Author Names
Kiran, N., Ahmed Awan, W., Sahar, W., Hameed, N., Sarfraz, N., & Niaz, A.
Reviewer Name
Emma Vohringer, SPT
Reviewer Affiliation(s)
Duke University Doctor of Physical Therapy Division
Paper Abstract
Abstract
Background: Chronic plantar fasciitis has been historically treated with conventional physical therapy. The use of the Garston Technique® (GT) is a new intervention for the management of chronic plantar fascitis, but there is lack of evidence in the literature regarding its efficacy.
Study objective: To evaluate the effectiveness of the GT on pain, foot function and general foot health in patients with plantar fasciitis.
Methods: This was a randomized clinical trial conducted from November 2020 to March 2021. The non-probability purposive sampling technique was used to select 30 patients.
Setting: Madinah Teaching Hospital, Faisalabad, Pakistan.
Participants: A total of 30 patients of both genders with a 6-week history of planter fasciitis and the presence of a calcaneus everted ≥2° were included in this study and randomly assigned to one of two groups.
Intervention: Both groups received conventional physical therapy (CPT) for 4 weeks and the experimental group in addition received GT.
Primary outcome measures: The primary outcome measures were pain, measured at baseline, after the second week and after the end of treatment (ie, the fourth week) on the visual analog scale (VAS); and general foot health and foot function, measured at baseline and after the end of treatment with the Modified Foot Health Status Questionnaire (FHSQ).
Results: The mean age of the study patients was 34.1 ± 6.67 years. There was significant improvement in pain in the GT group compared with the CPT group after the second (P = .005; partial η2 = 0.263) and the 4th (P = .000; partial η2 = 0.535) week of intervention. Foot function was also significantly improved (P < .05) in the GT group compared with the CPT group with a large effect size (Cohen’s d = 0.080). But in the case of general foot health, no significant difference was observed between the groups at the end of the fourth week.
Conclusion: The use of the GT combined with CPT shows significant results compared with CPT alone; ie, GT speeds up the recovery from heel pain and foot function in patients with chronic plantar fasciitis.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Cannot Determine, Not Reported, or Not Applicable
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- No
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Cannot Determine, Not Reported, or Not Applicable
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Cannot Determine, Not Reported, or Not Applicable
- Was there high adherence to the intervention protocols for each treatment group?
- Cannot Determine, Not Reported, or Not Applicable
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- No
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Cannot Determine, Not Reported, or Not Applicable
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Graston technique can speed up the recovery of plantar fasciitis.
Key Finding #2
Graston technique is a good therapetuic intervention alongside other therapies.
Key Finding #3
Graston was only effective in this small group during this short amount of time,further research needs to be conducted to determine if it is effective across a larger population.
Please provide your summary of the paper
Through a randomized approach, a study of 30 participants of similar demographics with a history of chronic plantar fasciitis and heel pain were split into two treatment groups. Half of the study participants were allocated to just conventional physical therapy and the other half were allocated to physical therapy along with Graston Technique and taping. The group that was allocated physical therapy in addition to Graston overall had better outcomes in terms of speed of recovery, pain reduction, and increased function/range of motion. Due to the limitations of this study — short duration, smaller sample size of 30 people, and single-centered due to COVID-19 — it is unknown if the results could be replicated in a larger study.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
I do believe that the current research on the use of Graston Technique for plantar fasciitis is limited and while this research study is a great step in that direction, it is still not enough based on its limitations. I think that the results of this study are beneficial though for increased implementation of Graston Technique and taping along with conventional physical therapy. If we had more people using Graston to speed up recovery of heel pain associated with plantar fasciitis and then even converting this more into research, we would have a better vision of the place for Graston in conventional physical therapy.
