Proximal Hamstring Tendinopathy: A Systematic Review of Interventions.

Nasser, AM; Vicenzino, B; Grimaldi, A; Anderson, J; Semciw, AI

Proximal Hamstring Tendinopathy: A Systematic Review of Interventions.

Nasser, AM Vicenzino, B Grimaldi, A Anderson, J Semciw, AI

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Publisher:: International Journal of Sports Physical Therapy
Publication Type:: Journal Article
Citation:: International journal of sports physical therapy, 2021, 16, (2), pp. 288-305
Issue Date:: 2021-04-02

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Field	Value	Language
dc.contributor.author	Nasser, AM
dc.contributor.author	Vicenzino, B
dc.contributor.author	Grimaldi, A
dc.contributor.author	Anderson, J
dc.contributor.author	Semciw, AI
dc.date.accessioned	2021-05-04T05:27:25Z
dc.date.available	2021-05-04T05:27:25Z
dc.date.issued	2021-04-02
dc.identifier.citation	International journal of sports physical therapy, 2021, 16, (2), pp. 288-305
dc.identifier.issn	2159-2896
dc.identifier.issn	2159-2896
dc.identifier.uri	http://hdl.handle.net/10453/148609
dc.description.abstract	<h4>Background</h4>Proximal hamstring tendinopathy affects athletic and non-athletic populations and is associated with longstanding buttock pain. The condition is common in track and field, long distance running and field-based sports. Management options need to be evaluated to direct appropriate clinical management.<h4>Purpose/hypothesis</h4>To evaluate surgical and non-surgical interventions used in managing proximal hamstring tendinopathy.<h4>Study design</h4>Systematic review.<h4>Methods</h4>Electronic databases were searched to January 2019. Studies (all designs) investigating interventions for people with proximal hamstring tendinopathy were eligible. Outcomes included symptoms, physical function, quality of life and adverse events. Studies were screened for risk of bias. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Randomized Controlled Trials [RCT]) and the Joanna Briggs Institute Checklist (Case Series). Effect sizes (Standard mean difference or Standard paired difference) of 0.2, 0.5 and 0.8 were considered as small, medium and large respectively. Overall quality of evidence was rated according to GRADE guidelines.<h4>Results</h4>Twelve studies (2 RCTs and 10 case series) were included (n=424; males 229). RCTs examined the following interventions: platelet-rich plasma injection (n=1), autologous whole-blood injection (n=1), shockwave therapy (n=1) and multi-modal intervention (n=1). Case series included evaluation of the following interventions: platelet-rich plasma injection (n=3), surgery (n=4), corticosteroid injection (n=2), multi-modal intervention + platelet-rich plasma injection (n=1). Very low-level evidence found shockwave therapy was more effective than a multi-modal intervention, by a large effect on improving symptoms (-3.22 SMD; 95% CI -4.28, -2.16) and physical function (-2.42 SMD; 95% CI-3.33, -1.50) in the long-term. There was very low-level evidence of no difference between autologous whole-blood injection and platelet-rich plasma injection on physical function (0.17 SMD; 95% CI -0.86, 1.21) to (0.24 SMD; 95% CI -0.76, 1.24) and quality of life (-0.04 SMD; 95%CI -1.05, 0.97) in the medium-term. There was very low-quality evidence that surgery resulted in a large reduction in symptoms (-1.89 SPD; 95% CI -2.36, -1.41) to (-6.02 SPD; 95% CI -8.10, -3.94) and physical function (-4.08 SPD; 95%CI -5.53, -2.63) in the long-term.<h4>Conclusions</h4>There is insufficient evidence to recommend any one intervention over another. A pragmatic approach would be to initially trial approaches proven successful in other tendinopathies.<h4>Level of evidence</h4>Level 2a.
dc.format	Electronic
dc.language	eng
dc.publisher	International Journal of Sports Physical Therapy
dc.relation.ispartof	International journal of sports physical therapy
dc.relation.isbasedon	10.26603/001c.21250
dc.rights	info:eu-repo/semantics/openAccess
dc.title	Proximal Hamstring Tendinopathy: A Systematic Review of Interventions.
dc.type	Journal Article
utslib.citation.volume	16
utslib.location.activity	United States
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health/GSH.Physiotherapy
utslib.copyright.status	open_access	*
dc.date.updated	2021-05-04T05:27:23Z
pubs.issue	2
pubs.publication-status	Published
pubs.volume	16
utslib.citation.issue	2

Abstract:

Background

Proximal hamstring tendinopathy affects athletic and non-athletic populations and is associated with longstanding buttock pain. The condition is common in track and field, long distance running and field-based sports. Management options need to be evaluated to direct appropriate clinical management.

Purpose/hypothesis

To evaluate surgical and non-surgical interventions used in managing proximal hamstring tendinopathy.

Study design

Systematic review.

Methods

Electronic databases were searched to January 2019. Studies (all designs) investigating interventions for people with proximal hamstring tendinopathy were eligible. Outcomes included symptoms, physical function, quality of life and adverse events. Studies were screened for risk of bias. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Randomized Controlled Trials [RCT]) and the Joanna Briggs Institute Checklist (Case Series). Effect sizes (Standard mean difference or Standard paired difference) of 0.2, 0.5 and 0.8 were considered as small, medium and large respectively. Overall quality of evidence was rated according to GRADE guidelines.

Results

Twelve studies (2 RCTs and 10 case series) were included (n=424; males 229). RCTs examined the following interventions: platelet-rich plasma injection (n=1), autologous whole-blood injection (n=1), shockwave therapy (n=1) and multi-modal intervention (n=1). Case series included evaluation of the following interventions: platelet-rich plasma injection (n=3), surgery (n=4), corticosteroid injection (n=2), multi-modal intervention + platelet-rich plasma injection (n=1). Very low-level evidence found shockwave therapy was more effective than a multi-modal intervention, by a large effect on improving symptoms (-3.22 SMD; 95% CI -4.28, -2.16) and physical function (-2.42 SMD; 95% CI-3.33, -1.50) in the long-term. There was very low-level evidence of no difference between autologous whole-blood injection and platelet-rich plasma injection on physical function (0.17 SMD; 95% CI -0.86, 1.21) to (0.24 SMD; 95% CI -0.76, 1.24) and quality of life (-0.04 SMD; 95%CI -1.05, 0.97) in the medium-term. There was very low-quality evidence that surgery resulted in a large reduction in symptoms (-1.89 SPD; 95% CI -2.36, -1.41) to (-6.02 SPD; 95% CI -8.10, -3.94) and physical function (-4.08 SPD; 95%CI -5.53, -2.63) in the long-term.

Conclusions

There is insufficient evidence to recommend any one intervention over another. A pragmatic approach would be to initially trial approaches proven successful in other tendinopathies.

Level of evidence

Level 2a.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/148609