Viana Vuvan1, Bill Vicenzino1, Rebecca Mellor1, Luke James Heales2, Brooke Kaye Coombes3. 1. School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, AUSTRALIA. 2. School of Health, Medical, and Applied Sciences, Central Queensland University, Rockhampton, AUSTRALIA. 3. School of Allied Health Sciences, Griffith University, Brisbane, AUSTRALIA.
Abstract
PURPOSE: This study aimed to investigate the effect of unsupervised isometric exercise compared with a wait-and-see approach on pain, disability, global improvement, and pain-free grip strength in individuals with lateral elbow tendinopathy. METHODS:Forty participants with unilateral lateral elbow tendinopathy of at least 6 wk duration were randomized to either wait-and-see (n = 19) or a single supervised instruction session by a physiotherapist, followed by an 8-wk unsupervised daily program of progressive isometric exercise (n = 21). Primary outcomes were Patient-Rated Tennis Elbow Evaluation, global rating of change on a six-point scale (dichotomized to success and no success) and pain-free grip strength at 8 wk. Secondary outcomes were resting and worst pain on an 11-point numerical rating scale, and thermal and pressure pain thresholds as a measure of pain sensitivity. RESULTS:Thirty-nine (98%) participants completed 8-wk measurements. The exercise group had lower Patient-Rated Tennis Elbow Evaluation scores compared with wait-and-see at 8 wk (standardized mean difference [SMD], -0.92; 95% confidence interval [CI], -1.58 to -0.26). No group differences were found for success on global rating of change (29% exercise vs 26% wait-and-see (risk difference, 2.3%; 95% CI, -24.5 to 29.1)), or pain-free grip strength (SMD, -0.33; 95% CI, -0.97 to 0.30). No differences were observed for all secondary outcomes except for worst pain, which was moderately lower in the exercise group (SMD, -0.80; 95% CI, -1.45 to -0.14). CONCLUSIONS:Unsupervised isometric exercise was effective in improving pain and disability, but not perceived rating of change and pain-free grip strength when compared with wait-and-see at 8 wk. With only one of the three primary outcomes being significantly different after isometric exercises, it is doubtful if this form of exercise is efficacious as a sole treatment.
RCT Entities:
PURPOSE: This study aimed to investigate the effect of unsupervised isometric exercise compared with a wait-and-see approach on pain, disability, global improvement, and pain-free grip strength in individuals with lateral elbow tendinopathy. METHODS: Forty participants with unilateral lateral elbow tendinopathy of at least 6 wk duration were randomized to either wait-and-see (n = 19) or a single supervised instruction session by a physiotherapist, followed by an 8-wk unsupervised daily program of progressive isometric exercise (n = 21). Primary outcomes were Patient-Rated Tennis Elbow Evaluation, global rating of change on a six-point scale (dichotomized to success and no success) and pain-free grip strength at 8 wk. Secondary outcomes were resting and worst pain on an 11-point numerical rating scale, and thermal and pressure pain thresholds as a measure of pain sensitivity. RESULTS: Thirty-nine (98%) participants completed 8-wk measurements. The exercise group had lower Patient-Rated Tennis Elbow Evaluation scores compared with wait-and-see at 8 wk (standardized mean difference [SMD], -0.92; 95% confidence interval [CI], -1.58 to -0.26). No group differences were found for success on global rating of change (29% exercise vs 26% wait-and-see (risk difference, 2.3%; 95% CI, -24.5 to 29.1)), or pain-free grip strength (SMD, -0.33; 95% CI, -0.97 to 0.30). No differences were observed for all secondary outcomes except for worst pain, which was moderately lower in the exercise group (SMD, -0.80; 95% CI, -1.45 to -0.14). CONCLUSIONS: Unsupervised isometric exercise was effective in improving pain and disability, but not perceived rating of change and pain-free grip strength when compared with wait-and-see at 8 wk. With only one of the three primary outcomes being significantly different after isometric exercises, it is doubtful if this form of exercise is efficacious as a sole treatment.
Authors: Peter Lapner; Ana Alfonso; Jonah Herbert-Davies; J W Pollock; Jonathan Marsh; Graham King Journal: Can J Surg Date: 2022-09-21 Impact factor: 2.840