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The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis [with consumer summary]
Jafarian FS, Demneh ES, Tyson SF
The Journal of Orthopaedic and Sports Physical Therapy 2009 Jun;39(6):484-489
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: Controlled laboratory study using a randomized crossover design. OBJECTIVE: To determine the immediate effect of 3 common types of orthoses (2 elbow counterforce orthoses and a wrist splint) on grip strength in individuals with lateral epicondylosis. BACKGROUND: Lateral epicondylosis is a common cause of pain and upper limb dysfunction. Although the effectiveness of orthoses has been reported, comparisons of effectiveness among orthoses are limited. METHODS AND MEASURES: Fifty-two subjects with lateral epicondylosis were recruited (20 men, 32 women; mean +/- SD age 41 +/- 8 years). Maximum and pain-free grip strength were assessed using a digital hand grip dynamometer immediately after the application of each orthosis. The 4 testing conditions included a placebo orthosis as a control condition, an elbow strap orthosis, an elbow sleeve orthosis, and a wrist splint. Data were analyzed using a 1-way analysis of variance for each outcome measure. RESULTS: Pain-free grip-strength was greater when using the elbow strap or the elbow sleeve orthosis compared to when using the placebo control orthosis or the wrist splint (p < 0.02), but there was no difference between the elbow sleeve and strap orthoses (p > 0.05), nor between the wrist splint and placebo orthosis (p > 0.05). Maximum grip strength was less when using the wrist splint compared to when tested with the elbow sleeve or the elbow strap (p <= 0.003). Use of the elbow strap, elbow sleeve, or wrist splint did not change maximum grip strength compared to the control placebo orthosis condition (p > 0.05). There was also no difference in maximum grip strength between the elbow strap and the elbow sleeve conditions (p > 0.05). CONCLUSION: The use of the 2 types of elbow orthoses (strap and sleeve) resulted in an immediate increase in pain-free grip strength. No differences between the 2 orthoses were found, suggesting that either can be used. A wrist splint produced no immediate change in pain-free or maximum grip-strength, indicating that it should not be used as a first-choice orthosis based on those outcome measures.

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