Effectiveness of Mobilization with Movement of Elbow Compared with Manipulation of Wrist in Patients of Lateral Epicondylitis

Author Names

Patel, Namrata

Reviewer Name

Jasmin Flores, SPT

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Purpose: To evaluate the effectiveness of mobilization with movement of elbow compared with manipulation of wrist on pain, strength and activities of daily living in patients of lateral epicondylitis. Methodology: An interventional comparative study was conducted on 30 patients having symptomatic lateral epicondylitis. They were randomly assigned to one of the three groups. Group A (n=10) control group, Group B (n=10) Mobilization with movement group and Group C (n=10) wrist manipulation. All the 3 groups were received conventional treatment of ultrasound, stretching and strengthening of wrist extensors. Baseline measurements of pain (VAS score), functional status (PRTEE questionnaire) and strength (maximal isometric grip strength) were taken on day 1 and after 10th treatment session.  Results: The data analysis was performed with Graph Pad Instat trial version 3 software. All three groups showed improvement in VAS, maximal isometrics grip strength and PRTEE questionnaire. There is statistically significant difference between groups B (Mobilization with movement) and Group C (Manipulation of wrist) for VAS and PRTEE questionnaire score. But No statistically significant difference is found in maximal isometric grip strength. Mobilization with movement of elbow along with conventional therapy showed significant improvement in Pain and functional status as compared to wrist manipulation.  Conclusion: It can be concluded that mobilization with movement of elbow along with conventional therapy program is effective in treating chronic lateral epicondylitis. KEYWORDS: Lateral epicondylitis; Mobilization with movement; Wrist manipulation.

 

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

2. Was the method of randomization adequate (i.e., use of randomly generated assignment)?

• Cannot Determine, Not Reported, or Not Applicable

3. Was the treatment allocation concealed (so that assignments could not be predicted)?

• Cannot Determine, Not Reported, or Not Applicable

4. Were study participants and providers blinded to treatment group assignment?

• No

5. Were the people assessing the outcomes blinded to the participants’ group assignments?

• No

6. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?

• Yes

7. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?

• Yes

8. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?

• Yes

9. Was there high adherence to the intervention protocols for each treatment group?

• No

10. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?

• Cannot Determine, Not Reported, or Not Applicable

11. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?

• Yes

12. 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?

• No

13. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?

• No

14. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?

• Yes

 

Key Finding #1

When comparing the group that received conventional treatment and mobilization with movement of elbow (Group B) and the group that received conventional treatment and wrist manipulation (Group C), there was significant improvement in pain and functional status for Group B.

Key Finding #2

Mobilization with movement of the elbow was beneficial for patients to maintain their daily activities and it is effective within short periods.

Key Finding #3

All three groups, Group A was a control group, did not show statistically significant differences in grip strength throughout the testing period.

 

Please provide your summary of the paper

This paper focuses on the most effective treatment for patients with symptomatic lateral epicondylitis though three 3 randomized groups of 10 individuals in each group. Group A was the control group, Group B were given conventional treatment and mobilization with movement of elbow, and Group C were given conventional treatment and wrist manipulation. Conventional treatment was defined as ultrasound, static stretching of forearm extensors, and strengthening exercises of the wrist extensors. The baseline measurements that were used were pain (VAS score), functional status (PRTEE questionnaire), and strength (maximal isometrics grip strength). After 10 treatment sessions they found that the study showed improvement in VAS, maximal isometric grip strength, and PRTEE scores in all 3 groups, however there was significantly better outcomes for group B. There was a significant difference between groups B and C, and between group A and group B for VAS and PRTEE questionnaire score. There was no significant difference found between the groups for grip strength. Overall, there is a significant improvement in pain and functional status when given conventional treatment and mobilization with movement of elbow.

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

Even though this paper did have limitations like having a small sample size, there was no long term follow up on the patients, and it was a short study, I believe it gives a good insight on different ways we can treat lateral epicondylitis (tennis elbow). Since there was no long term follow up, it is difficult to determine if these treatments are effective for patients with chronic lateral epicondylitis. However, a combination of ultrasound, wrist extension stretching, wrist extensor strengthening, and mobilization with movement of the elbow may be the most effective way to treat this condition according to the article.