Letters cluded from the analysis as some patients in both trials re- The steroid injections received by some patients in the stud- ceived “a steroid injection in the parasacrococygeal region,” ies by Blomberg et al and Grunnesjö et al have no evidence of ef- which makes it unclear whether SMT or the steroids were re- fectiveness, and the 2017 review by Chou et al concluded that sponsible for any observed effects. The statistical combina- there were “no differences between a single intramuscular in- tion of such heterogeneous studies may be hard to justify from jection or a 5-day course of systemic steroids and placebo in pain a clinical point of view. and function” in patients with acute nonradicular low back pain. Furthermore, although the authors downgraded the Hence, there is no evidence to support, and some evidence to quality of evidence from high to moderate due to inconsis- refute, that the steroid injection included as part of the tency of results according to Grading of Recommendations manual therapy intervention in the studies by Blomberg et al and Assessment, Development, and Evaluation (GRADE), risk of Grunnesjö et al had any impact on effectiveness, and we felt jus- bias was not
JAMA – American Medical Association
Published: Sep 5, 2017
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