PAIN+ CPN

OBJECTIVE: This study aimed to compare the effects of 7 physical therapy interventions delivered with Home Exercise Program (HEP) versus HEP alone on pain and function in plantar fasciitis (PF).

DATA SOURCES: Studies were identified through PubMed, Embase, the Cochrane Library, Web of Science, and Scopus from database inception to January 2026.

STUDY SELECTION: Randomized controlled trials (RCTs) comparing physical therapy interventions delivered with HEP versus HEP alone in individuals with PF were included.

DATA EXTRACTION AND SYNTHESIS: A frequentist random-effects network meta-analysis was conducted.Outcomes were assessed at short-term (=6 weeks), medium-term (6-12 weeks), and long-term (=12 weeks) follow-up periods. Eight treatment nodes were analyzed: extracorporeal shock wave therapy, ultrasound therapy, manual therapy, taping, low-level laser therapy, orthoses, and dry needling, all delivered with HEP, and HEP alone as the control. Risk of bias was assessed using the Cochrane Risk-of-Bias tool, and the certainty of evidence was evaluated with the Confidence in Network Meta-Analysis framework.

MAIN OUTCOMES AND MEASURES: Pain and functional outcomes were evaluated using standardized mean differences (SMDs) with 95% CIs.

RESULTS: Twenty-four RCTs (1240 participants) were included. For pain outcomes, dry needling (DN) (SMD = -1.26, 95% CI = -2.25 to -0.28), low-level laser therapy (-1.54, -2.82 to -0.27), and manual therapy (MT) (-1.02, -1.82 to -0.21), delivered with HEP, resulted in clinically significant improvements in short-term pain (moderate-quality evidence). The pain-relieving effects of DN delivered with HEP were sustained in the medium term (-1.14, -1.62 to -0.66; high-quality evidence). For functional outcomes, DN (0.66, 0.13 to 1.19) and taping (0.84, 0.27 to 1.40), delivered with HEP, resulted in clinically significant improvements in short-term function (moderate-quality evidence). Additionally, DN with HEP sustained significant clinical improvements in medium-term function (1.06, 0.24 to 1.87; moderate-quality evidence).

CONCLUSIONS AND RELEVANCE: When delivered with HEP, DN, low-level laser therapy, and MT provided clinically significant short-term improvements in pain compared to HEP alone, with DN and taping improving short-term functional outcomes. Dry needling further sustained its benefits in both pain and function into the medium term.

Rehab Clinician (OT/PT) rater

As emphasized by the authors, interpret the results with caution due to the heterogeneity of the home exercise programs, the lack of clarity in FITT protocols, and uncertainty regarding patients' adherence, which compromise the precise evaluation of the physical therapy interventions.

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