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|The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: a systematic review and meta-analysis of randomized controlled trials|
|Shahabi S, Bagheri Lankarani K, Heydari ST, Jalali M, Ghahramani S, Kamyab M, Tabrizi R, Hosseinabadi M|
|Prosthetics and Orthotics International 2020 Jul 8:Epub ahead of print|
BACKGROUND: Lateral elbow tendinopathy, also known as "tennis elbow" or "lateral epicondylitis," is a common disease leading to pain in the lateral side of the elbow and disability during hand gripping. A counterforce brace is one of the most conventional treatments. However, its effects on outcomes remain inconclusive. OBJECTIVES: To investigate the effects of counterforce braces on pain in subjects with lateral elbow tendinopathy. Grip strength was reviewed as a secondary outcome. STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials. METHODS: PubMed, Embase, Scopus, Web of Science, CENTRAL, PEDro, ProQuest, RECAL, and RehabData were searched from January 1, 1995, through June 15, 2019. RESULTS: Seventeen studies were included with a total of 1,145 participants. A small improvement in pain over the short term (standardized mean difference -0.02; 95% confidence interval: -0.85 to 0.80) and a moderate-to-large improvement in pain in subjects 45 years or younger (standardized mean difference -0.86; 95% confidence interval -2.45 to 0.72) in favor of the brace versus physiotherapy interventions were found. In contrast, over the long-term physiotherapy interventions (standardized mean difference 1.17; 95% confidence interval -0.00 to 2.34), wrist splint (standardized mean difference 0.35; 95% confidence interval -0.07 to 0.76), and laser therapy (standardized mean difference 0.58; 95% confidence interval -0.44 to 1.59) had better effects on pain improvement versus the brace. CONCLUSION: The results indicated that physiotherapy interventions compared to counterforce braces have better effects, especially over the long-term. However, counterforce braces may have better effects on pain in younger people (< 45 years old) over the short term (< 6 weeks). CLINICAL RELEVANCE: The results suggest that counterforce bracing is a reasonable strategy to alleviate pain over the short term. However, the subgroup analysis suggests that factors such as age may have a role in their effectiveness.