TY - JOUR
T1 - Comparison of Interventions for Lateral Elbow Tendinopathy
T2 - A Systematic Review and Network Meta-Analysis for Patient-Rated Tennis Elbow Evaluation Pain Outcome
AU - Lowdon, Hamish
AU - Chong, Han Hong
AU - Dhingra, Mohit
AU - Gomaa, Abdul Rahman
AU - Teece, Lucy
AU - Booth, Sarah
AU - Watts, Adam C.
AU - Singh, Harvinder Pal
N1 - Publisher Copyright:
© 2024 American Society for Surgery of the Hand
PY - 2024/4/28
Y1 - 2024/4/28
N2 - Purpose: There is controversy regarding the optimal treatment for lateral elbow tendinopathy (LET), and not all available treatment options have been compared directly with placebo/control. A network meta-analysis was conducted to compare the effectiveness of different LET treatments directly and indirectly against control/placebo based on a validated outcome, the Patient-Rated Tennis Elbow Evaluation (PRTEE) pain score. Methods: Randomized, controlled trials comparing different treatment methods for LET were included, provided they reported outcome data using the PRTEE pain score. A network meta-analysis with random effect was used to combine direct and indirect evidence between treatments compared with placebo in the short term (up to six weeks) and midterm (more than six weeks and up to six months) after intervention. Results: Thirteen studies with 12 comparators including control/placebo were eligible. The results indicated no significant improvement in PRTEE pain score in the short term across all treatments compared with control/placebo. In the midterm, physiotherapy/exercise showed benefit against placebo (mean difference: −4.32, 95% confidence interval: −7.58 and −1.07). Although steroid injections, dry needling, and autologous blood also exhibited potential treatment effects, it is crucial for the clinician to consider certain pitfalls when considering these treatments. The limited number of small studies and paucity of data call for caution in interpreting the results and need for further evidence. Conclusions: Patients should be informed that there is currently no strong evidence that any treatment produces more rapid improvement in pain symptoms when compared with control/placebo in the short and medium terms. Type of study/level of evidence: Therapeutic I.
AB - Purpose: There is controversy regarding the optimal treatment for lateral elbow tendinopathy (LET), and not all available treatment options have been compared directly with placebo/control. A network meta-analysis was conducted to compare the effectiveness of different LET treatments directly and indirectly against control/placebo based on a validated outcome, the Patient-Rated Tennis Elbow Evaluation (PRTEE) pain score. Methods: Randomized, controlled trials comparing different treatment methods for LET were included, provided they reported outcome data using the PRTEE pain score. A network meta-analysis with random effect was used to combine direct and indirect evidence between treatments compared with placebo in the short term (up to six weeks) and midterm (more than six weeks and up to six months) after intervention. Results: Thirteen studies with 12 comparators including control/placebo were eligible. The results indicated no significant improvement in PRTEE pain score in the short term across all treatments compared with control/placebo. In the midterm, physiotherapy/exercise showed benefit against placebo (mean difference: −4.32, 95% confidence interval: −7.58 and −1.07). Although steroid injections, dry needling, and autologous blood also exhibited potential treatment effects, it is crucial for the clinician to consider certain pitfalls when considering these treatments. The limited number of small studies and paucity of data call for caution in interpreting the results and need for further evidence. Conclusions: Patients should be informed that there is currently no strong evidence that any treatment produces more rapid improvement in pain symptoms when compared with control/placebo in the short and medium terms. Type of study/level of evidence: Therapeutic I.
KW - Lateral elbow tendinopathy
KW - network meta-analysis
KW - outcome
KW - tennis elbow
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U2 - 10.1016/j.jhsa.2024.03.007
DO - 10.1016/j.jhsa.2024.03.007
M3 - Article (journal)
AN - SCOPUS:85191537842
SN - 0363-5023
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
ER -