Microsoft word - iontophoresis for plantar fasciitis

American International College
Effectiveness of iontophoretic administration of dexamethasone on musculoskeletal pain,
specifically plantar fasciitis.
Effectiveness of iontophoretic administration of dexamethasone on musculoskeletal pain, specifically plantar fasciitis. 1. Iontophoretic administration of dexamethasone is effective in pain reduction of plantar fasciitis in the acute phase. 2. Iontophoretic administration of dexamethasone is no more effective than manual physical therapy and exercise for pain reduction of chronic Does iontophoretic administration of dexamethasone decrease pain in patients I: Iontophoretic administration of dexamethasone I used PubMed, Cochrane Library, Medline, PEDro, and CINAHL to search for studies with high levels of evidence such as systematic reviews or randomized Key Words : Iontophoresis, plantar fasciitis, dexamethasone
Limits Selected: None, but looked for highest levels of evidence
# of Hits: PubMed – 14 (2 relevant)
1. Gudeman SD, Eisele SA, Heidt RS, Jr, Colosimo AJ, Stroupe AL. Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double- blind, placebo-controlled study. Am J Sports Med. 1997 May-Jun; 25(3): 312-316 2. Osborne HR, Allison GT. Treatment of plantar fasciitis by LowDye taping and iontophoresis: short term results of a double blinded, randomised, placebo controlled clinical trial of dexamethasone and acetic acid. Br J Sports Med. 2006 3. Torro J, Brunetti L, Patel MK, M.D. Iontophoretic administration of dexamethasone for musculoskeletal pain. The Journal of Musculoskeletal Medicine. 2011;28(11):410-413,418-421.
1. Subjects were randomly assigned to two groups. Group 1 was the control group which received iontophoresis to the plantar fascia but only a buffered saline solution was delivered. Group 2 was the experimental group and received iontophoresis to the plantar fascia with a 0.4% dexamethasone sodium phosphate USP. 6 treatments were administered to each group over two weeks and outcome measures were taken before and after the 6 treatments. The outcome measure of choice for this study was the Maryland Foot Score (MFS) which assesses both pain and function on a 100 point scale. 2. Subjects were randomly assigned to one of three groups using computer generated block randomization. Each group received iontophoresis. Group 1 received 0.4% dexamethasone, group 2 received 5% acetic acid, or a placebo treatment of 0.9% NaCl. Every group also received LowDye taping. Measurements of primary outcomes were done at 2 week intervals (baseline, after treatment, at follow up) and patients were surveyed at the follow up to see which drug they thought was used in order to determine if masking had been successful. The outcome measure of choice for this study was the Visual 3: A medical literature search was conducted in MEDLINE/PubMed, Web of Science, International Pharmaceutical Abstracts,and Google Scholar; the terms "dexamethasone," "iontophoresis," and "musculoskeletal disorders" were used to identify relevant original research articles. Priority was placed on data derived from humans, especially those obtained from randomized controlled trials. A total of 13 clinical trials that met the inclusion/exclusion criteria were reviewed 1: Strengths- Subjects were randomly assigned to each group, inclusion and
exclusion criteria were defined, testers were blinded to pre-treatment baseline MFS, subjects were blinded to treatment received Weaknesses- Patient populations were not similar at baseline (32 women, 7
men), data collectors were not blinded to group membership. 2: Strengths- Randomization of subjects to treatment groups occurred. Subjects
were blinded to group assignment, inclusion and exclusion criteria were clearly Weaknesses- Patient populations were not similar at baseline.
3: Strengths- Randomized controlled trials were lowest level of evidence, 8
different musculoskeletal conditions considered Weaknesses- Only 3 studies on plantar fasciitis
1: Overall, the results of the study were that patient’s pain decreased and function increased post intervention with a statistically significant P-value of 0.022. 95% percent of patients had excellent results and 5% had good/fair results. Confidence intervals of 95% reported in table form. Numbers needed to treat were not reported, however a cost analysis was shown. This study had a 2: The results of this study show that dexamethasone and acetic acid provide equal benefits over placebo treatments. Statistical significance was set at p<.05. Confidence intervals of 95% were reported in table form of p= .025. Numbers needed to treat were not reported in this study. 3: These results of this study suggest that iontophoresis may be beneficial in the short-term (acute-phase) management of plantar heel pain, but no more beneficial than manual physical therapy plus exercise in the long-term. Since the results of the literature conclude that iontophoretic administration of dexamethasone is beneficial for pain management in the acute phase of healing of plantar fasciitis, I would incorporate it into my practice. However, if my patient presented with plantar fasciitis that was in the chronic stage, I would likely choose a different intervention. It can also be beneficial because it circumvents the toxicities associated with injections of dexamethasone. I would use the Lower Extremity Functional Scale (LEFS) or the Foot Function

Source: http://www.aic.edu/aic3/pub/pt_iontophoresis_for_plantar_fasciitis.pdf