Non-surgical management of piriformis syndrome: a systematic review Cramp F, Bottrell O, Campbell H, Ellyatt P, Smith C, Wilde B CRD summary This review evaluated conservative non-surgical management of Piriformis Syndrome. The authors' conclusions appeared to be that Botox injections may be an effective treatment for Piriformis Syndrome and that further research is recommended. This was a poorly reported review, with methodological weaknesses identified within a very limited evidence base. The extent to which the authors' conclusions are reliable is unclear. Authors' objectives To evaluate conservative non-surgical management of Piriformis Syndrome. Searching The following databases were searched (terms reported): The Cochrane Library, SPORTDiscus, AMED (1985 to Feb 2006), CINAHL (1982 to Feb 2006), EMBASE and Medline (1966 to Feb 2006). Two journals were handsearched (Sports Exercise and Injury, Physiotherapy in Sport) and reference lists were checked for relevant studies. Only English language studies published between 1996 and the end of February 2006 were considered for inclusion. Study selection Eligible studies were required to be randomised controlled trials (RCTs) of non-surgical management for Piriformis Syndrome in adults. Studies without clear ethical approval were excluded. The included studies were RCTs (parallel and crossover) evaluating the effects of botulinum toxin type A (Botox) injections on Piriformis Syndrome symptoms. The control arms received saline or lidocaine steroid injections. In one study all participants also received physiotherapy. The inclusion criteria for each primary study differed in level of detail. Mean participant age was between 42.1 and 57.4 years. Most patients were female. Pain duration, where reported, ranged from 16 to 84 months. Visual analogue scales were used as the primary outcome measure, with some data reported on H-reflex and motion analysis. Follow-up periods ranged from 12 weeks to 20 weeks. The authors stated neither how the papers were selected for the review nor how many reviewers performed the selection. Assessment of study quality Included papers were assessed for validity using the Physiotherapy Evidence Database (PEDro) scale, which evaluates randomisation, blinding and analysis methods (including intention to treat) used to produce an overall numeric score out of 10. Five reviewers independently assessed the quality of included papers, then discussed the overall results to resolve any disagreements. Data extraction The authors stated neither how the data were extracted for this review nor how many reviewers performed the data extraction. Methods of synthesis A narrative synthesis was carried out. Results of the review Two RCTs were included in this review (total n = 76). Both studies were double-blind trials. One RCT used a crossover design (n=9) to compare Botox injections with saline injections. The second RCT (n=67) compared Botox versus saline versus lidocaine (steroid), with all patients also receiving a concurrent standardised physiotherapy programme twice Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2019 University of York Page: 1 / 3