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• W61398628 abstract "This thesis aims to evaluate the clinical efficacy of three common conservative treatments in themanagement of patients with lateral epicondylalgia (LE): physiotherapy, corticosteroid injectionsand a wait and see approach. Furthermore, this thesis aims to extend our understanding ofsensorimotor deficits in LE and evaluate treatment outcomes using these novel measures ofimpairment. Lateral epicondylalgia (LE) is a chronic musculoskeletal condition that substantiallyimpacts on the Australian health care system. Despite a large number of studies previouslypublished on LE, there remain significant gaps in our knowledge and understanding on theaetiology of the condition and treatments that provide optimal short- and long-term outcomes.With little high level evidence to support the use of physical interventions in the management ofLE, an updated systematic review and meta-analysis was performed (Chapter 3). The results foundevidence against the use of extracorporeal shock wave therapy and insufficient evidence for thelong-term benefit of other physical interventions in general. There was low level evidence of apositive benefit in the use of a manual therapy technique called ‘Mobilisation with Movement’(MWM) as well as therapeutic exercise. Future research was recommended to assess theseinterventions within the framework of a high quality randomised controlled trial (RCT).A RCT was then conducted to investigate the efficacy of a physiotherapy program of MWM andexercise, compared with a wait and see approach and corticosteroid injections over 52 weeks inpatients with LE (Chapter 4). Outcome measures such as pain severity and grip strength wereutilised. Physiotherapy was superior to wait and see in the first six weeks and superior tocorticosteroid injections after six weeks, providing a reasonable alternative to injections in the midtolong-term. The significant short-term benefits of corticosteroid injection were paradoxicallyreversed after six weeks with high recurrence rates, implying that this treatment should be used withcaution in the management of LE.Whilst clinical trials provide insight into the efficacy of interventions for the average population, itwas unknown if the effects of treatment were different for patients with specific characteristics,such as higher pain severity or longer duration of their condition. A subgroup analysis was thereforeconducted using pooled individual patient data from two RCTs (N=383) (Chapter 5). The treatmentoutcomes were largely similar between trials and not different between most subgroups studied. Thesubgroup of patients with higher baseline pain showed no significant difference on pain outcomesbetween physiotherapy and wait and see at six weeks and non-manual workers who had an injectionwere the only work subgroup to demonstrate differential effects between injections and wait and seeon global improvement at 52 weeks. In LE, it would appear that treatment outcomes are onlyminimally dependent on baseline patient characteristics, which supports the generalisability ofindividual trial results.In addition to clinical impairments such as reduced pain free grip strength, there is emergingevidence of sensorimotor impairments in patients with LE. Spontaneous wrist posture during agripping task, upper limb reaction time and speed of movement were investigated in a case controlstudy (Chapter 6). In patients with LE, the posture adopted during a gripping task was in 11° lesswrist extension when compared to a healthy control group. There were also bilateral deficits inupper limb reaction time and speed of movement in patients with unilateral LE.Conservative treatments have demonstrated efficacy in the restoration of sensorimotor function inother musculoskeletal conditions, however the impact conservative treatments have on sensorimotordeficits in LE is unknown. Chapter 7 is the first study to utilise the sensorimotor measures of upperlimb reaction time and speed of movement to evaluate the time course of sensorimotor deficits inlateral epicondylalgia (LE) and how these deficits may be influenced by common conservativetreatments. Overall, despite some improvement over time, there were no significant differencesbetween the treatment groups of physiotherapy, corticosteroid injection and a wait and seeapproach. Significant bilateral deficits remained in patients with LE when compared to healthyindividuals. This prompts conjecture as to the relationship and clinical relevance of sensorimotordeficits in LE.Through improving our understanding of the underlying aetiology and providing an evidence basefor the efficacy of interventions in patients with LE, these findings provide direction for futureresearch." @default.
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• W61398628 date "2008-02-01" @default.
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• W61398628 title "Physiotherapy intervention for patients with lateral epicondylalgia" @default.
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