Samenvatting

Centre for ABSTRACT

Researchers
Hamnebukt JI, Emaus J, Sæther K, Kaum-Nathaus S

Background
Lateral epicondylitis is a common and complex condition, which is often associated with considerable disability and long absence from work. Therefore, the need for effective and qualitatively high treat¬ment forms is obvious. However, despite the fact that the condition has been known and diagnosed for over 130 years now, much controversy exists about the etiology, pathology, and suitable treatment options. Evidence of the effects of the various treatment means is often lacking.69, 75

Objective
The objective was to do a literature research revealing treatment approaches that give the best short- and long-term treatment effects on pain, strength, and ADL-function for patients diagnosed with lateral epicondylitis.

Search strategy
Several databases and search engines were employed in the search for articles in order to ensure that as many articles as possible were found and also to minimize the risk of selection bias. Concentrated article search was carried out in the period from the 3rd of April to the 21st of April 2008 in the Nether¬lands and in Germany.
The search was conducted via:
- Cochrane (03-04-08 to 07-04-08; 14-04-08 to 15-04.08)
- Medline (03-04-08 to 07-04-08; 14-04-08 to 15-04-08)
- PEDro (03-04-08 to 10-04-08; 15-04.08)
- PubMed (03-04-08 to 10-04-08; 15-04-08)
- Doconline (15-04-08).
Reference checking of the articles was carried out on the 21st of April 2008.

Selection criteria
Randomized Controlled Trials (RCTs), Controlled Clinical Trials and systematic reviews discussing any of the known treatment options for lateral epicondylitis were admitted to the study, when they addressed at least one of the outcome measures pain, strength, and ADL-function.

Data collection & analysis
After two independent review teams assessed the quality of the studies, relevant data was extracted from eligible articles. The collected data was then analyzed.

Main results
Twenty-nine articles were included in the research, of which seventeen were randomized controlled trials. The remaining twelve articles were designed as systematic reviews. Methodological quality was checked by applying modifications of user guidelines established by the 'Health Evi¬dence'14, and all the selected articles displayed sufficient quality. Various treatment modalities for lateral epicondylitis were discussed with regard to the outcome measures of pain, strength, and ADL-function in the articles. Short-term, intermediate-term, and long-term effects were described. The studies diverged in design, methodological quality, intervention, and outcome measurement tools.

Researchers' conclusion
Unfortunately, evidence is still incomplete, and strong conclusions cannot yet be drawn to either support or refute the most common interventions used today. Nevertheless, preliminary conclusions and indications on the effectiveness of the discussed treatment options can still be presented. Speaking of short-term effects on either pain, strength, or ADL-function, fairly strong evidence was found for stretching and strengthening, the use of NSAIDs, and the injection of corticosteroids.
Weak evidence was seen in ultrasound therapy and acupuncture treatment (twenty-four hour effect), while deep transverse friction massage, surgical interventions, orthotic devices, laser treatment and shock wave therapy were reported to have either no or no significant effects.
Promising treatment interventions that have displayed early beneficial effects needing further confirmation were manipulative treatment, injection of botulinum toxin, and the application of topical nitric oxide.
Long-term effects with regard to pain, strength, and ADL-function were not measured frequently for the various treatment modalities. However, seven of the included trials obtained these measurements.
Ultrasound therapy, orthotic devices, corticosteroid injections, and shock wave therapy were recognized to have no or no significant effects in long-term. Weak evidence was delivered for the effectiveness of NSAIDs, whereas local anesthetic injection and topical nitric oxide showed to be promising for long-term results as well.

Further high-quality research is required to gain more clarity on the subject matter.