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Conservative treatments for tennis elbow—do subgroups of patients respond differently?
1School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 2School of Physiotherapy and Exercise Science, Griffith University, Gold Coast, Australia, 3Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands, 4MRC Health Service Research Collaboration, Department of Social Medicine, University of Bristol, Bristol, UK, 5EMGO Institute, VU University Medical Center, The Netherlands, 6Primary Care Musculoskeletal Research Centre, Keele University, Staffordshire, UK and 7Faculty of Health Sciences, University of Queensland, Brisbane, Australia.
Correspondence to: B. Vicenzino, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia Qld 4072, Australia. E-mail: b.vicenzino{at}uq.edu.au
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Abstract |
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Objectives. To determine if subgroups of patients with tennis elbow respond differently in treatment.
Methods. This study used individual patient data (n = 383) from two randomized controlled trials that investigated a wait-and-see policy, corticosteroid injections and physiotherapy. Common outcome measures were: pain severity, global improvement, severity assessed by a blinded assessor, elbow disability and pain free grip strength. Subgroup analyses for previous history of elbow pain, baseline pain severity, duration of the current episode and employment status were performed at 6 and 52 weeks.
Results. Patients’ age, previous elbow symptoms and baseline pain severity were similar between trials, but other characteristics differed between trial populations. Based on individual patient data from both trials, we found that corticosteroid injections were statistically and clinically superior at 6 weeks, but significantly worse at 52 weeks compared with both wait-and-see and physiotherapy. Subgroup effects were scarce and small. Patients with higher baseline pain score showed less benefit on pain outcomes between physiotherapy and a wait-and-see policy at 6 weeks. It also appeared that non-manual workers who had an injection were the only work subgroup to follow the general trend that injections were significantly worse than a wait-and-see policy on global improvement at 52 weeks.
Conclusion. The treatment outcomes were largely similar between trials and not different between most subgroups studied. In tennis elbow, it would appear that patient characteristics play only a small role in predicting treatment outcomes, which supports the generalizability of individual trial results.
KEY WORDS: Tennis elbow, Randomized controlled trials, Corticosteroid injections, Physiotherapy
Submitted 13 April 2007; Accepted 21 June 2007