Use the Back button in your browser to see the other results of your search or to select another record.

Detailed Search Results

Corticosteroidinjecties, fysiotherapie of een afwachtend beleid voor patienten met een epicondylitis lateralis? Een gerandomiseerd onderzoek in de eerste lijn (Corticosteroid injections, physiotherapy or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial) [Dutch; with consumer summary]
Smidt N, van der Windt DAWM, Assendelft WJJ, Devill AW, Bouter LM
Nederlands Tijdschrift voor Fysiotherapie [Dutch Journal of Physical Therapy] 2004 Feb;114(1):14-18,23
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Lateral epicondylitis is generally treated with corticosteroid injections or physiotherapy. Dutch clinical guidelines recommend a wait-and-see policy. We compared the efficacy of these approaches. METHODS: Patients with lateral epicondylitis of at least 6 weeks' duration were recruited by general practitioners. We randomly allocated eligible patients to 6 weeks of treatment with corticosteroid injections, physiotherapy, or a wait-and-see policy. Outcome measures included general improvement, severity of the main complaint, pain, elbow disability, and patient satisfaction. Severity of elbow complaints, grip strength, and pressure pain threshold were assessed by a research physiotherapist who was unaware of treatment allocation. We assessed all outcomes at 3, 6, 12, 26, and 52 weeks. The principal analysis was done on an intention-to-treat basis. RESULTS: We randomly assigned 185 patients: 64 were treated with physiotherapy, 62 were treated with at least one corticosteroid injection, and 59 were treated according to the wait-and-see policy. At 6 weeks, corticosteroid injections were significantly better than all other therapy options for all outcome measures. Success rates were 92% (n = 57) compared with 47% (n = 30) for physiotherapy and 32% (n = 19) for wait-to-see policy. However, the recurrence rate in the injection group was high. Long-term differences between injections and physiotherapy were significantly in favour of physiotherapy. Success rates at 52 weeks were 69% (n = 43) for injections, 91% (n = 58) for physiotherapy, and 83% (n = 49) for wait-and-see policy. Physiotherapy had better results than a wait-and-see policy, but differences were not significant. CONCLUSION: Patients should be properly informed about the advantages and disadvantages of the treatment options for lateral epicondylitis. The decision to treat with physiotherapy or to adopt a wait-and-see policy might depend on available resources, since the relative gain of physiotherapy is so small.

There are no links to full text for this record.