Bisset L, Smidt N, Van der Windt D A, Bouter L M, Jull G, Brooks P, Vicenzino B
School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia.
Rheumatology (Oxford). 2007 Oct;46(10):1601-5. doi: 10.1093/rheumatology/kem192.
To determine if subgroups of patients with tennis elbow respond differently in treatment.
This study used individual patient data (n = 383) from two randomized controlled trials that investigated a wait-and-see policy, corticosteroid injections and physiotherapy. Common outcome measures were: pain severity, global improvement, severity assessed by a blinded assessor, elbow disability and pain free grip strength. Subgroup analyses for previous history of elbow pain, baseline pain severity, duration of the current episode and employment status were performed at 6 and 52 weeks.
Patients' age, previous elbow symptoms and baseline pain severity were similar between trials, but other characteristics differed between trial populations. Based on individual patient data from both trials, we found that corticosteroid injections were statistically and clinically superior at 6 weeks, but significantly worse at 52 weeks compared with both wait-and-see and physiotherapy. Subgroup effects were scarce and small. Patients with higher baseline pain score showed less benefit on pain outcomes between physiotherapy and a wait-and-see policy at 6 weeks. It also appeared that non-manual workers who had an injection were the only work subgroup to follow the general trend that injections were significantly worse than a wait-and-see policy on global improvement at 52 weeks.
The treatment outcomes were largely similar between trials and not different between most subgroups studied. In tennis elbow, it would appear that patient characteristics play only a small role in predicting treatment outcomes, which supports the generalizability of individual trial results.
确定网球肘患者亚组在治疗中的反应是否不同。
本研究使用了两项随机对照试验的个体患者数据（n = 383），这两项试验调查了观望策略、皮质类固醇注射和物理治疗。常见的结局指标包括：疼痛严重程度、总体改善情况、由盲法评估者评估的严重程度、肘部功能障碍和无痛握力。在6周和52周时，对肘部疼痛既往史、基线疼痛严重程度、当前发作持续时间和就业状况进行亚组分析。
两项试验中患者的年龄、既往肘部症状和基线疼痛严重程度相似，但试验人群的其他特征有所不同。基于两项试验的个体患者数据，我们发现皮质类固醇注射在6周时在统计学和临床上均更具优势，但在52周时与观望策略和物理治疗相比明显更差。亚组效应很少且较小。基线疼痛评分较高的患者在6周时，物理治疗和观望策略在疼痛结局方面的获益较少。此外，接受注射的非体力劳动者似乎是唯一遵循总体趋势的工作亚组，即在52周时，注射在总体改善方面明显比观望策略差。
两项试验的治疗结果在很大程度上相似，且在所研究的大多数亚组之间没有差异。在网球肘方面，患者特征在预测治疗结果中似乎只起很小的作用，这支持了单个试验结果的可推广性。
