Author Names

Rompe, J. D., Riedel, C., Betz, U., & Fink, C.

Reviewer Name

Juan Carlos Chavez Casiano

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Rompe JD, Riedel C, Betz U, Fink C. Chronic lateral epicondylitis of the elbow: a prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine. Arch Phys Med Rehabil 2001;82:578-82. Objective: To compare the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine in treating chronic tennis elbow. Design: Prospective, matched single-blind control trial. Setting: University hospital clinic. Patients: Thirty patients with unilateral chronic tennis elbow, an unsuccessful conservative therapy during the 6 months before referral, and clinical signs of cervical dysfunction (eg, pressure pain at the C4-5 and/or C5-6 level, protraction of the head). Interventions: Three times at weekly intervals all patients received 1000 shockwave impulses of an energy flux density of.16mJ/mm2 at the lateral elbow. Additionally, they underwent manual therapy of the cervical spine and the cervicothoracic junction 10 times (group I). For each patient, a control matched by age (3-yr range) and gender at first conservative treatment was drawn at random from 127 patients who had undergone low-energy shockwave therapy in the same unit in the past 3 years (group II). Follow-up examinations took place at 12 weeks and at 12 months. Main Outcome Measures: The Roles and Maudsley outcome score at 12 months, defining an excellent or good result with no or only occasional discomfort without limitation of activity and range of motion. Results: Neither group differed statistically before the study, with a poor rating for all patients (p>.05). At 12 months, there was still no significant difference, with the outcome being excellent or good in 56% in group I, and in 60% in group II (p >.05). Each group showed significant improvement compared with the respective prestudy evaluation (p <.0001). Conclusion: ESWT may be an effective conservative treatment method for unilateral chronic tennis elbow. The efficacy of additional cervical manual therapy for lateral epicondylitis remains questionable.

 

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

  1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
  • Yes
  1. Was the method of randomization adequate (i.e., use of randomly generated assignment)?
  • Yes
  1. Was the treatment allocation concealed (so that assignments could not be predicted)?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were study participants and providers blinded to treatment group assignment?
  • Yes
  1. Were the people assessing the outcomes blinded to the participants’ group assignments?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
  • Yes
  1. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
  • Yes
  1. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Was there high adherence to the intervention protocols for each treatment group?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
  • Yes
  1. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
  • Yes
  1. Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
  • Yes
  1. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
  • Cannot Determine, Not Reported, or Not Applicable

 

Key Finding #1

There was no statistically significant difference between group I and group II in the Roles and Maudsley scores (extended Fisher test) and the VAS rating (Wilcoxon test for independent samples).

Key Finding #2

There was a highly significant improvement within both groups for the VAS and on the Roles and Maudsley outcome score upon follow ups.

Key Finding #3

This study shows the values of low-energy ESWT in patients with chronic lateral epicondylalgia but it also questions the usefulness of additional cervical spine manual treatment in these patients.

 

Please provide your summary of the paper

This study compared the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine un treating chronic tennis elbow. Group I received shockwave therapy and manual therapy to the cervical spine ang group II underwent a monotherapy with low-energy shockwaves. Both group were treated under the same condition and the patients were treated singly to avoid influencing one another. One this this study failed to do was to compare the effects of only manual therapy. There was a significant improvement for both groups with the respective pre study evaluation. In conclusion further studies are needed to establish the optimum treatment regime with ESWT for patients with a recalcitrant tennis elbow and to clarify the effects of manual therapy.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

The study looked at the benefits of using extracorporeal shockwave therapy (ESWT) and ESWT plus manual therapy on patients with tennis elbow. According to the study both groups showed significant improvement. In clinical I could use a combination of both depending on how sever the patients pain is. I think another study could be done but with a third group that only gets manual therapy, to see how just manual therapy affects the patients.