Effectiveness of physiotherapy for lateral epicondylitis: a systematic review

Abstract

AIM: To evaluate the available evidence of the AIM: To evaluate the available evidence of the effectiveness of physiotherapy for lateral epicondylitis effectiveness of physiotherapy for lateral epicondylitis of the elbow. of the elbow. METHOD: Randomised controlled trials (RCTs) identi-METHOD: Randomised controlled trials (RCTs) identi®ed by a highly sensitive search strategy in six ®ed by a highly sensitive search strategy in six databases in combination with reference checking. databases in combination with reference checking. Two independent reviewers selected RCTs that Two independent reviewers selected RCTs that included a physiotherapy intervention, patients with included a physiotherapy intervention, patients with lateral epicondylitis, and at least one clinically lateral epicondylitis, and at least one clinically relevant outcome measure. No language restrictions relevant outcome measure. No language restrictions were made. Methodological quality was independently were made. Methodological quality was independently assessed by two blinded reviewers. A best evidence assessed by two blinded reviewers. A best evidence synthesis, including a quantitative and qualitative synthesis, including a quantitative and qualitative analysis, was conducted, weighting the studies with analysis, was conducted, weighting the studies with respect to their internal validity, statistical signi®-respect to their internal validity, statistical signi®-cance, clinical relevance, and statistical power. cance, clinical relevance, and statistical power. RESULTS: 23 RCTs were included in the review, RESULTS: 23 RCTs were included in the review, evaluating the effects of lasertherapy, ultrasound evaluating the effects of lasertherapy, ultrasound treatment, electrotherapy, and exercises and mobilisatreatment, electrotherapy, and exercises and mobilisation techniques. Fourteen studies satis®ed at least tion techniques. Fourteen studies satis®ed at least 50% of the internal validity criteria. Except for 50% of the internal validity criteria. Except for ultrasound, pooling of data from RCTs was not ultrasound, pooling of data from RCTs was not possible because of insuf®cient data, or clinical or possible because of insuf®cient data, or clinical or statistical heterogeneity. The pooled estimate of the statistical heterogeneity. The pooled estimate of the treatment effects of two studies on ultrasound treatment effects of two studies on ultrasound compared to placebo ultrasound, showed statistically compared to placebo ultrasound, showed statistically signi®cant and clinically relevant differences in favour signi®cant and clinically relevant differences in favour of ultrasound. There is insuf®cient evidence either to of ultrasound. There is insuf®cient evidence either to demonstrate bene®t or lack of effect of lasertherapy, demonstrate bene®t or lack of effect of lasertherapy, electrotherapy, exercises and mobilisation techniques electrotherapy, exercises and mobilisation techniques for lateral epicondylitis. for lateral epicondylitis. CONC...

Effectiveness of Iontophoresis for Lateral Elbow Tendinopathy

“…Iontophoresis is a therapeutic technique that involves the introduction of ions into the body tissues by means of a direct electrical current [11]. Iontophoresis has several advantages as a treatment technique in than it is a painless, sterile, noninvasive technique for introducing ions into the tissue that has been demonstrated to have positive effect on the healing process [15]. Its effectiveness has been evaluated in two previously published systematic reviews, which have addressed the effectiveness of conservative treatments for LET [21,22] but conclusions, positive or negative, cannot be drawn from these two reviews because of the small number of studies included.…”

“…These treatments have different theoretical mechanisms of action, but all have the same aim, to reduce pain and improve function. Such a variety of treatment options suggests that the optimal treatment strategy is not known, and more research is needed to discover the most effective treatment in patients with LET [11,[18][19][20].Iontophoresis has attracted much interest in the last 20-25 years as it has been applied to common musculoskeletal conditions such as LET. Iontophoresis is a therapeutic technique that involves the introduction of ions into the body tissues by means of a direct electrical current [11].…”

“…Physiotherapy is a conservative treatment that is usually recommended for LET patients [11,13,14]. A wide array of physiotherapy treatments have been recommended for the management of LET [11,[15][16][17]. These treatments have different theoretical mechanisms of action, but all have the same aim, to reduce pain and improve function.…”

“…These treatments have different theoretical mechanisms of action, but all have the same aim, to reduce pain and improve function. Such a variety of treatment options suggests that the optimal treatment strategy is not known, and more research is needed to discover the most effective treatment in patients with LET [11,[18][19][20].…”

Are there Effective Ultrasound Parameters in the Management of Lateral Elbow Tendinopathy? A Systematic Review of the Literature

“…Physiotherapy is a conservative treatment that is usually recommended for LET patients [8]. A wide array of physiotherapy treatments have been recommended for the management of LET [9][10][11]. These treatments have different theoretical mechanisms of action, but all have the same aim: to reduce pain and improve function.…”