A SYSTEMATIC REVIEW OF RANDOMIZED CONTROL TRIALS TO ASSESS EXERCISE PRESCRIPTION PRACTICE IN TENNIS ELBOW

J. Rai¹, E Ivemey², O Khaiyat³, C. Coulthard⁴, E Turgut⁵, D Towey⁶, T Richardson⁷, J Mohammed⁷

¹Kent Community Health NHS Foundation Trust, Integrated Musculoskeletal Physiotherapy, Ashford, United Kingdom, ²Lincolnshire Community Health NHS Foundation Trust, IMSK, Lincolnshire, United Kingdom, ³Liverpool Hope University, Rehabilitation, Liverpool Hope University, United Kingdom, ⁴Ashford and St Peter's Hospitals NHSFT, IMSK, Surrey, United Kingdom, ⁵Hacettepe University, Physiotherapy and Rehabilitation, Ankara, Turkey, ⁶Lincolnshire Community Health NHSFT, IMSK, Lincolnshire, United Kingdom, ⁷Lincolnshire Community Health NHS Trust, IMSK, Lincolnshire, United Kingdom

Background: TE accounts for two-thirds of cases seen in general practice, with the population prevalence estimated up to 3% and an incidence of 4–7 per 1000 individuals a year. Some studies have suggested no intervention to be as effective as conservative or surgical management. Furthermore, the National Institute for Health and Care Excellence (NICE) guidelines recommend stretching and strengthening exercises along with eccentric loading of the wrist extensor muscles for the management of TE (NICE 2020). There are concerns about the appropriate integration of underpinning scientific rationale and methodology when designing exercise programmes for Tennis Elbow (TE) rehabilitation and their subsequent efficacy towards achieving optimal outcomes. Patient and public were involved in developing the systematic review throughout the process so that their lived experience can be used to improve the intervention.

Purpose: To systematically review the exercise prescription practices in the management of Tennis Elbow.

Methods: A comprehensive literature search was conducted using recommended methods using Boolean logic with the following terms: physiotherapy; physical therapy; rehabilitation; exercise; tennis elbow; lateral epicondylitis and lateral elbow tendinopathy. The study was registered under PROSPERO registration number: CRD42021281976. PICO and PRISMA was used to guide the search and report the process of synthesizing the search results. The quality of the RCTs was assessed using The Physiotherapy Evidence Database (PEDro) scale.
Inclusion criteria: Randomised controlled trials, Control trials with randomization, adults with diagnosis of TE participating
Exercise interventions and their outcomes.
Patient-reported: pain, physical function, QoL, activities of daily living (ADL), work and social life,
Objective: physical performance, range of motion, strength, and endurance
Duration: 2015 to 2021
Available full-text in English language only
Exclusion criteria: Case reports, preclinical studies, studies reported as abstracts only.
P - Adults with diagnosis of TE.
I - Exercise therapy
C - Exercise models and outcomes
O - Physical function, ADL, muscle strength, quality of life.

Results: Out of the total of 848 articles that were identified from the initial search 22 RCT’s were shortlisted for the current systematic review. On the PEDro scale, of the 22 RCT’s only 2 scored as excellent, 12 as good, 7 fair and 1 poor. Majority of the studies failed to outline their scientific rationale for choosing exercises and have also not provided science behind exercise progression aimed at achieving optimal benefits.

Conclusions: There is clearly a paucity of high-quality evidence available to guide physiotherapists in designing and progressing exercise programs for patients with TE. Further research in the field of exercise prescription and related progression and dosage is required to provide more robust evidence in prescribing exercise for the management of TE in clinical practice.

Implications: There is need to improve the description of exercise therapy prescription in TE in clinical trials in terms of dosage, load and repetitions. Involvement of patient and public is crucial at all stages of the research including systematic review so that their lived experience can help to improve the outcome of the interventions.

Funding acknowledgements: N/A

Keywords:
Tennis elbow
Exercise prescription
Dosage, load and repetition

Topics:
Research methodology, knowledge translation & implementation science
Musculoskeletal: upper limb

Did this work require ethics approval? No

Reason: Not applicable as its only systematic review of literature only.