From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; and Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University.
Plast Reconstr Surg. 2022 Sep 1;150(3):594e-607e. doi: 10.1097/PRS.0000000000009437. Epub 2022 Jul 1.
Lateral epicondylitis is a common enthesopathy, possibly caused by overuse and repetitive activity. Although nonoperative management is the primary approach for treating lateral epicondylitis, clinical guidelines and the literature fail to identify the most effective nonoperative treatment. Therefore, the authors conducted a network meta-analysis to compare the effectiveness of physical therapy and electrophysiotherapy treatments for the treatment of lateral epicondylitis.
The authors searched MEDLINE, EMBASE, Web of Science, and Scopus for peer-reviewed randomized controlled trials evaluating the effectiveness of physical therapy and electrophysiotherapy treatments. Data related to article characteristics and outcomes (grip strength and pain visual analog scale score) were collected.
Twenty-three clinical trials including 1363 participants (mean age ± SD, 47.4 ± 7.5 years; 53.1 percent women) were included in this study. Pain visual analog scale demonstrated significant reductions in scores after treatment with magnetic field [mean difference (95 percent CI), -1.88 (-2.66 to -1.11)], exercise [-0.90 (-1.69 to -0.1)], and acoustic waves [-0.83 (-1.37 to -0.29)] compared with placebo. For grip strength, no treatment modality was found to be significantly effective. A sensitivity analysis that excluded studies with high publication bias and high degrees of heterogeneity produced similar results to the main analysis with the exception of statistically improved grip strength after light therapy [mean difference (95 percent CI), 5.38 (1.71 to 9.04)] and acoustic wave therapy [7.79 (2.44 to 13.15)].
Electrophysiotherapy treatments should be prioritized over physical therapy. Magnetic field therapy was associated with pain reduction, whereas acoustic wave and light therapy were associated with increased grip strength.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
外侧肱骨上髁炎是一种常见的腱病，可能由过度使用和重复活动引起。虽然非手术治疗是治疗外侧肱骨上髁炎的主要方法，但临床指南和文献未能确定最有效的非手术治疗方法。因此，作者进行了一项网络荟萃分析，以比较物理治疗和电生理治疗治疗外侧肱骨上髁炎的效果。
作者检索了 MEDLINE、EMBASE、Web of Science 和 Scopus 中评价物理治疗和电生理治疗效果的同行评议随机对照试验。收集了与文章特征和结果（握力和疼痛视觉模拟评分）相关的数据。
这项研究纳入了 23 项临床试验，共 1363 名参与者（平均年龄±标准差，47.4±7.5 岁；53.1%为女性）。与安慰剂相比，磁场[平均差值（95%置信区间），-1.88（-2.66 至-1.11）]、运动[0.90（-1.69 至-0.1）]和声波[-0.83（-1.37 至-0.29）]治疗后疼痛视觉模拟评分显著降低。对于握力，没有一种治疗方法被发现具有显著效果。敏感性分析排除了有高发表偏倚和高度异质性的研究后，结果与主要分析相似，除了光疗后握力有统计学上的显著提高[平均差值（95%置信区间），5.38（1.71 至 9.04）]和声波治疗[7.79（2.44 至 13.15）]。
电生理治疗应优先于物理治疗。磁场治疗与疼痛减轻相关，而声波和光疗与握力增加相关。
临床问题/证据水平：治疗性，II 级。
