Pienimäki T, Karinen P, Kemilä T, Koivukangas P, Vanharanta H
Department of Physical Medicine and Rehabilitation, Oulu University Hospital, Finland.
Scand J Rehabil Med. 1998 Sep;30(3):159-66. doi: 10.1080/003655098444093.
This study aimed to assess the long-term outcome of progressive exercise and local pulsed ultrasound in the treatment of 30 chronic tennis elbow patients (2 men, 18 women, mean age 42.3 years). The patients were originally randomised into 1) four-step progressive exercise (EX, n = 16) and 2) local pulsed ultrasound (US, n = 14) treatment groups. Before the beginning of the treatment, the groups were similar in terms of pain scores, sick-leave days and duration of symptoms. The patients underwent an 8-week treatment intervention. Long-term follow-up evaluation of the patients was performed 1) prospectively using a pain questionnaire on VAS and pain drawings classified into 5 categories, and 2) retrospectively with a postal questionnaire (which was sent to the patients to fill in. Sick-leave days, medical and physiotherapy visits, operations, early retirements and job relocations were inquired in the postal questionnaire. The diagnosis-related sick-leave days of the patients were collected from the Database of the Social Insurance Institution of Finland and the number of operations from the local hospital register. Twenty-three patients (12 in the EX group and 11 in the US group) responded. The mean follow-up time was 36 months. After the treatment the patients in the EX group needed significantly less physiotherapy (p = 0.02), fewer medical consultations (p = 0.005) and other treatments and had fewer sick-leave days (p = 0.005) than before the treatment intervention. The patients in the US group had after the treatment intervention more 17 medical visits (ns), 291 sick-leave days (ns) and less 95 physiotherapy visits (ns) than before the treatment. Eight patients (67%) in the EX group and 5 (45%) in the US group still held their previous job, while two patients in the US group, but none in the EX group were absent from work because of the tennis elbow syndrome. The patients in the EX group reported significantly lower pain scores on VAS than those in the US group. The mean pain drawing category was 1.5 in the EX group and 2.7 in the US group (p = 0.008). All the pain scores and pain drawing categories in the EX group had changed to be significantly better than in the US group, where only pain under strain had significantly improved. Because of resistant symptoms, 5 patients were operated in the US group and one in the EX group. Neither spontaneous healing, nor self-limiting of the disorder were noted during the follow-up period. The progressive exercise evaluated in this study showed beneficial long-term effects compared to ultrasound treatment in terms of pain alleviation and working ability, and the functional overall condition of the exercise patients was also better. Exercise may be able to prevent chronicity and should hence be tried and recommended.
本研究旨在评估渐进性运动和局部脉冲超声治疗30例慢性网球肘患者（2例男性，18例女性，平均年龄42.3岁）的长期疗效。患者最初被随机分为1）四步渐进性运动组（EX，n = 16）和2）局部脉冲超声组（US，n = 14）。在治疗开始前，两组在疼痛评分、病假天数和症状持续时间方面相似。患者接受了为期8周的治疗干预。对患者进行了长期随访评估：1）前瞻性地使用视觉模拟评分法（VAS）疼痛问卷和分为5类的疼痛绘图；2）回顾性地使用邮寄问卷（寄给患者填写。邮寄问卷中询问了病假天数、医疗和物理治疗就诊次数、手术、提前退休和工作调动情况。患者的诊断相关病假天数从芬兰社会保险机构数据库中收集，手术次数从当地医院登记册中收集。23例患者（EX组12例，US组11例）进行了回复。平均随访时间为36个月。治疗后，EX组患者所需的物理治疗显著减少（p = 0.02），医疗咨询次数减少（p = 0.005），其他治疗次数减少，病假天数减少（p = 0.005）。与治疗干预前相比，US组患者在治疗干预后进行了更多的17次医疗就诊（无统计学意义）、291天病假（无统计学意义）和更少的95次物理治疗就诊（无统计学意义）。EX组8例患者（67%）和US组5例患者（45%）仍从事先前工作，而US组有2例患者因网球肘综合征缺勤，EX组无此类情况。EX组患者在VAS上报告的疼痛评分显著低于US组。EX组的平均疼痛绘图类别为1.5，US组为2.7（p = 0.008）。EX组所有疼痛评分和疼痛绘图类别均有显著改善，优于US组，US组仅在用力时疼痛有显著改善。由于症状顽固，US组有5例患者接受了手术，EX组有1例。随访期间未观察到疾病的自发愈合或自限情况。本研究评估的渐进性运动与超声治疗相比，在缓解疼痛和工作能力方面显示出有益的长期效果，运动组患者的功能总体状况也更好。运动可能能够预防慢性化，因此应尝试并推荐。
