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N Smidt - One of the best experts on this subject based on the ideXlab platform.
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surgery for lateral Elbow Pain
Cochrane Database of Systematic Reviews, 2011Co-Authors: R Buchbinder, L Barnsley, W J Assendelft, Renea V Johnston, Simon N Bell, N SmidtAbstract:Background Surgery is sometimes recommended for persistent lateral Elbow Pain where other less invasive interventions have failed. Objectives To determine the benefits and safety of surgery for lateral Elbow Pain. Search methods We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL and Web of Science unrestricted by date or language (to 15 December 2010). Selection criteria Randomised and controlled clinical trials assessing a surgical intervention compared with no treatment or another intervention including an alternate surgical intervention, in adults with lateral Elbow Pain. Data collection and analysis Two authors independently selected trials for inclusion, assessed risk of bias and extracted data. Main results We included five trials involving 191 participants with persistent symptoms of at least five months duration and failed conservative treatment. Three trials compared two different surgical procedures and two trials compared surgery to a non-surgical treatment. All trials were highly susceptible to bias. Meta-analysis was precluded due to differing comparator groups and outcome measures. One trial (24 participants) reported no difference between open extensor carpi radialis brevis (ECRB) surgery and radiofrequency microtenotomy, although reanalysis found that Pain was significantly lower in the latter group at three weeks (MD -2.80 points on 10 point scale, 95% CI -5.07 to -0.53). One trial (26 participants) reported no difference between open ECRB surgery and decompression of the posterior interosseous nerve in terms of the number of participants with improvement in Pain Pain on activity, or tenderness on palpation after an average of 31 months following surgery. One trial (45 participants) found that compared with open release of the ERCB muscle, percutaneous release resulted in slightly better function. One trial (40 participants) found comparable results between open surgical release of the ECRB and botulinum toxin injection at two years, although we could not extract any data for this review. One trial (56 participants) found that extracorporeal shock wave therapy (ESWT) improved Pain at night compared with percutaneous tenotomy at 12 months (MD 5 points on 100 point VAS, 95% CI 1.12 to 8.88), but there were no differences in Pain at rest or Pain on applying pressure. Authors' conclusions Due to a small number of studies, large heterogeneity in interventions across trials, small sample sizes and poor reporting of outcomes, there was insufficient evidence to support or refute the effectiveness of surgery for lateral Elbow Pain. Further well-designed randomised controlled trials and development of standard outcome measures are needed.
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shock wave therapy for lateral Elbow Pain
Cochrane Database of Systematic Reviews, 2005Co-Authors: R Buchbinder, S Green, L Barnsley, W J Assendelft, Joanne Maree Youd, N SmidtAbstract:BACKGROUND This review is one in a series of reviews of interventions for lateral Elbow Pain. Lateral Elbow Pain, or tennis Elbow, is a common condition causing Pain in the Elbow and forearm and lack of strength and function of the Elbow and wrist. Shock wave therapy (ESWT) involves the application of single pulsed acoustic wave. Since the 1990's reports of benefit of ESWT in the treatment of tendon disorders have been appearing in the literature. A systematic review published in the German language appeared in 2000 (Boddeker 2000) OBJECTIVES To determine the effectiveness and safety of ESWT in the treatment of adults with lateral Elbow Pain. SEARCH STRATEGY Comprehensive electronic searches of MEDLINE, CINAHL, EMBASE and SCISEARCH were combined with searches of the Cochrane Clinical Trails Registrar and the Musculoskeletal Review Group's specialist trial database. Identified keywords and authors were searched again in an effort to identify as many trials as possible. SELECTION CRITERIA Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were evaluated for inclusion in the review provided they described individuals with lateral Elbow Pain and were comparing the use of ESWT as a treatment strategy. DATA COLLECTION AND ANALYSIS For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference. Weighted mean difference using a random effects model was selected when outcomes were measured on standard scales. A fixed effects model was used to interpret results and assess heterogeneity. For binary data numbers of events and total population were analysed and interpreted as relative risk. MAIN RESULTS Two trials of ESWT versus placebo are included in this review (~~Rompe 1996~~, ~~Haake 2001~~). Both trials included similar study populations consisting of participants with chronic symptoms who had failed other conservative treatment. The frequency of ESWT application and the doses and techniques used were similar in both trials. The first trial demonstrated highly significant differences in favour of ESWT whereas the second trial found no benefits of ESWT over placebo. When the data from the two trials were pooled, the benefits observed in the first trial were no longer statistically significant. The relative risk for treatment failure (defined as Roles-Maudsley score of 4) of ESWT over placebo was 0.40 (95% CI, 0.08 to 1.91) at six weeks and 0.44 (95% CI, 0.09 to 2.17) at one year. After 6 weeks, there was no statistically significant improvement in Pain at rest [WMD Pain out of 100 = - 11.40 (95% CI, -26.10 to 3.30)], Pain with resisted wrist extension [WMD Pain out of 100 = -16.20 (95% CI, -47.75 to 15.36)] or Pain with resisted middle finger extension [WMD Pain out of 100 = -20.51(95% CI, -56.57 to 15.56)]. Results after 12 or 24 weeks were similar. REVIEWER'S CONCLUSIONS The two trials included in this review yielded conflicting results. Further trials are needed to clarify the value of ESWT for lateral Elbow Pain.
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acupuncture for lateral Elbow Pain
Cochrane Database of Systematic Reviews, 2002Co-Authors: S Green, R Buchbinder, L Barnsley, N Smidt, Stephen Hall, Millicent White, W J AssendelftAbstract:Background This review is one in a series of reviews of interventions for lateral Elbow Pain. Lateral Elbow Pain, or tennis Elbow, is a common condition causing Pain in the Elbow and forearm and lack of strength and function of the Elbow and wrist. Acupuncture has long been used to treat lateral Elbow Pain in China and in Western countries practitioners and consumers are increasingly exploring acupuncture as a first line treatment for musculoskeletal disorders. No previous systematic review of the available evidence has been conducted to determine whether acupuncture is efficacious in the treatment lateral Elbow Pain. Objectives To determine the effectiveness of acupuncture in the treatment of adults with lateral Elbow Pain with respect to Pain reduction, improvement in function, grip strength and adverse effects. Search methods We searched MEDLINE, CINAHL, EMBASE and SCISEARCH and the Cochrane Clinical Trials Register and the Musculoskeletal Review Group's specialist trial database from 1966 to June 2001. Identified keywords and authors were searched in an effort to retrieve as many trials as possible. Selection criteria Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were included in the review provided they were testing acupuncture compared to placebo or another intervention in adults with lateral Elbow Pain (tennis Elbow). Outcomes of interest were Pain, function, disability, quality of life, strength, participant satisfaction with treatment and adverse effect. Data collection and analysis For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference, while for binary data numbers of events and total population were analysed and interpreted as relative risks. Trial results were combined only in the absence of clinical and statistical heterogeneity. Main results Four small randomized controlled trials were included but due to flaws in study designs (particularly small populations, uncertain allocation concealment and substantial loss to follow up) and clinical differences between trials, data from trials could not be combined in a meta-analysis. One randomised controlled trial found that needle acupuncture results in relief of Pain for significantly longer than placebo (WMD = 18.8 hours, 95%CI 10.1 to 27.5) and is more likely to result in a 50% or greater reduction in Pain after 1 treatment (RR 0.33, 95%CI 0.16 to 0.69) (Molsberger 1994) . A second randomized controlled trial demonstrated needle acupuncture to be more likely to result in overall participant reported improvement than placebo in the short term (RR = 0.09 95% CI 0.01 to 0.64) (Haker 1990a) . No significant differences were found in the longer term (after 3 or 12 months). A randomized controlled trial of laser acupuncture versus placebo demonstrated no differences between laser acupuncture and placebo with respect to overall benefit (Haker 1990b). A fourth included trial published in Chinese demonstrated no difference between Vitamin B12 injection plus acupuncture, and Vitamin B12 injection alone (Wang 1997). Authors' conclusions There is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral Elbow Pain. This review has demonstrated needle acupuncture to be of short term benefit with respect to Pain, but this finding is based on the results of 2 small trials, the results of which were not able to be combined in meta-analysis. No benefit lasting more than 24 hours following treatment has been demonstrated. No trial assessed or commented on potential adverse effect. Further trials, utilising appropriate methods and adequate sample sizes, are needed before conclusions can be drawn regarding the effect of acupuncture on tennis Elbow.
R Buchbinder - One of the best experts on this subject based on the ideXlab platform.
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non steroidal anti inflammatory drugs nsaids for treating lateral Elbow Pain in adults
Cochrane Database of Systematic Reviews, 2013Co-Authors: Porjai Pattanittum, S Green, Tari Turner, R BuchbinderAbstract:Background Lateral Elbow Pain, or tennis Elbow, is a common condition that causes Pain in the Elbow and forearm. Although self-limiting, it can be associated with significant disability and often results in work absence. It is often treated with topical and oral non-steroidal anti-inflammatory drugs (NSAIDs). This is an update of a review first published in 2002 (search date October 11, 2012). Objectives To assess the benefits and harms of topical and oral NSAIDs for treating people with lateral Elbow Pain. Search methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE and SciSearch up to October 11, 2012. No language restriction was applied. Selection criteria Studies were included if they were randomised or quasi-randomised controlled trials (RCTs or CCTs) that compared topical or oral NSAIDs with placebo or another intervention, or compared two NSAIDs in adults with lateral Elbow Pain. Outcomes of interest were Pain, function, quality of life, Pain-free grip strength, overall treatment success, work loss and adverse effects. Data collection and analysis Two review authors independently selected the studies for inclusion, extracted the data, and performed a risk of bias assessment. Main results Fifteen trials, involving 759 participants and reporting 17 comparisons, were included in the review. Four new trials identified from the updated search were included, along with 11 of 14 trials included in the original review (three trials included in the previous review were found not to meet inclusion criteria). Of eight trials that studied topical NSAIDs (301 participants), five compared topical NSAIDs with placebo, one compared manipulative therapy and topical NSAIDs with manipulative therapy alone, one compared leech therapy with topical NSAIDs and one compared two different topical NSAIDs. Of seven trials that investigated oral NSAIDs (437 participants), two compared oral NSAIDs with placebo, one compared oral NSAIDs and bandaging with bandaging alone, three compared oral NSAIDs with glucocorticoid injection, one compared oral NSAIDs with a vasodilator and two compared two different oral NSAIDs. No trials directly compared topical NSAIDs with oral NSAIDs. Few trials used intention-to-treat analysis, and the sample size of most was small. The median follow-up was 2 weeks (range 1 week to 1 year). Low-quality evidence was obtained from three trials (153 participants) suggesting that topical NSAIDs were significantly more effective than placebo with respect to Pain in the short term (mean difference -1.64, 95% confidence interval (CI) -2.42 to -0.86) and number needed to treat to benefit (7 (95% CI 3 to 21) on a 0 to 10 scale). Low-quality evidence was obtained from one trial (85 participants) indicating that significantly more participants report fair, good or excellent effectiveness with topical NSAIDs versus placebo at 28 days (14 days of therapy) (risk ratio (RR) 1.49, 95% CI 1.04 to 2.14). No participants withdrew as the result of adverse events, but some studies reported mild adverse effects such as rash in 2.5% of those exposed to topical NSAIDs compared with 1.3% of those exposed to placebo. Low-quality and conflicting evidence regarding the benefits of oral NSAIDs obtained from two trials could not be pooled. One trial found significantly greater improvement in Pain compared with placebo, and the other trial found no between-group differences; neither trial found differences in function. One trial reported a withdrawal due to adverse effects for a participant in the NSAIDs group. Use of oral NSAIDs was associated with increased risk of gastrointestinal side effects compared with placebo in one trial in the review. Another trial reported discontinuation of treatment due to gastrointestinal side effects in four participants taking NSAIDs, and another participant developed an allergic reaction in response to oral NSAIDs. Very scant and conflicting evidence regarding the comparative effects of oral NSAIDs and glucocorticoid injection was obtained. One trial reported a significant improvement in Pain with glucocorticoid injection, and another found no between-group differences; treatment success was similar between groups (RR of fair, good or excellent effectiveness 0.74; 95% CI 0.43 to 1.26). Transient Pain may occur following injection. Authors' conclusions There remains limited evidence from which to draw firm conclusions about the benefits or harms of topical or oral NSAIDs in treating lateral Elbow Pain. Although data from five placebo-controlled trials suggest that topical NSAIDs may be beneficial in improving Pain (for up to 4 weeks), non-normal distribution of data and other methodological issues precluded firm conclusions. Some people may expect a mild transient skin rash. Evidence about the benefits of oral NSAIDs has been conflicting, although oral NSAID use may result in gastrointestinal adverse effects in some people. No direct comparisons between oral and topical NSAIDs were available. Some trials demonstrated greater benefit from glucocorticoid injection than from NSAIDs in the short term, but this was not apparent in all studies and was not apparent by 6 months in the only study that included longer-term outcomes.
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surgery for lateral Elbow Pain
Cochrane Database of Systematic Reviews, 2011Co-Authors: R Buchbinder, L Barnsley, W J Assendelft, Renea V Johnston, Simon N Bell, N SmidtAbstract:Background Surgery is sometimes recommended for persistent lateral Elbow Pain where other less invasive interventions have failed. Objectives To determine the benefits and safety of surgery for lateral Elbow Pain. Search methods We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL and Web of Science unrestricted by date or language (to 15 December 2010). Selection criteria Randomised and controlled clinical trials assessing a surgical intervention compared with no treatment or another intervention including an alternate surgical intervention, in adults with lateral Elbow Pain. Data collection and analysis Two authors independently selected trials for inclusion, assessed risk of bias and extracted data. Main results We included five trials involving 191 participants with persistent symptoms of at least five months duration and failed conservative treatment. Three trials compared two different surgical procedures and two trials compared surgery to a non-surgical treatment. All trials were highly susceptible to bias. Meta-analysis was precluded due to differing comparator groups and outcome measures. One trial (24 participants) reported no difference between open extensor carpi radialis brevis (ECRB) surgery and radiofrequency microtenotomy, although reanalysis found that Pain was significantly lower in the latter group at three weeks (MD -2.80 points on 10 point scale, 95% CI -5.07 to -0.53). One trial (26 participants) reported no difference between open ECRB surgery and decompression of the posterior interosseous nerve in terms of the number of participants with improvement in Pain Pain on activity, or tenderness on palpation after an average of 31 months following surgery. One trial (45 participants) found that compared with open release of the ERCB muscle, percutaneous release resulted in slightly better function. One trial (40 participants) found comparable results between open surgical release of the ECRB and botulinum toxin injection at two years, although we could not extract any data for this review. One trial (56 participants) found that extracorporeal shock wave therapy (ESWT) improved Pain at night compared with percutaneous tenotomy at 12 months (MD 5 points on 100 point VAS, 95% CI 1.12 to 8.88), but there were no differences in Pain at rest or Pain on applying pressure. Authors' conclusions Due to a small number of studies, large heterogeneity in interventions across trials, small sample sizes and poor reporting of outcomes, there was insufficient evidence to support or refute the effectiveness of surgery for lateral Elbow Pain. Further well-designed randomised controlled trials and development of standard outcome measures are needed.
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shock wave therapy for lateral Elbow Pain
Cochrane Database of Systematic Reviews, 2005Co-Authors: R Buchbinder, S Green, L Barnsley, W J Assendelft, Joanne Maree Youd, N SmidtAbstract:BACKGROUND This review is one in a series of reviews of interventions for lateral Elbow Pain. Lateral Elbow Pain, or tennis Elbow, is a common condition causing Pain in the Elbow and forearm and lack of strength and function of the Elbow and wrist. Shock wave therapy (ESWT) involves the application of single pulsed acoustic wave. Since the 1990's reports of benefit of ESWT in the treatment of tendon disorders have been appearing in the literature. A systematic review published in the German language appeared in 2000 (Boddeker 2000) OBJECTIVES To determine the effectiveness and safety of ESWT in the treatment of adults with lateral Elbow Pain. SEARCH STRATEGY Comprehensive electronic searches of MEDLINE, CINAHL, EMBASE and SCISEARCH were combined with searches of the Cochrane Clinical Trails Registrar and the Musculoskeletal Review Group's specialist trial database. Identified keywords and authors were searched again in an effort to identify as many trials as possible. SELECTION CRITERIA Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were evaluated for inclusion in the review provided they described individuals with lateral Elbow Pain and were comparing the use of ESWT as a treatment strategy. DATA COLLECTION AND ANALYSIS For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference. Weighted mean difference using a random effects model was selected when outcomes were measured on standard scales. A fixed effects model was used to interpret results and assess heterogeneity. For binary data numbers of events and total population were analysed and interpreted as relative risk. MAIN RESULTS Two trials of ESWT versus placebo are included in this review (~~Rompe 1996~~, ~~Haake 2001~~). Both trials included similar study populations consisting of participants with chronic symptoms who had failed other conservative treatment. The frequency of ESWT application and the doses and techniques used were similar in both trials. The first trial demonstrated highly significant differences in favour of ESWT whereas the second trial found no benefits of ESWT over placebo. When the data from the two trials were pooled, the benefits observed in the first trial were no longer statistically significant. The relative risk for treatment failure (defined as Roles-Maudsley score of 4) of ESWT over placebo was 0.40 (95% CI, 0.08 to 1.91) at six weeks and 0.44 (95% CI, 0.09 to 2.17) at one year. After 6 weeks, there was no statistically significant improvement in Pain at rest [WMD Pain out of 100 = - 11.40 (95% CI, -26.10 to 3.30)], Pain with resisted wrist extension [WMD Pain out of 100 = -16.20 (95% CI, -47.75 to 15.36)] or Pain with resisted middle finger extension [WMD Pain out of 100 = -20.51(95% CI, -56.57 to 15.56)]. Results after 12 or 24 weeks were similar. REVIEWER'S CONCLUSIONS The two trials included in this review yielded conflicting results. Further trials are needed to clarify the value of ESWT for lateral Elbow Pain.
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acupuncture for lateral Elbow Pain
Cochrane Database of Systematic Reviews, 2002Co-Authors: S Green, R Buchbinder, L Barnsley, N Smidt, Stephen Hall, Millicent White, W J AssendelftAbstract:Background This review is one in a series of reviews of interventions for lateral Elbow Pain. Lateral Elbow Pain, or tennis Elbow, is a common condition causing Pain in the Elbow and forearm and lack of strength and function of the Elbow and wrist. Acupuncture has long been used to treat lateral Elbow Pain in China and in Western countries practitioners and consumers are increasingly exploring acupuncture as a first line treatment for musculoskeletal disorders. No previous systematic review of the available evidence has been conducted to determine whether acupuncture is efficacious in the treatment lateral Elbow Pain. Objectives To determine the effectiveness of acupuncture in the treatment of adults with lateral Elbow Pain with respect to Pain reduction, improvement in function, grip strength and adverse effects. Search methods We searched MEDLINE, CINAHL, EMBASE and SCISEARCH and the Cochrane Clinical Trials Register and the Musculoskeletal Review Group's specialist trial database from 1966 to June 2001. Identified keywords and authors were searched in an effort to retrieve as many trials as possible. Selection criteria Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were included in the review provided they were testing acupuncture compared to placebo or another intervention in adults with lateral Elbow Pain (tennis Elbow). Outcomes of interest were Pain, function, disability, quality of life, strength, participant satisfaction with treatment and adverse effect. Data collection and analysis For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference, while for binary data numbers of events and total population were analysed and interpreted as relative risks. Trial results were combined only in the absence of clinical and statistical heterogeneity. Main results Four small randomized controlled trials were included but due to flaws in study designs (particularly small populations, uncertain allocation concealment and substantial loss to follow up) and clinical differences between trials, data from trials could not be combined in a meta-analysis. One randomised controlled trial found that needle acupuncture results in relief of Pain for significantly longer than placebo (WMD = 18.8 hours, 95%CI 10.1 to 27.5) and is more likely to result in a 50% or greater reduction in Pain after 1 treatment (RR 0.33, 95%CI 0.16 to 0.69) (Molsberger 1994) . A second randomized controlled trial demonstrated needle acupuncture to be more likely to result in overall participant reported improvement than placebo in the short term (RR = 0.09 95% CI 0.01 to 0.64) (Haker 1990a) . No significant differences were found in the longer term (after 3 or 12 months). A randomized controlled trial of laser acupuncture versus placebo demonstrated no differences between laser acupuncture and placebo with respect to overall benefit (Haker 1990b). A fourth included trial published in Chinese demonstrated no difference between Vitamin B12 injection plus acupuncture, and Vitamin B12 injection alone (Wang 1997). Authors' conclusions There is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral Elbow Pain. This review has demonstrated needle acupuncture to be of short term benefit with respect to Pain, but this finding is based on the results of 2 small trials, the results of which were not able to be combined in meta-analysis. No benefit lasting more than 24 hours following treatment has been demonstrated. No trial assessed or commented on potential adverse effect. Further trials, utilising appropriate methods and adequate sample sizes, are needed before conclusions can be drawn regarding the effect of acupuncture on tennis Elbow.
W J Assendelft - One of the best experts on this subject based on the ideXlab platform.
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surgery for lateral Elbow Pain
Cochrane Database of Systematic Reviews, 2011Co-Authors: R Buchbinder, L Barnsley, W J Assendelft, Renea V Johnston, Simon N Bell, N SmidtAbstract:Background Surgery is sometimes recommended for persistent lateral Elbow Pain where other less invasive interventions have failed. Objectives To determine the benefits and safety of surgery for lateral Elbow Pain. Search methods We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL and Web of Science unrestricted by date or language (to 15 December 2010). Selection criteria Randomised and controlled clinical trials assessing a surgical intervention compared with no treatment or another intervention including an alternate surgical intervention, in adults with lateral Elbow Pain. Data collection and analysis Two authors independently selected trials for inclusion, assessed risk of bias and extracted data. Main results We included five trials involving 191 participants with persistent symptoms of at least five months duration and failed conservative treatment. Three trials compared two different surgical procedures and two trials compared surgery to a non-surgical treatment. All trials were highly susceptible to bias. Meta-analysis was precluded due to differing comparator groups and outcome measures. One trial (24 participants) reported no difference between open extensor carpi radialis brevis (ECRB) surgery and radiofrequency microtenotomy, although reanalysis found that Pain was significantly lower in the latter group at three weeks (MD -2.80 points on 10 point scale, 95% CI -5.07 to -0.53). One trial (26 participants) reported no difference between open ECRB surgery and decompression of the posterior interosseous nerve in terms of the number of participants with improvement in Pain Pain on activity, or tenderness on palpation after an average of 31 months following surgery. One trial (45 participants) found that compared with open release of the ERCB muscle, percutaneous release resulted in slightly better function. One trial (40 participants) found comparable results between open surgical release of the ECRB and botulinum toxin injection at two years, although we could not extract any data for this review. One trial (56 participants) found that extracorporeal shock wave therapy (ESWT) improved Pain at night compared with percutaneous tenotomy at 12 months (MD 5 points on 100 point VAS, 95% CI 1.12 to 8.88), but there were no differences in Pain at rest or Pain on applying pressure. Authors' conclusions Due to a small number of studies, large heterogeneity in interventions across trials, small sample sizes and poor reporting of outcomes, there was insufficient evidence to support or refute the effectiveness of surgery for lateral Elbow Pain. Further well-designed randomised controlled trials and development of standard outcome measures are needed.
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Systematic review of the efficacy and safety of shock wave therapy for lateral Elbow Pain.
The Journal of rheumatology, 2006Co-Authors: Rachelle Buchbinder, L Barnsley, W J Assendelft, Joanne Maree Youd, Sally Green, Nynke SmidtAbstract:OBJECTIVE: To determine the efficacy and safety of extracorporeal shock wave therapy (ESWT) for lateral Elbow Pain. METHODS: Systematic review of randomized controlled trials using Cochrane Collaboration methodology. RESULTS: Nine placebo-controlled trials (1006 participants) and one trial of ESWT versus steroid injection (93 participants) were included. The 9 placebo-controlled trials reported conflicting results, although 11 of 13 pooled analyses found no significant benefit of ESWT over placebo, e.g., weighted mean difference for improvement in Pain (on a 100-point scale) from baseline to 4-6 weeks (pooled analysis of 3 trials, 446 participants) was -9.42 (95% CI -20.70 to 1.86). Two pooled results favored ESWT, e.g., relative risk of treatment success (at least 50% improvement in Pain with resisted wrist extension at 12 weeks) for ESWT in comparison to placebo (pooled analysis of 2 trials, 192 participants) was 2.2 (95% CI 1.55 to 3.12). However, this finding was not supported by the results of 4 other trials that were unable to be pooled. Steroid injection was more effective than ESWT at 3 months after the end of treatment assessed by a reduction of Pain of 50% from baseline [21/25 (84%) vs 29/48 (60%); p
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shock wave therapy for lateral Elbow Pain
Cochrane Database of Systematic Reviews, 2005Co-Authors: R Buchbinder, S Green, L Barnsley, W J Assendelft, Joanne Maree Youd, N SmidtAbstract:BACKGROUND This review is one in a series of reviews of interventions for lateral Elbow Pain. Lateral Elbow Pain, or tennis Elbow, is a common condition causing Pain in the Elbow and forearm and lack of strength and function of the Elbow and wrist. Shock wave therapy (ESWT) involves the application of single pulsed acoustic wave. Since the 1990's reports of benefit of ESWT in the treatment of tendon disorders have been appearing in the literature. A systematic review published in the German language appeared in 2000 (Boddeker 2000) OBJECTIVES To determine the effectiveness and safety of ESWT in the treatment of adults with lateral Elbow Pain. SEARCH STRATEGY Comprehensive electronic searches of MEDLINE, CINAHL, EMBASE and SCISEARCH were combined with searches of the Cochrane Clinical Trails Registrar and the Musculoskeletal Review Group's specialist trial database. Identified keywords and authors were searched again in an effort to identify as many trials as possible. SELECTION CRITERIA Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were evaluated for inclusion in the review provided they described individuals with lateral Elbow Pain and were comparing the use of ESWT as a treatment strategy. DATA COLLECTION AND ANALYSIS For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference. Weighted mean difference using a random effects model was selected when outcomes were measured on standard scales. A fixed effects model was used to interpret results and assess heterogeneity. For binary data numbers of events and total population were analysed and interpreted as relative risk. MAIN RESULTS Two trials of ESWT versus placebo are included in this review (~~Rompe 1996~~, ~~Haake 2001~~). Both trials included similar study populations consisting of participants with chronic symptoms who had failed other conservative treatment. The frequency of ESWT application and the doses and techniques used were similar in both trials. The first trial demonstrated highly significant differences in favour of ESWT whereas the second trial found no benefits of ESWT over placebo. When the data from the two trials were pooled, the benefits observed in the first trial were no longer statistically significant. The relative risk for treatment failure (defined as Roles-Maudsley score of 4) of ESWT over placebo was 0.40 (95% CI, 0.08 to 1.91) at six weeks and 0.44 (95% CI, 0.09 to 2.17) at one year. After 6 weeks, there was no statistically significant improvement in Pain at rest [WMD Pain out of 100 = - 11.40 (95% CI, -26.10 to 3.30)], Pain with resisted wrist extension [WMD Pain out of 100 = -16.20 (95% CI, -47.75 to 15.36)] or Pain with resisted middle finger extension [WMD Pain out of 100 = -20.51(95% CI, -56.57 to 15.56)]. Results after 12 or 24 weeks were similar. REVIEWER'S CONCLUSIONS The two trials included in this review yielded conflicting results. Further trials are needed to clarify the value of ESWT for lateral Elbow Pain.
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extracts from concise clinical evidence tennis Elbow
BMJ, 2003Co-Authors: W J Assendelft, Sally Green, Rachelle Buchbinder, Peter A A Struijs, Nynke SmidtAbstract:Definition Tennis Elbow has many analogous terms, including lateral Elbow Pain, lateral epicondylitis, rowing Elbow, tendonitis of the common extensor origin, and peritendonitis of the Elbow. Tennis Elbow is characterised by Pain and tenderness over the lateral epicondyle of the humerus and Pain on resisted dorsiflexion of the wrist, middle finger, or both. For the purposes of this review, tennis Elbow was restricted to lateral Elbow Pain or lateral epicondylitis.
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acupuncture for lateral Elbow Pain
Cochrane Database of Systematic Reviews, 2002Co-Authors: S Green, R Buchbinder, L Barnsley, N Smidt, Stephen Hall, Millicent White, W J AssendelftAbstract:Background This review is one in a series of reviews of interventions for lateral Elbow Pain. Lateral Elbow Pain, or tennis Elbow, is a common condition causing Pain in the Elbow and forearm and lack of strength and function of the Elbow and wrist. Acupuncture has long been used to treat lateral Elbow Pain in China and in Western countries practitioners and consumers are increasingly exploring acupuncture as a first line treatment for musculoskeletal disorders. No previous systematic review of the available evidence has been conducted to determine whether acupuncture is efficacious in the treatment lateral Elbow Pain. Objectives To determine the effectiveness of acupuncture in the treatment of adults with lateral Elbow Pain with respect to Pain reduction, improvement in function, grip strength and adverse effects. Search methods We searched MEDLINE, CINAHL, EMBASE and SCISEARCH and the Cochrane Clinical Trials Register and the Musculoskeletal Review Group's specialist trial database from 1966 to June 2001. Identified keywords and authors were searched in an effort to retrieve as many trials as possible. Selection criteria Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were included in the review provided they were testing acupuncture compared to placebo or another intervention in adults with lateral Elbow Pain (tennis Elbow). Outcomes of interest were Pain, function, disability, quality of life, strength, participant satisfaction with treatment and adverse effect. Data collection and analysis For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference, while for binary data numbers of events and total population were analysed and interpreted as relative risks. Trial results were combined only in the absence of clinical and statistical heterogeneity. Main results Four small randomized controlled trials were included but due to flaws in study designs (particularly small populations, uncertain allocation concealment and substantial loss to follow up) and clinical differences between trials, data from trials could not be combined in a meta-analysis. One randomised controlled trial found that needle acupuncture results in relief of Pain for significantly longer than placebo (WMD = 18.8 hours, 95%CI 10.1 to 27.5) and is more likely to result in a 50% or greater reduction in Pain after 1 treatment (RR 0.33, 95%CI 0.16 to 0.69) (Molsberger 1994) . A second randomized controlled trial demonstrated needle acupuncture to be more likely to result in overall participant reported improvement than placebo in the short term (RR = 0.09 95% CI 0.01 to 0.64) (Haker 1990a) . No significant differences were found in the longer term (after 3 or 12 months). A randomized controlled trial of laser acupuncture versus placebo demonstrated no differences between laser acupuncture and placebo with respect to overall benefit (Haker 1990b). A fourth included trial published in Chinese demonstrated no difference between Vitamin B12 injection plus acupuncture, and Vitamin B12 injection alone (Wang 1997). Authors' conclusions There is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral Elbow Pain. This review has demonstrated needle acupuncture to be of short term benefit with respect to Pain, but this finding is based on the results of 2 small trials, the results of which were not able to be combined in meta-analysis. No benefit lasting more than 24 hours following treatment has been demonstrated. No trial assessed or commented on potential adverse effect. Further trials, utilising appropriate methods and adequate sample sizes, are needed before conclusions can be drawn regarding the effect of acupuncture on tennis Elbow.
Marcus Gadau - One of the best experts on this subject based on the ideXlab platform.
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a multi center international study of acupuncture for lateral Elbow Pain results of a randomized controlled trial
European Journal of Pain, 2020Co-Authors: Marcus Gadau, Shi-ping Zhang, Zhaoxiang Bian, Fu Chun Wang, Sergio Bangrazi, Stefano Liguori, Wei Hong Liu, Christine Berle, Shohreh Razavy, Petti FilomenaAbstract:Background Lateral Elbow Pain (LEP) due to tendinosis is one of the most common musculoskeletal Pains of the upper limbs, yet there is no satisfactory treatment. This study was an international, prospective, multi-centre, randomized, controlled, clinical trial to evaluate the efficacy of acupuncture compared to sham laser in the treatment of LEP. Methods The study used a parallel and stratified design (1:1 allocation using a computer-generated sequence) and was participant-, outcome assessor- and statistician-blinded. Subjects from 18 to 80 years with unilateral chronic LEP (minimum three months) were recruited at four centres in Australia, China, Hong Kong and Italy. The treatment group received manual acupuncture at acupoints LI 10 and LI 11 on the affected side whereas the control group received sham laser acupuncture at the same acupoints. The primary endpoint was disabilities of the arm, shoulder, and hand (DASH) questionnaire score at the three-week post-treatment follow-up visit. Three VAS scales (Pain at rest, Pain on motion and Pain during exertion) were secondary outcomes measures. Ninety-six subjects were allocated to either the treatment group (n = 47) or control group (n = 49) and were all included in the analysis. Results At the follow-up visit, we found significant differences in DASH score between the two groups (p = .015). The median change to baseline for the treatment group was -11.7 (interval: -50.83 to 23.33), and for the control group -7.50 (interval: -36.67 to 29.10). The estimated effect size was 0.47, indicating a medium effect. Significant differences were also found for secondary outcome measures for VAS of Pain. There were no severe adverse events. Our findings suggest that acupuncture has a moderate efficacy in the treatment of LEP. Conclusions Acupuncture was shown to be efficacious in improving the function of the arm associated with lateral Elbow tendinosis. Both the DASH score and the Pain VAS on two occasions (at rest and during motion) showed a significant change over time indicating acupuncture as a potential treatment for LEP due to tendinosis.
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Pattern Differentiation of Lateral Elbow Pain in Traditional Chinese Medicine: A Systematic Review.
Journal of alternative and complementary medicine (New York N.Y.), 2016Co-Authors: Marcus Gadau, Shi-ping Zhang, Ho-yin Yip, Fai Yeung, Zhaoxiang Bian, Chris ZaslawskiAbstract:Abstract Background: Traditional Chinese Medicine (TCM) uses a sophisticated diagnostic system called pattern differentiation, which allows for the tailor-made treatment of individuals. Objective: This study aimed to identify the commonly used TCM patterns for lateral Elbow Pain (LEP), as well as the clinical features associated with these patterns. Method: Journal literature in 15 major Chinese and English databases and textbooks from five medical libraries as well as Chinamaxx were reviewed. Results: Five hundred and fifty-five full-text journal articles, as well as 465 textbooks, were retrieved for further assessment, but only eight studies and seven books that mentioned LEP patterns could be identified and included in this study. The top four patterns that were identified were the wind-cold-dampness pattern, the qi stagnation and blood stasis pattern, the dual deficiency of qi and blood pattern, and the retained dampness-heat pattern, each of which was associated with unique features that were made up...
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TCM Pattern Questionnaire for Lateral Elbow Pain: Development of an Instrument via a Delphi Process
Hindawi Limited, 2016Co-Authors: Marcus Gadau, Shi-ping Zhang, Wing-fai YeungAbstract:Individualized acupuncture treatment has been practiced for Pain therapy. This study used acupuncture treatment for lateral Elbow Pain (LEP) as an example to study the diagnostic practice of individualized acupuncture treatment. A provisional version of LEP pattern questionnaire was developed based on a recent systematic review on TCM pattern diagnosis for LEP. A Delphi panel of 33 clinical experts from seven different countries was formed, and the Delphi survey was conducted in Chinese and English language for two rounds. Consensus was achieved from all 26 panelists who responded to the second round on 243 items of the instrument, which included a 72-question-long questionnaire. The mean level of expert consensus on the items of the final questionnaire was 85%. Consensus was found on four TCM patterns that could underlie LEP, namely, the wind-cold-dampness pattern, the qi stagnation and blood stasis pattern, the dual deficiency of qi and blood pattern, and the retained dampness-heat pattern. A list of signs and symptoms indicating one of the four TCM patterns and a list of preferred treatment modalities for each pattern were also generated. Our instrument shows considerable content validity. Further validity and reliability studies are under way
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Acupuncture and moxibustion for lateral Elbow Pain: a systematic review of randomized controlled trials
BMC complementary and alternative medicine, 2014Co-Authors: Marcus Gadau, Chris Zaslawski, Fai Yeung, Zhaoxiang Bian, Hua Liu, Yuan Sheng Tan, Fu Chun Wang, Sergio Bangrazi, Ka Fai Chung, Shi-ping ZhangAbstract:Background: Acupuncture and moxibustion have widely been used to treat lateral Elbow Pain (LEP). A comprehensive systematic review of randomized controlled trials (RCTs) including both English and Chinese databases was conducted to assess the efficacy of acupuncture and moxibustion in the treatment of LEP. Methods: Revised STRICTA (2010) criteria were used to appraise the acupuncture procedures, the Cochrane risk of bias tool was used to assess the methodological quality of the studies. A total of 19 RCTs that compared acupuncture and/ or moxibustion with sham acupuncture, another form of acupuncture, or conventional treatment were included. Results: All studies had at least one domain rated as high risk or uncertain risk of bias in the Cochrane risk of bias tool. Results from three RCTs of moderate quality showed that acupuncture was more effective than sham acupuncture. Results from 10 RCTs of mostly low quality showed that acupuncture or moxibustion was superior or equal to conventional treatment, such as local anesthetic injection, local steroid injection, non-steroidal anti- inflammatory drugs, or ultrasound. There were six low quality RCTs that compared acupuncture and moxibustion combined with manual acupuncture alone, and all showed that acupuncture and moxibustion combined was superior to manual acupuncture alone. Conclusion: Moderate quality studies suggest that acupuncture is more effective than sham acupuncture. Interpretations of findings regarding acupuncture vs. conventional treatment, and acupuncture and moxibustion combined vs. manual acupuncture alone are limited by the methodological qualities of these studies. Future studies with improved methodological design are warranted to confirm the efficacy of acupuncture and moxibustion for LEP.
Shi-ping Zhang - One of the best experts on this subject based on the ideXlab platform.
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a multi center international study of acupuncture for lateral Elbow Pain results of a randomized controlled trial
European Journal of Pain, 2020Co-Authors: Marcus Gadau, Shi-ping Zhang, Zhaoxiang Bian, Fu Chun Wang, Sergio Bangrazi, Stefano Liguori, Wei Hong Liu, Christine Berle, Shohreh Razavy, Petti FilomenaAbstract:Background Lateral Elbow Pain (LEP) due to tendinosis is one of the most common musculoskeletal Pains of the upper limbs, yet there is no satisfactory treatment. This study was an international, prospective, multi-centre, randomized, controlled, clinical trial to evaluate the efficacy of acupuncture compared to sham laser in the treatment of LEP. Methods The study used a parallel and stratified design (1:1 allocation using a computer-generated sequence) and was participant-, outcome assessor- and statistician-blinded. Subjects from 18 to 80 years with unilateral chronic LEP (minimum three months) were recruited at four centres in Australia, China, Hong Kong and Italy. The treatment group received manual acupuncture at acupoints LI 10 and LI 11 on the affected side whereas the control group received sham laser acupuncture at the same acupoints. The primary endpoint was disabilities of the arm, shoulder, and hand (DASH) questionnaire score at the three-week post-treatment follow-up visit. Three VAS scales (Pain at rest, Pain on motion and Pain during exertion) were secondary outcomes measures. Ninety-six subjects were allocated to either the treatment group (n = 47) or control group (n = 49) and were all included in the analysis. Results At the follow-up visit, we found significant differences in DASH score between the two groups (p = .015). The median change to baseline for the treatment group was -11.7 (interval: -50.83 to 23.33), and for the control group -7.50 (interval: -36.67 to 29.10). The estimated effect size was 0.47, indicating a medium effect. Significant differences were also found for secondary outcome measures for VAS of Pain. There were no severe adverse events. Our findings suggest that acupuncture has a moderate efficacy in the treatment of LEP. Conclusions Acupuncture was shown to be efficacious in improving the function of the arm associated with lateral Elbow tendinosis. Both the DASH score and the Pain VAS on two occasions (at rest and during motion) showed a significant change over time indicating acupuncture as a potential treatment for LEP due to tendinosis.
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Pattern Differentiation of Lateral Elbow Pain in Traditional Chinese Medicine: A Systematic Review.
Journal of alternative and complementary medicine (New York N.Y.), 2016Co-Authors: Marcus Gadau, Shi-ping Zhang, Ho-yin Yip, Fai Yeung, Zhaoxiang Bian, Chris ZaslawskiAbstract:Abstract Background: Traditional Chinese Medicine (TCM) uses a sophisticated diagnostic system called pattern differentiation, which allows for the tailor-made treatment of individuals. Objective: This study aimed to identify the commonly used TCM patterns for lateral Elbow Pain (LEP), as well as the clinical features associated with these patterns. Method: Journal literature in 15 major Chinese and English databases and textbooks from five medical libraries as well as Chinamaxx were reviewed. Results: Five hundred and fifty-five full-text journal articles, as well as 465 textbooks, were retrieved for further assessment, but only eight studies and seven books that mentioned LEP patterns could be identified and included in this study. The top four patterns that were identified were the wind-cold-dampness pattern, the qi stagnation and blood stasis pattern, the dual deficiency of qi and blood pattern, and the retained dampness-heat pattern, each of which was associated with unique features that were made up...
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TCM Pattern Questionnaire for Lateral Elbow Pain: Development of an Instrument via a Delphi Process
Hindawi Limited, 2016Co-Authors: Marcus Gadau, Shi-ping Zhang, Wing-fai YeungAbstract:Individualized acupuncture treatment has been practiced for Pain therapy. This study used acupuncture treatment for lateral Elbow Pain (LEP) as an example to study the diagnostic practice of individualized acupuncture treatment. A provisional version of LEP pattern questionnaire was developed based on a recent systematic review on TCM pattern diagnosis for LEP. A Delphi panel of 33 clinical experts from seven different countries was formed, and the Delphi survey was conducted in Chinese and English language for two rounds. Consensus was achieved from all 26 panelists who responded to the second round on 243 items of the instrument, which included a 72-question-long questionnaire. The mean level of expert consensus on the items of the final questionnaire was 85%. Consensus was found on four TCM patterns that could underlie LEP, namely, the wind-cold-dampness pattern, the qi stagnation and blood stasis pattern, the dual deficiency of qi and blood pattern, and the retained dampness-heat pattern. A list of signs and symptoms indicating one of the four TCM patterns and a list of preferred treatment modalities for each pattern were also generated. Our instrument shows considerable content validity. Further validity and reliability studies are under way
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Acupuncture and moxibustion for lateral Elbow Pain: a systematic review of randomized controlled trials
BMC complementary and alternative medicine, 2014Co-Authors: Marcus Gadau, Chris Zaslawski, Fai Yeung, Zhaoxiang Bian, Hua Liu, Yuan Sheng Tan, Fu Chun Wang, Sergio Bangrazi, Ka Fai Chung, Shi-ping ZhangAbstract:Background: Acupuncture and moxibustion have widely been used to treat lateral Elbow Pain (LEP). A comprehensive systematic review of randomized controlled trials (RCTs) including both English and Chinese databases was conducted to assess the efficacy of acupuncture and moxibustion in the treatment of LEP. Methods: Revised STRICTA (2010) criteria were used to appraise the acupuncture procedures, the Cochrane risk of bias tool was used to assess the methodological quality of the studies. A total of 19 RCTs that compared acupuncture and/ or moxibustion with sham acupuncture, another form of acupuncture, or conventional treatment were included. Results: All studies had at least one domain rated as high risk or uncertain risk of bias in the Cochrane risk of bias tool. Results from three RCTs of moderate quality showed that acupuncture was more effective than sham acupuncture. Results from 10 RCTs of mostly low quality showed that acupuncture or moxibustion was superior or equal to conventional treatment, such as local anesthetic injection, local steroid injection, non-steroidal anti- inflammatory drugs, or ultrasound. There were six low quality RCTs that compared acupuncture and moxibustion combined with manual acupuncture alone, and all showed that acupuncture and moxibustion combined was superior to manual acupuncture alone. Conclusion: Moderate quality studies suggest that acupuncture is more effective than sham acupuncture. Interpretations of findings regarding acupuncture vs. conventional treatment, and acupuncture and moxibustion combined vs. manual acupuncture alone are limited by the methodological qualities of these studies. Future studies with improved methodological design are warranted to confirm the efficacy of acupuncture and moxibustion for LEP.