Samenvatting

STUDY DESIGN: Literature review.

MAIN QUESTION: What is the most evidence based physiotherapeutic diagnostic tool and physiotherapeutic treatment method for patients with the piriformis syndrome?

BACKGROUND: Piriformis syndrome is difficult to diagnose and resistant to therapy. The existence of piriformis syndrome has been doubted for years. While there is some controversy in the medical community, many health professionals believe that an accurate diagnosis and a comprehensive management approach are critical to alleviate the painful symptoms of this condition. The authors of this review wanted to research the effect of physiotherapy on the piriformis syndrome with regards to the diagnostic tool(s) and treatment methods.

OBJECTIVE: A literature review of scientifically evidence-based literature establishing the most effective physiotherapy diagnosing tool and treatment method of the piriformis syndrome in the common man in relation to effectiveness, accuracy, pain, ADL function and quality of life.
A diagnosing and treatment protocol based on current evidence and structured according to the phases of the physiotherapy process. This protocol establishes the most effective diagnosing tool to use on a person with piriformis syndrome in relation to effectiveness, accuracy, pain, ADL function and quality of life.

METHOD: A literature review has been done, implementing steps from the Cochrane reviewer's handbook. Electronic databases like PubMed (Medline), Cinahl, and PEDro were searched that met the inclusion criteria. Two of the studies were eligible for quality assessment using the PEDro scale and bias assessment tool. Fourteen studies were assessed for their quality using level of evidence and recommendations. A data extraction form was designed to gather the most relevant information from the articles obtained. In the end the results were interpreted and combined in order to come up with a proper conclusion.

RESULTS: 16 articles were included in this study. There is low level evidence on the diagnostic and treatment processes of the piriformis syndrome. A diagnosing protocol and treatment protocol were based on the evidence found in the included literature.

CONCLUSION: No physiotherapy intervention could be found on the outcome measures effectiveness, ADL function, Health Related Quality of Life and long/short term effects. Physiotherapy interventions on the outcome measures accuracy, pain and muscle function existed, and have been shown to be of effect. The methodological quality is low, level of evidence and recommendations is low and the risk of bias is high. Therefore, it is difficult to truly create a valid and reliable diagnostic tool and treatment protocol for patients with the piriformis syndrome. A combination of different tests and treatment methods from the newest literature were composed to find the current best way to diagnose and treat the syndrome.