Washington University School of Medicine, Program of Occupational Therapy, Milliken Hand Rehabilitation Center, Saint Louis, MO, USA.
Washington University School of Medicine, Program of Occupational Therapy, Milliken Hand Rehabilitation Center, Saint Louis, MO, USA.
J Hand Ther. 2021 Oct-Dec;34(4):619-626. doi: 10.1016/j.jht.2020.10.009. Epub 2020 Oct 16.
Lateral epicondyle tendinopathy (LET) is the most common cause of lateral elbow pain. The literature on rehabilitation of the condition encompasses a plethora of interventions with most current evidence indicating that stretches and some form of strengthening are vital components. However, patient outcomes are infrequently reported further than 12 weeks from the start of therapy and it is unclear which components of a home exercise program are necessary to alleviate symptoms up to one year from the initiation of a therapy program.
The purpose of the study is to determine if a therapy program with 4 to 6 visits spaced out over 12 weeks focusing on self-management and strengthening is more effective in reducing pain and improving function long term than the same program without strengthening, for individuals with LET.
This is a randomized controlled trial.
Ninety-four patients were randomly allocated into two groups: both groups received the interventions of education in pertinent pathoanatomy, stretching, pain management through rest and icing, and activity modification. Group 1 (n = 38) was also provided with a strengthening component to the home exercise program, whereas group 2 did not (n = 21). Our primary outcome measure was pain at rest and pain with activity; our secondary measure was the level of functional impairment as measured by the quick disabilities of arm shoulder and hand. Outcome measurements were assessed at baseline, 6, 12, 24, and 52 weeks after initiation of therapy.
Both groups demonstrated statistically significant improvement with a moderate to large effect size in pain and function scores when compared with previous time point at 6, 12, and 24 weeks. Pain continued to decrease for both groups from 24 weeks to 52 weeks, but interestingly, there was a significant increase with moderate effect size in the quick disabilities of arm shoulder and hand score at 52 weeks when compared with week 24. No statistically significant difference was found between the two groups at any time point up to 52 weeks from the start of therapy.
This study demonstrates that a therapy program consisting of a low number of visits spaced out over 12 weeks based on education, stretches, activity modification, and pain management techniques is effective at reducing pain and increasing function in patients with LET. The addition of strengthening to this program did not improve outcomes. The therapy approach used in this study is consistent with the International Classification of Function guidelines and focuses on engaging patients in self-management of the condition through patient education and self-empowerment.
外侧肱骨突腱病（LET）是引起肘部外侧疼痛的最常见原因。关于该疾病康复的文献涵盖了大量干预措施，目前大多数证据表明，伸展运动和某种形式的力量训练是至关重要的组成部分。然而，患者的治疗结果很少在治疗开始后 12 周以上进行报告，并且不清楚家庭锻炼计划中的哪些组成部分对于缓解症状是必要的，缓解症状的时间可以长达治疗计划开始后的一年。
本研究的目的是确定在 12 周内进行 4 到 6 次治疗，重点关注自我管理和力量训练的治疗方案是否比没有力量训练的相同方案更能长期有效减轻 LET 患者的疼痛并改善功能。
这是一项随机对照试验。
94 名患者被随机分配到两组：两组均接受教育相关病理、伸展、通过休息和冰敷进行疼痛管理以及活动调整。第 1 组（n=38）还接受家庭锻炼计划中的强化成分，而第 2 组则没有（n=21）。我们的主要结局测量是静息时疼痛和活动时疼痛；次要测量是通过快速残疾手臂肩手（Quick Disabilities of the Arm, Shoulder and Hand，DASH）测量的功能障碍程度。在治疗开始后基线、6、12、24 和 52 周进行结果测量。
两组在疼痛和功能评分方面均表现出统计学上显著的改善，且在 6、12 和 24 周时具有中度至较大的效应量。与 24 周相比，两组的疼痛在 24 周到 52 周期间持续下降，但有趣的是，在 52 周时 DASH 评分出现了具有中度效应量的显著增加。在治疗开始后 52 周内的任何时间点，两组之间均未发现统计学上的显著差异。
这项研究表明，由教育、伸展、活动调整和疼痛管理技术组成的、低次数就诊间隔为 12 周的治疗方案，可有效减轻 LET 患者的疼痛并改善其功能。在该方案中加入力量训练并没有改善结果。本研究中使用的治疗方法符合国际功能分类指南，并侧重于通过患者教育和自我赋权，让患者参与到对疾病的自我管理中。
