A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: a meta-analysis of randomized controlled trials.

Estudo comparativo da eficácia do ultrassom e das ondas de choque extracorpóreas no tratamento do cotovelo de tenista: uma metanálise de ensaios clínicos randomizados.

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ID: 4555
2019
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Abstract
Tennis elbow or lateral epicondylitis is a common source of pain among craftsmen. Although it cannot be completely resolved, extracorporeal shock wave therapy (ESWT) and ultrasonics (US) have been found to be effective for tennis elbow as highlighted in previously published randomized controlled trials (RCTs) and reviews. However, the efficacy of these two therapies in treating tennis elbow is unknown. This meta-analysis compares the effectiveness of ESWT and US in relieving pain and restoring the functions of tennis elbow following tendinopathy.RCTs published in the PubMed, Embase, Cochrane Library, and SpringerLink databases comparing ESWT and US in treating tennis elbow were identified by a software and manual search. The risk of bias and clinical relevance of the included studies were assessed. Publication bias was explored using funnel plot and statistical tests (Egger's test and Begg's test). The major outcomes of the studies were analyzed using the Review Manager 5.3.Five RCTs comprising five patients were included in the present meta-analysis. The results revealed a significantly lower VAS score of pain in the ESWT group (1 month: MD = 4.47, p = 0.0001; 3 months: MD = 20.32, p < 0.00001; and 6 months: MD = 4.32, p < 0.0001) compared to US. Besides, the grip strength was markedly higher 3 months after the intervention in ESWT (MD = 8.87, p < 0.00001) than in the US group. Although no significant difference was observed in the scores of the elbow function after 3 months of treatment (SMD = 1.51, p = 0.13), the subjective scores of elbow functions were found to be better in the ESWT group (SMD = 3.34; p = 0.0008) compared to the US group.Although there was no significant difference in the elbow function evaluation scores between ESWT and US, the superiority of the ESWT group in the VAS of pain (both at 1 month, 3 months, and 6 months follow-ups) raised grip strength in ESWT group and the scores for subjective evaluation of efficacy indicated that ESWT offers more effective therapy for lateral epicondylitis than US therapy.
O cotovelo de tenista ou epicondilite lateral é uma causa comum de dor entre trabalhadores manuais. Embora não possa ser completamente resolvida, a terapia por ondas de choque extracorpóreas (ESWT) e o ultrassom (US) demonstraram ser eficazes para o cotovelo de tenista, conforme destacado em ensaios clínicos randomizados (ECRs) e revisões publicados anteriormente. No entanto, a eficácia dessas duas terapias no tratamento do cotovelo de tenista é desconhecida. Esta metanálise compara a eficácia da ESWT e do US no alívio da dor e na restauração funcional do cotovelo de tenista decorrente de tendinopatia. ECRs publicados nas bases de dados PubMed, Embase, Cochrane Library e SpringerLink comparando a ESWT e o US no tratamento do cotovelo de tenista foram identificados por meio de busca manual e em software. O risco de viés e a relevância clínica dos estudos incluídos foram avaliados. O viés de publicação foi investigado utilizando gráfico de funil e testes estatísticos (teste de Egger e teste de Begg). Os principais desfechos dos estudos foram analisados por meio do Review Manager 5.3. Cinco ECRs compreendendo cinco pacientes foram incluídos na presente metanálise. Os resultados revelaram um escore de dor na EVA significativamente menor no grupo ESWT (1 mês: MD = 4,47, p = 0,0001; 3 meses: MD = 20,32, p < 0,00001; e 6 meses: MD = 4,32, p < 0,0001) em comparação ao US. Além disso, a força de preensão manual foi marcadamente superior 3 meses após a intervenção no grupo ESWT (MD = 8,87, p < 0,00001) em relação ao grupo US. Embora nenhuma diferença significativa tenha sido observada nos escores de função do cotovelo após 3 meses de tratamento (SMD = 1,51, p = 0,13), os escores subjetivos das funções do cotovelo mostraram-se superiores no grupo ESWT (SMD = 3,34; p = 0,0008) em comparação ao grupo US. Embora não tenha havido diferença significativa nos escores de avaliação da função do cotovelo entre a ESWT e o US, a superioridade do grupo ESWT na EVA de dor (nos acompanhamentos de 1 mês, 3 meses e 6 meses), o aumento da força de preensão no grupo ESWT e os escores de avaliação subjetiva de eficácia indicaram que a ESWT oferece uma terapia mais eficaz para a epicondilite lateral do que a terapia por US.
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Authors Yan, Chenchen;Xiong, Yuan;Chen, Lang;Endo, Yori;Hu, Liangcong;Liu, Mengfei;Liu, Jing;Xue, Hang;Abududilibaier, Abudula;Mi, Bobin;Liu, Guohui;
Journal journal of orthopaedic surgery and research
Year 2019
DOI
10.1186/s13018-019-1290-y
URL
Keywords Keywords not found

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