Critically appraised paper: Education plus exercise, and corticosteroid injection, are superior to a wait-and-see approach for gluteal tendinopathy [commentary]

摘要

Question: Is education plus exercise, and corticosteroid injection, more effec- tive than wait and see on global changes in hip conditions and pain in people with gluteal tendinopathy? Design: Multicentre, three-arm randomised controlled trial with concealed allocation. Setting: Two university departments in Australia. Participants: Community-dwelling participants from Brisbane and Melbourne. Inclusion criteria were age 35 to 70 years, lateral hip pain (> 3 months) of intensity at least 4/10 on a numerical rating scale, and gluteal ten- dinopathy confirmed by clinical diagnosis and magnetic resonance imaging. Low back, sciatic, or groin pain, corticosteroid injection (previous 12 months), and current physiotherapy treatment were exclusion criteria. Randomisation of 204 participants allocated 66 to corticosteroid injection, 69 to education plus exercise, and 60 to wait and see. Interventions: Education plus exercise comprised 14 sessions with a physiotherapist over 8 weeks (60 minutes initial, otherwise 30 minutes) and involved education on tendon care and loading, and daily home exercises (hip abductor strengthening; dynamic control of hip adduction). The corticosteroid injections were ultrasound-guided by a radiol- ogist. The wait-and-see approach included one session with a physiotherapist for information about gluteal tendinopathy, risk factors, advice regarding continuation of activity, and reassurance.