Bias</subject><subject>Blood platelets</subject><subject>Citation indexes</subject><subject>Decision making</subject><subject>Effectiveness</subject><subject>Exercise</subject><subject>Exercise Therapy - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Injections, Intramuscular</subject><subject>Injuries</subject><subject>Intervention</subject><subject>Male</subject><subject>Meta-analysis</subject><subject>Muscle Stretching Exercises - methods</subject><subject>Muscle, Skeletal - injuries</subject><subject>Patient satisfaction</subject><subject>Physical therapy</subject><subject>Plasma</subject><subject>Platelet-Rich Plasma</subject><subject>Quality</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Rehabilitation</subject><subject>Return to Sport</subject><subject>Sports injuries</subject><subject>Studies</subject><subject>Systematic review</subject><subject>Therapists</subject><subject>Young Adult</subject><issn>0306-3674</issn><issn>1473-0480</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkstu1DAUhi0EosPAGyBkiU2RCLXj-BJ2qCoXqRIbWEeOc9JxlBu2MzAP2PfqSadlwQLNyj7S938nin9CXnP2gXOhLuouzlNIMcsZlxkrC6PLJ2TDCy0yVhj2lGyYYCoTShdn5EWMHWM8l8w8J2e54qURptyQ26u29c66A51aGmBna9_7ZJOfRnrew3iTdjD68eYdhT8QnI8Q39O5twl6SFnwbrdOcbDUjx24NYeAHRs6YTJQhzOEPQr3gEjCO4z3FE7UuiUB3dkhpoBLVscSPMSPaKDL3OCahsZDTDCgweEH7j38vtcPkGxmR9sfoo8vybPW9hFePZxb8vPz1Y_Lr9n19y_fLj9dZ7XkMmV5rlunmS4KKbQwIFslXC4d4w1XUvBaqcIpw3PF6qIVTesaWyoQzoBhBiNbcn70zmH6tUBM1eCjg763I0xLrDhiijPJTkB1nnMtNWMnoKwUpdD4ZFvy9h-0m5aAf2GldClwv9H_pzjHt-e8QKo4Ui5MMQZoqzn4wYZDxVm1Vqx6rFi1Vqw6Vgxjbx7kSz1A8zf02CkELo5APXSnKe8ATo_g5Q</recordid><startdate>201509</startdate><enddate>201509</enddate><creator>Pas, Haiko IMFL</creator><creator>Reurink, Gustaaf</creator><creator>Tol, Johannes L</creator><creator>Weir, Adam</creator><creator>Winters, Marinus</creator><creator>Moen, Maarten H</creator><general>BMJ Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201509</creationdate><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><author>Pas, Haiko IMFL ; Reurink, Gustaaf ; Tol, Johannes L ; Weir, Adam ; Winters, Marinus ; Moen, Maarten H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b515t-227fc7074453738e5f63c25c01d16531b664c681260b4f3dfcda96e3c8e808373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Athletic Injuries - rehabilitation</topic><topic>Bias</topic><topic>Blood platelets</topic><topic>Citation indexes</topic><topic>Decision making</topic><topic>Effectiveness</topic><topic>Exercise</topic><topic>Exercise Therapy - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Injections, Intramuscular</topic><topic>Injuries</topic><topic>Intervention</topic><topic>Male</topic><topic>Meta-analysis</topic><topic>Muscle Stretching Exercises - methods</topic><topic>Muscle, Skeletal - injuries</topic><topic>Patient satisfaction</topic><topic>Physical therapy</topic><topic>Plasma</topic><topic>Platelet-Rich Plasma</topic><topic>Quality</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Rehabilitation</topic><topic>Return to Sport</topic><topic>Sports injuries</topic><topic>Studies</topic><topic>Systematic review</topic><topic>Therapists</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><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><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pas, Haiko IMFL</au><au>Reurink, Gustaaf</au><au>Tol, Johannes L</au><au>Weir, Adam</au><au>Winters, Marinus</au><au>Moen, Maarten H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis</atitle><jtitle>British journal of sports medicine</jtitle><addtitle>Br J Sports Med</addtitle><date>2015-09</date><risdate>2015</risdate><volume>49</volume><issue>18</issue><spage>1197</spage><epage>1205</epage><pages>1197-1205</pages><issn>0306-3674</issn><eissn>1473-0480</eissn><abstract>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<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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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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