Effectiveness of Physical Therapy Treatments on Lateral Epicondylitis

Kohia, Mohamed; Brackle, John; Byrd, Kenny; Jennings, A.; Murray, William S.; Wilfong, Erin

doi:10.1123/jsr.17.2.119

Cited by 50 publications

(29 citation statements)

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“…Ten [57][58][59]61,62,65,68,70,79,84 of the 29 studies identified in the current review were also included in the review by Bisset et al 80 Evidence from these 10 studies was evaluated in the overview by Bisset et al; 80 a summary of recommendations from the overview is given in Table 31. We compare our results against these recommendations in Chapter 4, Current clinical effectiveness evidence in context.…”

Section: Systematic Reviewsmentioning

confidence: 99%

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Long

Briscoe

Cooper

et al. 2015

Health Technology Assessment

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BackgroundLateral elbow tendinopathy (LET) is a common complaint causing characteristic pain in the lateral elbow and upper forearm, and tenderness of the forearm extensor muscles. It is thought to be an overuse injury and can have a major impact on the patient’s social and professional life. The condition is challenging to treat and prone to recurrent episodes. The average duration of a typical episode ranges from 6 to 24 months, with most (89%) reporting recovery by 1 year.ObjectivesThis systematic review aims to summarise the evidence concerning the clinical effectiveness and cost-effectiveness of conservative interventions for LET.Data sourcesA comprehensive search was conducted from database inception to 2012 in a range of databases including MEDLINE, EMBASE and Cochrane Databases.Methods and outcomesWe conducted an overview of systematic reviews to summarise the current evidence concerning the clinical effectiveness and a systematic review for the cost-effectiveness of conservative interventions for LET. We identified additional randomised controlled trials (RCTs) that could contribute further evidence to existing systematic reviews. We searched MEDLINE, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science, The Cochrane Library and other important databases from inception to January 2013.ResultsA total of 29 systematic reviews published since 2003 matched our inclusion criteria. These were quality appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist; five were considered high quality and evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. A total of 36 RCTs were identified that were not included in a systematic review and 29 RCTs were identified that had only been evaluated in an included systematic review of intermediate/low quality. These were then mapped to existing systematic reviews where further evidence could provide updates. Two economic evaluations were identified.LimitationsThe summary of findings from the review was based only on high-quality evidence (scoring of > 5 AMSTAR). Other limitations were that identified RCTs were not quality appraised and dichotomous outcomes were also not considered. Economic evaluations took effectiveness estimates from trials that had small sample sizes leading to uncertainty surrounding the effect sizes reported. This, in turn, led to uncertainty of the reported cost-effectiveness and, as such, no robust recommendations could be made in this respect.ConclusionsClinical effectiveness evidence from the high-quality systematic reviews identified in this overview continues to suggest uncertainty as to the effectiveness of many conservative interventions for the treatment of LET. Although new RCT evidence has been identified with either placebo or active controls, there is uncertainty as to the size of effects reported within them because of the small sample size. Conclusions regarding cost-effectiveness are also unclear. We consider that, although updated or new systematic reviews may also be of value, the primary focus of future work should be on conducting large-scale, good-quality clinical trials using a core set of outcome measures (for defined time points) and appropriate follow-up. Subgroup analysis of existing RCT data may be beneficial to ascertain whether or not certain patient groups are more likely to respond to treatments.Study registrationThis study is registered as PROSPERO CRD42013003593.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Systematic Reviewsmentioning

confidence: 99%

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Long

Briscoe

Cooper

et al. 2015

Health Technology Assessment

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“…injection, medication, rest, ice, bracing, therapeutic modalities, therapeutic exercise, massage, mobilization and manipulation. [10][11][12][13][14][15][16][17] This deficit could be a plausible explanation for research indicating that there is no significant long-term benefit of conservative treatment when compared to a wait and see appro ach. 10,13,17 The use of specific patho-anatomic diagnoses in patients with spinal conditions has also shown unacceptable levels of reliability.…”

Section: Introductionmentioning

confidence: 99%

The application of mechanical diagnosis and therapy in lateral epicondylalgia

Maccio

Fink

Yarznbowicz³

et al. 2016

Journal of Manual & Manipulative Therapy

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Background: lateral epicondylalgia (LE) is a musculoskeletal diagnosis that causes pain and dysfunction in the lateral aspect of the elbow. Mechanical diagnosis and therapy (MDT) is an orthopaedic classification and treatment system based on mechanical and symptomatic response to repeated and sustained end-range movement. There has been no investigation of the association between MDT and patients diagnosed with LE. Case description: this report presents three patients matching the currently accepted diagnostic criteria for LE, two with a diagnosis of lateral epicondylitis (tennis elbow) from a medical doctor. These patients were classified and treated by a diplomat of MDT and two third-year doctoral students of physical therapy using MDT. Outcomes: short-and long-term (one year) outcomes were excellent, demonstrating rapid abolishment of symptoms and return to prior levels of function in 3-6 visits between 11-59 days. Patients demonstrated the ability to prevent and manage reoccurrence of symptoms independently without seeking further health care. Discussion: this case series raises questions about whether or not the pathologies traditionally associated with the aetiology of LE are actually at fault. Moreover, it raises questions about the utility of special tests typically utilized to identify those structures. The series provides preliminary evidence that MDT may be capable of providing effective short-and long-term outcomes in the management of LE. Level of Evidence: 4

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“…In clinical assessment instruments used to assess functional progress during wrist and forearm rehabilitation, forearm strength contributes up to 25% of the overall functional assessment (Souer, LozanoCalderon, & Ring, 2008). Thus, forearm pronation and supination strength are integral parts of the rehabilitation of people with elbow disorders, such as lateral epicondylitis (Alizadehkhaiyat et al, 2007;Erak, Day, & Wang, 2004;Kohia et al, 2008), rheumatoid arthritis (Shigeyama, Inoue, Hashizume, Nagashima, & Senda, 1997), forearm fractures (Dubberley, Faber, MacDermid, Patterson, & King, 2006;Droll et al, 2007;Souer et al, 2008), and nerve impairment (Rainville, Noto, Jouve, & Jenis, 2007;Rosén, Dahlin, & Lundborg, 2000) as well as the development of baseball (Szymanski, Szymanski, Molloy, & Pascoe, 2004) and tennis athletes (Alizadehkhaiyat et al, 2007;Ellenbecker, Roetert, & Riewald, 2006).…”

mentioning

confidence: 99%

“…Forearm strength assessment has often been limited to grip strength (Kohia et al, 2008;Rosén et al, 2000). When forearm pronation and supination have been assessed, a variety of methods have been used, including manual muscle tests (Rainville et al, 2007), weight-lifting maximum repetitions (Szymanski et al, 2004), research torque cells devices (Matsuoka, Berger, Berglund, & An, 2006;O'Sullivan & Gallwey, 2005;Shigeyama et al, 1997), work simulators (Droll et al, 2007;Dubberley et al, 2006), and isokinetic rehabilitation and assessment devices such as the Cybex 6000 (Ellenbecker et al, 2006).…”

mentioning

confidence: 99%

New Assessment of Forearm Strength: Reliability and Validity

Wong

Moskovitz

2010

The American Journal of Occupational Therapy

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KEY WORDSforearm muscle strength dynamometer reproducibility of results OBJECTIVE. The objective was to determine the reliability of a portable forearm strength hydraulic dynamometer with a doorknob handle and assess its validity compared with a Cybex 6000 (Cybex International, Inc., Medway, MA) isometric torque assessment.METHOD. Eighteen volunteers (with a total of 30 forearms) participated in this one-session methodological study to determine the intra-and interrater reliability and criterion validity of a forearm dynamometer. CONCLUSION. The Baseline hydraulic dynamometer with a more functional doorknob handle had good intraand interrater reliability and demonstrated moderate validity compared with Cybex 6000 strength testing. RESULTS.

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Effectiveness of Physical Therapy Treatments on Lateral Epicondylitis

Abstract: There are numerous treatments for lateral epicondylitis and no single intervention has been proven to be the most efficient. Therefore, future research is needed to provide a better understanding of beneficial treatment options for people living with this condition.

Cited by 50 publications

References 25 publications

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

The application of mechanical diagnosis and therapy in lateral epicondylalgia

New Assessment of Forearm Strength: Reliability and Validity

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