Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with immobilization. The University of Montreal Orthopaedic Research Group

Labelle, Hubert; Guibert, R

doi:10.1001/archfami.6.3.257

Cited by 71 publications

(29 citation statements)

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“…The requirement for escape treatments was evaluated, including all cointerventions, analgesics or NSAIDs, outside consultation, and surgery. Three outcome scores were analyzed: the Patient-rated Tennis Elbow Evaluation (PRTEE) [32] score; the DASH [18] score; and the Pain-Free Function Index (PFFI) score, using either the eight-or 10-item version of this questionnaire [21,38]. When it was necessary to compute a total outcome score from reported components of the score, such as the pain and function components of the PRTEE score, the individual means and SDs were combined.…”

Section: Data Itemsmentioning

confidence: 99%

“…The methodologic quality of each included RCT was assessed using the 22-point Consolidated Standards Of Reporting Trials (CONSORT) checklist [34]. Studies were scored and classified as excellent (18)(19)(20)(21)(22), good (13)(14)(15)(16)(17), fair (8)(9)(10)(11)(12), or poor (B 7). A sensitivity analysis [22] was performed using only trials of excellent or good methodologic quality according to the CONSORT score.…”

Section: Data Synthesis and Statistical Analysismentioning

confidence: 99%

“…The followup ranged from 6 months to 5 years, and 10 studies reported data for two intermediate-to long-term followup periods. The methodologic quality was excellent in 10 studies, good in four, and fair in eight, yielding a mean CONSORT score of 15.5 (range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. A funnel plot (Fig.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis

Sayegh

Strauch

2015

Clinical Orthopaedics &Amp; Related Research

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Background Lateral epicondylitis is a painful tendinopathy for which several nonsurgical treatment strategies are used. Superiority of these nonsurgical treatments over nontreatment has not been definitively established. Questions/purposes We asked whether nonsurgical treatment of lateral epicondylitis compared with observation only or placebo provides (1) better overall improvement, (2) less need for escape interventions, (3) better outcome scores, and (4) improved grip strength at intermediate-to long-term followup. Methods The English-language literature was searched using PubMed and the Cochrane Central Register of Controlled Trials. Randomized-controlled trials (RCTs) comparing any form of nonsurgical treatment with either observation only or placebo at followup of at least 6 months were included. Nonsurgical treatments included injections (corticosteroid, platelet-rich plasma, autologous blood, sodium hyaluronate, or glycosaminoglycan polysulfate), physiotherapy, shock wave therapy, laser, ultrasound, corticosteroid iontophoresis, topical glyceryl trinitrate, or oral naproxen. Methodologic quality was assessed with the Consolidated Standards of Reporting Trials (CONSORT) checklist, and 22 RCTs containing 2280 patients were included. Pooled analyses were performed to evaluate overall improvement; requirement for escape interventions (treatment of any kind, outside consultation, and surgery); outcome scores (Patient-Rated Tennis Elbow Evaluation [PRTEE]; DASH; Pain-Free Function Index [PFFI]; EuroQoL [EQ]-5D; and overall function); and maximum and pain-free grip strength. Sensitivity analyses were performed using only trials of excellent or good quality. Heterogeneity analyses were performed, and funnel plots were constructed to assess for publication bias.

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Section: Data Itemsmentioning

confidence: 99%

Section: Data Synthesis and Statistical Analysismentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis

Sayegh

Strauch

2015

Clinical Orthopaedics &Amp; Related Research

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“…Fourteen trials were included in the review. 35,37,[40][41][42][43][44][45][46][47][48][49][50][51][52] The sample size of the included studies was generally small, with a median follow-up of 2 weeks (range 1-12 weeks). 33 The authors concluded that there is some support for the use of topical NSAIDs to relieve lateral elbow pain at least in the short term [weighted mean difference (WMD) = -1.88, 95% confidence interval (CI) -2.54 to -1.21].…”

Section: Current Evidencementioning

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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“…Controlling this inflammation helps to reduce pain. One large study looked at 129 patients who received 28 days of either anti-inflammatory medications or a placebo 12 . Those who received anti-inflammatories had better pain relief, but had more gastrointestinal complications.…”

Section: Treatment Outcomesmentioning

confidence: 99%

Lateral Epicondylitis (Tennis Elbow)

Ialenti¹,

Buller²

2014

Rev LibrOfMed

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Lateral epicondylitis, commonly known as "Tennis Elbow," is a common condition that typically affects active individuals in their 30s to 50s. Pain on the lateral (outside) aspect of the elbow is the most common presenting symptom. The diagnosis can be made based on patient history and physical exam. The overall prognosis is excellent. Although symptoms can last up to eighteen months, the vast majority of patients don't require surgery to improve. For the small percentage of patients with persistent symptoms, despite non-operative treatment, surgery can be effective with minimal risk.Background Information

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Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with immobilization. The University of Montreal Orthopaedic Research Group

Cited by 71 publications

References 0 publications

Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis

Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No Treatment? A Meta-analysis

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

Lateral Epicondylitis (Tennis Elbow)

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