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. 2018 Jan-Dec:14:1744806918768972.
doi: 10.1177/1744806918768972.

The effectiveness of therapeutic strategies for patients with radiculopathy: A network meta-analysis

Xiaoyu Zhang  1 , Zhiqiang Zhang  2 , Jianzhong Wen  3 , Jie Lu  4 , Yingchun Sun  5 , Dechun Sang  1
Affiliations

The effectiveness of therapeutic strategies for patients with radiculopathy: A network meta-analysis

Xiaoyu Zhang et al. Mol Pain. 2018 Jan-Dec.

Abstract

Objectives The aim of this network meta-analysis is to assess the effectiveness of therapeutic strategies for patients with radiculopathy, including physical, medical, surgical, and other therapies. Methods We electronically searched electronic databases including PubMed and Embase for randomized controlled trials. The response rate and visual analog scale of pain change were considered as primary outcomes. The outcomes were measured by odds ratio (OR) value and corresponding 95% credible intervals (CrIs) or standardized mean difference (MD) with 95% CrIs. Besides, surface under cumulative ranking curve (SUCRA) were performed to rank efficacy and safety of treatments on each end points. Results A total of 16 eligible studies with 1071 subjects were included in this analysis. Our results showed that corticosteroid was significantly more effective than control regarding the response rate (OR = 3.86, 95% CrI: 1.16, 12.55). Surgery had a better performance in pain change compared with control (MD = -1.92, 95% CrI: -3.58, -0.15). According to the SUCRA results, corticosteroid, collar, and physiotherapy ranked the highest concerning response rate (SUCRA = 0.656, 0.652, and 0.610, respectively). Surgery, traction, and corticosteroid were superior to others in pain change (SUCRA = 0.866, 0.748, and 0.589, respectively). Conclusion According to the network meta-analysis result, we recommended surgery as the optimal treatment for radiculopathy patients; traction and corticosteroids were also recommended for their beneficial interventions.

Keywords: Radiculopathy; network meta-analysis; pain change; response rate; treatment.

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Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
Figure 2.
Figure 2.
Network of response rate and pain change. Lines represent direct comparisons between two interventions. The thicker the line is, the greater the number of existing direct comparisons between the two interventions. Numbers above dots show the total number of patients for each intervention. NSAID: non-steroidal anti-inflammatory drugs; PRF: pulsed radiofrequency.
Figure 3.
Figure 3.
Forest plot of response rate and pain change. Odds ratio (OR) and 95% credible intervals (CrIs) for response rate and mean difference (MD) and 95% CrIs for pain change. NSAID: non-steroidal anti-inflammatory drugs; PRF: pulsed radiofrequency.
Figure 4.
Figure 4.
Heat plot of pain change. The area of the gray squares displays the contribution of the direct estimate in design (shown in the column) to the network estimate in design (shown in the row). The colors are associated with the change in inconsistency between direct and indirect evidence (shown in the row) after detaching the effect (shown in the column). Cold colors indicate an increase in inconsistency, and warm colors indicate a decrease in inconsistency (the stronger the color is, the stronger the change is).
See this image and copyright information in PMC

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