Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials
ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCT...
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| Published in | British journal of sports medicine Vol. 55; no. 9; pp. 477 - 485 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
01.05.2021
BMJ Publishing Group LTD |
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| Abstract | ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703. |
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| AbstractList | To evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.OBJECTIVETo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.Systematic review and meta-analysis.DESIGNSystematic review and meta-analysis.We used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.METHODSWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.RCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.ELIGIBILITY CRITERIARCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.RESULTS30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.Low and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.CONCLUSIONSLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.CRD42018082703.PROSPERO REGISTRATION NUMBERCRD42018082703. ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703. To evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function. Systematic review and meta-analysis. We used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures. RCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET. 30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident. Low and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small. CRD42018082703. |
| Author | Vasilogeorgis, Ioannis Karanasios, Stefanos Woodbridge, Sarah Gioftsos, Georgios Korakakis, Vasileios Whiteley, Rod |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33148599$$D View this record in MEDLINE/PubMed |
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| Keywords | exercise elbow tennis elbow tendinopathy |
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19 Couppé (2025080113585919000_55.9.477.78) 2015; 45 2025080113585919000_55.9.477.28 Yelland (2025080113585919000_55.9.477.55) 2019; 20 Chen (2025080113585919000_55.9.477.66) 2019; 35 Olaussen (2025080113585919000_55.9.477.36) 2015; 16 Overdevest (2025080113585919000_55.9.477.79) 2015 2025080113585919000_55.9.477.3 2025080113585919000_55.9.477.6 2025080113585919000_55.9.477.5 Shim (2025080113585919000_55.9.477.24) 2013; 40 2025080113585919000_55.9.477.8 2025080113585919000_55.9.477.9 Bateman (2025080113585919000_55.9.477.4) 2019; 11 Dale (2025080113585919000_55.9.477.29) 2015; 53 2025080113585919000_55.9.477.62 2025080113585919000_55.9.477.61 Ganderton (2025080113585919000_55.9.477.72) 2018; 27 2025080113585919000_55.9.477.60 2025080113585919000_55.9.477.10 2025080113585919000_55.9.477.54 2025080113585919000_55.9.477.52 2025080113585919000_55.9.477.15 2025080113585919000_55.9.477.59 2025080113585919000_55.9.477.14 Dion (2025080113585919000_55.9.477.65) 2017; 33 2025080113585919000_55.9.477.13 Stasinopoulos (2025080113585919000_55.9.477.45) 2017; 30 2025080113585919000_55.9.477.19 2025080113585919000_55.9.477.18 2025080113585919000_55.9.477.17 2025080113585919000_55.9.477.16 Sayegh (2025080113585919000_55.9.477.57) 2015; 473 Glenny (2025080113585919000_55.9.477.80) 2005; 9 Ortega-Castillo (2025080113585919000_55.9.477.7) 2016; 19 2025080113585919000_55.9.477.2 2025080113585919000_55.9.477.1 Weber (2025080113585919000_55.9.477.58) 2015; 16 Paoloni (2025080113585919000_55.9.477.69) 2009; 19 Wadsworth (2025080113585919000_55.9.477.74) 1989; 11 Sethi (2025080113585919000_55.9.477.42) 2018; 23 Murtezani (2025080113585919000_55.9.477.34) 2015; 17 2025080113585919000_55.9.477.51 Drechsler (2025080113585919000_55.9.477.30) 1997; 6 2025080113585919000_55.9.477.50 Struijs (2025080113585919000_55.9.477.46) 2003; 83 Pieters (2025080113585919000_55.9.477.64) 2020; 50 2025080113585919000_55.9.477.44 2025080113585919000_55.9.477.43 2025080113585919000_55.9.477.41 2025080113585919000_55.9.477.48 2025080113585919000_55.9.477.47 2025080113585919000_55.9.477.49 Wang (2025080113585919000_55.9.477.25) 2018; 48 2025080113585919000_55.9.477.40 Murphy (2025080113585919000_55.9.477.77) 2018; 7 2025080113585919000_55.9.477.81 2025080113585919000_55.9.477.33 2025080113585919000_55.9.477.32 Bateman (2025080113585919000_55.9.477.70) 2019; 11 2025080113585919000_55.9.477.76 2025080113585919000_55.9.477.31 2025080113585919000_55.9.477.75 2025080113585919000_55.9.477.37 2025080113585919000_55.9.477.35 2025080113585919000_55.9.477.39 2025080113585919000_55.9.477.38 Vuvan (2025080113585919000_55.9.477.53) 2020; 52 Takasaki (2025080113585919000_55.9.477.73) 2008; 38 Stahl (2025080113585919000_55.9.477.12) 1997; 79 Lian (2025080113585919000_55.9.477.56) 2019; 47 2025080113585919000_55.9.477.71 |
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| Snippet | ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain... To evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and... |
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| SubjectTerms | Adrenal Cortex Hormones - therapeutic use Adult Bias Cryotherapy Elbow Exercise Exercise Therapy - methods Female Humans Intervention Male Manipulative therapy Meta-analysis Middle Aged Nonsteroidal anti-inflammatory drugs Pain Pain Measurement Patients Pinch Strength Publication Bias Questionnaires Randomized Controlled Trials as Topic Review Systematic review tendinopathy tennis elbow Tennis Elbow - therapy Treatment Outcome Ultrasonic Therapy Watchful Waiting |
| Title | Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials |
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