OBJECTIVES: This study investigates the influence of manual work on the persistence of lateral epicondylitis during a 12-month follow-up period after consultation in general practice. METHODS: A cohort study was made of 164 adult consulters with tennis elbow, who had initially been recruited to a randomized controlled trial from 23 general practices in North Staffordshire and South Cheshire. As part of the recruitment process prior to treatment randomization, self-reported questionnaires on symptoms and sociodemographic characteristics were completed. Four weeks, six months, and twelve months later, the schedules were repeated. The main outcomes were measures of elbow symptoms (pain and function) based on a ten-point Likert scale. Total pain and function for the whole 12-month period were assessed using an area-under-the-curve (AUC) analysis. The pain and function scores were analyzed according to employment status (manual versus nonmanual work) and severe versus mild upper-limb stress in manual occupations. RESULTS: The AUC scores for elbow pain and function were significantly higher for the manual workers, and manual work was associated with increased elbow pain and decreased function in the 4-week and 6-month follow-ups. The greater the severity of upper-limb stresses, the worse the outcome. CONCLUSIONS: Previous epidemiologic studies have shown that manual occupations are a risk factor for developing lateral epicondylitis. It is feasible that resuming manual work after treatment may hinder recovery or increase the risk of relapse. The study lends support to this hypothesis.
RCT Entities:
OBJECTIVES: This study investigates the influence of manual work on the persistence of lateral epicondylitis during a 12-month follow-up period after consultation in general practice. METHODS: A cohort study was made of 164 adult consulters with tennis elbow, who had initially been recruited to a randomized controlled trial from 23 general practices in North Staffordshire and South Cheshire. As part of the recruitment process prior to treatment randomization, self-reported questionnaires on symptoms and sociodemographic characteristics were completed. Four weeks, six months, and twelve months later, the schedules were repeated. The main outcomes were measures of elbow symptoms (pain and function) based on a ten-point Likert scale. Total pain and function for the whole 12-month period were assessed using an area-under-the-curve (AUC) analysis. The pain and function scores were analyzed according to employment status (manual versus nonmanual work) and severe versus mild upper-limb stress in manual occupations. RESULTS: The AUC scores for elbow pain and function were significantly higher for the manual workers, and manual work was associated with increased elbow pain and decreased function in the 4-week and 6-month follow-ups. The greater the severity of upper-limb stresses, the worse the outcome. CONCLUSIONS: Previous epidemiologic studies have shown that manual occupations are a risk factor for developing lateral epicondylitis. It is feasible that resuming manual work after treatment may hinder recovery or increase the risk of relapse. The study lends support to this hypothesis.
Authors: Linda S Chesterton; A Martyn Lewis; Julius Sim; Christian D Mallen; Elizabeth E Mason; Elaine M Hay; Daniëlle A van der Windt Journal: BMJ Date: 2013-09-02