Effectiveness of physiotherapy for lateral epicondylitis: a systematic review
Lateral epicondylitis (LE) is a common medical problem. In the general population, the annual incidence of this condition is between 1% and 3%. The average duration of a typical episode of LE is between 6 months and 2 years. A wide range of physiotherapeutic interventions are used for the treatment of LE. By tradition, poor methodological quality or based on studies with a relatively small study group size; choices appear to be motivated.
The aim of this study is to evaluate the available evidence of the effectiveness of physiotherapy for LE of the elbow. For this purpose, randomized controlled trials (RCTs) were identified by a very sensitive search strategy in six databases in combination with reference control. Two independent evaluators selected RCTs with a physiotherapeutic intervention, patients with LE and at least one clinically relevant outcome measure. No language restrictions were set. The methodological quality was independently assessed by two blinded assessors. A best evidence synthesis, including a quantitative and qualitative analysis, was performed with a weighting of the studies with respect to their internal validity, statistical significance, clinical relevance and statistical strength.
In the review 23 RCTs were included in which the effects of laser therapy, ultrasound, electrotherapy and exercises and mobilization techniques were evaluated. Fourteen studies met at least 50% of the internal validity criteria. Pooling of data from RCTs, with the exception of ultrasound, was not possible due to insufficient data or clinical or statistical heterogeneity. The pooled estimate of the treatment effects of two studies on ultrasound compared with placebo ultrasound showed statistically significant and clinically relevant differences in favor of ultrasound. To show benefit or lack of effect of laser therapy, electrotherapy, exercises and mobilization techniques for LE, there is insufficient evidence.
Despite the large number of studies, there is still insufficient evidence for most physiotherapeutic interventions for LE. This is due to conflicting results, insufficient power and the low number of examinations per intervention. Only weak effect in favor of ultrasound was found. In conclusion there is a need for better designed, executed and reported RCTs.