Comparison of effects of exercise programme, pulsed ultrasound and transverse friction in the treatment of chronic patellar tendinopathy

OBJECTIVE

To compare the effectiveness of an exercise programme, pulsed ultrasound and transverse friction in the treatment of chronic patellar tendinopathy.

DESIGN

Randomized controlled trial.

SETTING

Rheumatology and Rehabilitation Centre.

SUBJECTS

This study was carried out with 30 patients who had chronic patellar tendinopathy. They were randomized into three groups.

INTERVENTIONS

Group A (n = 10) was treated with exercise programme. Pulsed ultrasound was given to group B (n = 10). Group C (n = 10) received transverse friction. All patients received three treatments per week for four weeks.

OUTCOMES

Patients' pain was evaluated at the end of the four-week course of treatment (week 4), one month (week 8) and three months (week 16) after the end of treatment.

RESULTS

The exercise programme was statistically significantly better than the other two treatments at the end of treatment (chi2 = 12.21, p < 0.01), one month (chi2 = 23.2, p < 0.001) and three months (chi2 = 23.2, p < 0.001) after the end of the treatment.

CONCLUSION

Although the results suggested that the exercise programme was more effective treatment than ultrasound and transverse friction at the end of the treatment as well as at the follow-ups, future controlled studies are needed to establish the relative and absolute effectiveness of each of the three treatment interventions.

Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players

BACKGROUND

Ankle sprains are the most common form of acute injury in volleyball. A prevention programme consisting of technical training, proprioceptive training, and external support was previously designed to reduce the rate of ankle sprains in volleyball players.

OBJECTIVE

To investigate which of these three interventions is the most effective in preventing ankle sprain in female volleyball players.

METHODS

Participants were 52 players who suffered ankle sprains during the season 1998-1999. They were divided randomly into three preventive groups: group 1 (n = 18) followed the technical training programme; group 2 (n = 17) followed the proprioceptive programme; group 3 (n = 17) used orthosis. The players followed their respective programmes for the whole of the 1999-2000 season. Data were collected at the end of the season.

RESULTS

The three preventive strategies were all effective in preventive further ankle sprain. Technical training was slightly more effective than the other two methods. Orthosis was not effective in athletes who had suffered ankle sprains more than three times during their careers. Under those circumstances, technical training and proprioceptive training were equally effective at preventive further sprains.

CONCLUSIONS

Technical training and proprioceptive training are effective methods of preventing ankle sprain in volleyball players who have suffered this injury four or more times during their career. Orthosis appears effective only in players with fewer than four previous sprains.

An exercise programme for the management of lateral elbow tendinopathy

BACKGROUND

Home exercise programmes and exercise programmes carried out in a clinical setting are commonly advocated for the treatment of lateral elbow tendinopathy (LET), a very common lesion of the arm with a well-defined clinical presentation. The aim of this study is to describe the use and effects of strengthening and stretching exercise programmes in the treatment of LET.

ECCENTRIC EXERCISES

Slow progressive eccentric exercises for LET should be performed with the elbow in extension, forearm in pronation, and wrist in extended position (as high as possible). However, it is unclear how the injured tendon, which is loaded eccentrically, returns to the starting position without experiencing concentric loading and how the "slowness" of eccentric exercises should be defined. Nor has the treatment regimen of the eccentric exercises of a supervised exercise programme been defined.

STRETCHING EXERCISES

Static stretching is defined as passively stretching a given muscle-tendon unit by slowly placing and maintaining it in a maximal position of stretch. We recommend the position should be held for 30-45 s, three times before and three times after eccentric exercises during each treatment session with a 30 s rest interval between each procedure. The treatment region of static stretching exercises when a supervised exercise programme is performed is unknown.

DISCUSSION

A well designed trial is needed to study the effectiveness of a supervised exercise programme for LET consisting of eccentric and static stretching exercises. The issues relating to the supervised exercise programme should be defined so that therapists can replicate the programme.

A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy

BACKGROUND

The use of ice as a supplement to an exercise programme has been recommended for the management of lateral elbow tendinopathy (LET). No studies have examined its effectiveness.

OBJECTIVES

To investigate whether an exercise programme supplemented with ice is more successful than the exercise programme alone in treating patients with LET.

METHODS

Patients with unilateral LET for at least four weeks were included in this pilot study. They were sequentially allocated to receive five times a week for four weeks either an exercise programme with ice or the exercise programme alone. The exercise programme consisted of slow progressive eccentric exercises of wrist extensors and static stretching of the extensor carpi radialis brevis tendon. In the exercise programme/ice group, the ice was applied after the exercise programme for 10 minutes in the form of an ice bag to the facet of the lateral epicondyle. Patients were evaluated at baseline, at the end of treatment, and three months after the end of treatment. Outcome measures used were the pain visual analogue scale and the dropout rate.

RESULTS

Forty patients met the inclusion criteria. At the end of treatment there was a decline in visual analogue scale of about 7 units in both groups compared with baseline (p<0.0005, paired t test). There were no significant differences in the magnitude of reduction between the groups at the end of treatment and at the three month follow up (p<0.0005, independent t test). There were no dropouts.

CONCLUSIONS

An exercise programme consisting of eccentric and static stretching exercises had reduced the pain in patients with LET at the end of the treatment and at the follow up whether or not ice was included. Further research to establish the relative, absolute, and cost effectiveness as well as the mechanism of action of the exercise programme is needed.

Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy

STUDY DESIGN

RCT.

INTRODUCTION

Lateral elbow tendinopathy is a common clinical condition. eccentric exercises. eccentric-concentric loading and, isometric exercises are indicated to reduce and manage tendon pain.

PURPOSE OF THE STUDY

To compare the effectiveness of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy.

METHODS

A randomized clinical trial was carried out in a rheumatology and rehabilitation center. A group of 34 patients with later elbow tendinopathy was randomly allocated to Group A (n = 11) who underwent eccentric training, Group B had eccentric-concentric and Group C who had eccentric-concentric and isometric training. All patients received 5 treatments per week for 4 weeks. Pain was evaluated using a visual analog scale and function using a visual analog scale and pain-free grip strength at the end of the 4-week course of treatment (week 4) and 1 month (week 8) after the end of treatment.

RESULTS

The eccentric-concentric training combined with isomentric contractions produced the largest effect in the reduction of pain and improvement of function at the end of the treatment (P < .05) and at any of the follow-up time points (P < .05).

CONCLUSION

The eccentric-concentric training combined with isomentric contractions was the most effective treatment. Future well-designed studies are needed to confirm the results of the present trial.

LEVEL OF EVIDENCE

III.

Comparison of effects of Cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (Bioptron light) for the treatment of lateral epicondylitis

OBJECTIVE

To compare the effectiveness of Cyriax physiotherapy, a supervised exercise programme, and polarized polychromatic non-coherent light (Bioptron light) in the treatment of lateral epicondylitis.

DESIGN

Controlled clinical trial.

SETTING

Rheumatology and rehabilitation centre.

SUBJECTS

This study was carried out with 75 patients who had lateral epicondylitis. They were allocated to three groups by sequential allocation.

INTERVENTIONS

Group A (n = 25) was treated with Cyriax physiotherapy. A supervised exercise programme was given to group B (n = 25). Group C (n = 25) received polarized polychromatic non-coherent light (Bioptron light). All patients received three treatments per week for four weeks.

OUTCOMES

Pain was evaluated using a visual analogue scale and function using a visual analogue scale and pain-free grip strength at the end of the four-week course of treatment (week 4), one month (week 8), three months (week 16) and six months (week 28) after the end of treatment.

RESULTS

The supervised exercise programme produced the largest effect in the reduction of pain and in the improvement of function at the end of the treatment (P<0.05) and at any of the follow-up time points (P< 0.05).

CONCLUSION

The supervised exercise programme should be the first treatment option for therapists when they manage lateral epicondylitis patients. If this is not possible, Cyriax physiotherapy and polarized polychromatic non-coherent light (Bioptron light) may be suitable.

Cyriax physiotherapy for tennis elbow/lateral epicondylitis

Tennis elbow or lateral epicondylitis is one of the most common lesions of the arm with a well defined clinical presentation, which significantly impacts on the community. Many treatment approaches have been proposed to manage this condition. One is Cyriax physiotherapy. The effectiveness and reported effects of this intervention are reviewed.

'Lateral elbow tendinopathy' is the most appropriate diagnostic term for the condition commonly referred-to as lateral epicondylitis

A plethora of terms that have been used to describe lateral epicondylitis including tennis elbow (TE), epicondylalgia, tendonitis, tendinosis and tendinopathy. These terms usually have the prefix extensor or lateral elbow. Lateral elbow tendinopathy seems to be the most appropriate term to use in clinical practice because other terms make reference to inappropriate aetiological, anatomical and pathophysiological terms. The correct diagnostic term is important for the right treatment.

Effectiveness of extracorporeal shock wave therapy for tennis elbow (lateral epicondylitis)

Randomised controlled trials were reviewed to evaluate the evidence of the effectiveness of extracorporeal shock wave therapy in the management of tennis elbow. Seven relevant trials were found, which had satisfactory methodology but conflicting results. Further research with well designed randomised control trials is needed to establish the absolute and relative effectiveness of this intervention for tennis elbow.

Comparing the effects of eccentric training with eccentric training and static stretching exercises in the treatment of patellar tendinopathy. A controlled clinical trial

OBJECTIVE

The aim of the present study was to investigate the effectiveness of eccentric training and eccentric training with static stretching exercises in the management of patellar tendinopathy.

DESIGN

Controlled clinical trial.

SETTING

Rheumatology and rehabilitation centre.

SUBJECTS

Forty-three patients who had patellar tendinopathy for at least three months. They were allocated to two groups by alternative allocation.

INTERVENTIONS

Group A (n = 22) was treated with eccentric training of patellar tendon and static stretching exercises of quadriceps and hamstrings and Group B (n = 21) received eccentric training of patellar tendon. All patients received five treatments per week for four weeks.

OUTCOMES

Pain and function were evaluated using the VISA-P score at baseline, at the end of treatment (week 4), and six months (week 24) after the end of treatment.

RESULTS

At the end of treatment, there was a rise in VISA-P score in both groups compared with baseline (P<0.0005, paired t test). There were significant differences in the VISA-P score between the groups at the end of treatment (+14; 10 to 18) and at the six-month follow-up (+19; 13 to 24); eccentric training and static stretching exercises produced the largest effect (P<0.0005, one-way ANOVA).

CONCLUSIONS

Eccentric training and static stretching exercises is superior to eccentric training alone to reduce pain and improve function in patients with patellar tendinopathy at the end of the treatment and at follow-up.

Comparison of effects of a home exercise programme and a supervised exercise programme for the management of lateral elbow tendinopathy

BACKGROUND

Home and supervised exercise programmes consisting of stretching and eccentric exercises have been recommended for the management of lateral elbow tendinopathy (LET). No studies have examined their comparative efficacy effectiveness.

OBJECTIVE

In this study, whether a home exercise programme is more successful than a supervised exercise programme in treating patients with LET was investigated.

METHODS

Patients with unilateral LET for at least 4 weeks were included in this trial. They were sequentially allocated to receive either a home exercise programme or a supervised exercise programme five times a week for 12 weeks. The exercise programme consisted of slow progressive eccentric exercises of wrist extensors and static stretching of the extensor carpi radialis brevis tendon. Outcome measures were pain, using a visual analogue scale, and function, using a visual analogue scale and the pain-free grip strength. Patients were evaluated at baseline, at the end of treatment (week 12), and 3 months (week 24) after the end of treatment.

RESULTS

70 patients met the inclusion criteria. At the end of treatment, there was a decline in pain and a rise in function in both groups compared with baseline (p<0.0005, paired t test). There were significant differences in the reduction of pain and the improvement of function between the groups at the end of treatment and at the 3-month follow up; the supervised exercise programme produced the largest effect (p<0.0005, independent t test).

CONCLUSIONS

Supervised exercise programme is superior to home exercise programme to reduce pain and improve function in patients with LET at the end of the treatment and at the follow-up. Further research is needed to confirm our results.

Effectiveness of low-level laser therapy for lateral elbow tendinopathy

OBJECTIVE

Our aim was to determine the effectiveness of low-lever laser therapy (LLLT) in the management of lateral elbow tendinopathy (LET) and to provide recommendations based on this evidence.

BACKGROUND DATA

LET is a common clinical condition, and a wide array of physiotherapy treatments is used for treating LET.

METHODS

Randomized controlled trials (RCTs) identified by a search strategy in six databases were used in combination with reference checking. RCTs that included LLLT, patients with LET, and at least one of the clinically relevant outcome measure were selected. Aqualitative analysis of the selected studies was conducted using the Chalmers' technique.

RESULTS

Nine RCTs fulfilled the criteria and were included in the review. Although these studies had satisfactory methodology, shortcomings were not absent; poor results were revealed as to the effectiveness of LLLT for LET management.

CONCLUSIONS

LLLT need not be ruled out for LET as it is a dose-response modality, and the optimal treatment dose has obviously not yet have been discovered. Further research with well-designed RCTs is needed to establish the absolute and relative effectiveness of this intervention for LET.

Treatment of spondylolysis with external electrical stimulation in young athletes: a critical literature review

Lumbar spondylolysis is a common cause of low back pain in adolescent athletes. It is a unilateral or bilateral defect of the pars interarticularis. The cause is still a matter of debate. A wide range of conservative treatments has been used. The purpose of this critical literature review is to investigate the efficacy of external electrical stimulation in the healing of this disorder.

Comparing the effects of exercise program and low-level laser therapy with exercise program and polarized polychromatic non-coherent light (bioptron light) on the treatment of lateral elbow tendinopathy

BACKGROUND DATA

The use of low-level laser therapy (LLLT) and polarized polychromatic non-coherent light as supplements to an exercise program has been recommended for the management of lateral elbow tendinopathy (LET).

OBJECTIVE

To investigate whether an exercise program supplemented with LLLT is more successful than an exercise program supplemented with polarized polychromatic non-coherent light in treating LET.

MATERIALS AND METHODS

Patients with unilateral LET for at least 4 wk were sequentially allocated to receive either an exercise program with LLLT or an exercise program with polarized polychromatic non-coherent light. The exercise program consisted of eccentric and static stretching exercises of wrist extensors. In the LLLT group a 904-nm Ga-As laser was used in continuous mode, and the power density was 130 mW/cm(2), and the dose was 0.585 J/point. In the group receiving polarized polychromatic non-coherent light the Bioptron 2 was used to administer the dose perpendicularly to the lateral epicondyle at three points at an operating distance of 5-10 cm for 6 min at each position. The outcome measures were pain and function and were evaluated at baseline, at the end of the treatment (week 4), and 3 mo after the end of treatment (week 16).

RESULTS

Fifty patients met the inclusion criteria. At the end of treatment there was a decline in pain and a rise in function in both groups compared with baseline (p < 0.0005 on the paired t-test). There were no significant differences in the reduction of pain and the improvement of function between the groups at the end of treatment and at the 3-mo follow-up (p > 0.0005 on the independent t-test).

CONCLUSIONS

The results suggest that the combination of an exercise program with LLLT or polarized polychromatic non-coherent light is an adequate treatment for patients with LET. Further research to establish the relative and absolute effectiveness of such a treatment approach is needed.

Comparing two eccentric exercise programmes for the management of Achilles tendinopathy. A pilot trial

OBJECTIVE

To compare eccentric and static exercises as proposed by Stanish with eccentric exercises as proposed by Alfredson in the management of Achilles tendinopathy.

METHODS

Patients with midportion Achilles tendinopathy for at least 3 months were included in this trial. They were sequentially allocated to receive either Stanish's exercise programme or Alfredson's exercise programme. Outcome measures were pain and function using the VISA-A score. Patients were evaluated at baseline, at the end of treatment (week 12), and 6 months (week 36) after the end of treatment.

RESULTS

41 patients met the inclusion criteria. At the end of treatment, there was a rise in VISA-A score in both groups compared with baseline (p < 0.05, paired t-test). There were significant differences in the VISA-A score between the groups at the end of treatment and at the 6-month follow up; Alfredson exercise programme group produced the largest effect (p < 0.0005, independent t-test).

CONCLUSION

An exercise programme based on Alfredson protocol was superior to Stanish model to reduce pain and improve function in patients with Achilles tendinopathy at the end of the treatment and at the follow-up. Further research is needed to confirm our results.

Lateral elbow tendinopathy: Evidence of physiotherapy management

Lateral elbow tendinopathy (LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation.

Exercise for tendinopathy

Tendinopathies are one of the most common sports/musculoskeletal injury in modern western societies. Many physiotherapy approaches have been recommended in the literature for the management of tendinopathy. The most effective treatment in the management of tendinopathy is the eccentric training. Load, speed and frequency of contractions are the three principles of eccentric exercises, discussed in this report. However, eccentric training is not effective for all patients with tendinopathy and the effectiveness of this approach when applied as monotherapy is lower than it is applied as part of the rehabilitation process. For this reason, clinicians combine eccentric training with other physiotherapy techniques such as stretching, isometric and lumbar stability exercises, electrotherapy, manual therapy, soft tissue manipulation techniques, taping and acupuncture in the management of tendinopathies. Further research is needed to find out which treatment strategy combined with eccentric training will provide the best results in the rehabilitation of tendinopathy.

Comparing hip and knee focused exercises versus hip and knee focused exercises with the use of blood flow restriction training in adults with patellofemoral pain

BACKGROUND

Hip and knee strengthening exercises are implemented in rehabilitation of patellofemoral pain patients, but typically use high loads (70% of 1 repetition maximum). This may lead to increased patellofemoral joint stress. Low load training (20-30% of 1 repetition maximum) with blood flow restriction could allow for exercise strength benefits to proximal and distal muscles with reduced joint stress and by promoting hypoalgesia.

AIM

The aim of this study was to compare hip and knee focused exercises with and without blood flow restriction in adults with patellofemoral pain for short term effectiveness.

DESIGN

A randomized observed-blind controlled trial.

SETTING

Musculoskeletal laboratories of the European University Cyprus, Nicosia, Cyprus.

POPULATION

60 volunteer patients, 18-40 years of age with patellofemoral pain.

METHODS

Participants were randomly assigned to (1 reference group) hip and knee strengthening at (70% of 1 repetition maximum) or (2 experimental group) Strengthening with blood flow restriction at (30% of 1 repetition maximum at 70% of limb occlution pressure). Treatments took place 3 times per week for 4weeks and outcomes were assessed at baseline, end of treatment and at 2-month follow-up. The primary outcome was the Kujala Anterior Knee Pain Scale and secondary outcomes were worst and usual pain, pain with Single leg Squats, the maximum pain free flexion angle, the Tampa Scale of kinesiophobia, the Pain Catastrophizing Scale and isometric strength of knee extensors, hip extensors and hip abductors.

RESULTS

No difference were found for the main outcome of this study between groups. There was a significant effect of time for all outcome measures in both groups. Between group differences showed a significant difference for isometric strength of Knee extensor values at 2 month follow-up F(1,58)=5.56, P=0.02, partial η2=0.09, 459.4 (412.13, 506.64) vs. 380.68 (333.42, 427.93) and in worst pain post-treatment F(1,58)=5.27, P=0.02, partial η2=0.08, 0.76 (0.48, 1.04) vs. reference group 1.30 (0.91, 1.68) with significantly better scores in the blood flow restriction group.

CONCLUSIONS

Blood flow restriction exercises of the hip and knee musculature used in this study were as effective as usual exercises of Hip and knee musculature in reducing symptoms in the short term. They also indicated greater increases in strength and reduction of worst pain post-treatment.

CLINICAL REHABILITATION IMPACT

Further research is needed to investigate the dose response relationship with longer follow-ups.

Treatment of carpal tunnel syndrome with polarized polychromatic noncoherent light (Bioptron light): a preliminary, prospective, open clinical trial

OBJECTIVE

Our aim was to assess the efficacy of polarized polychromatic noncoherent light (Bioptron light) in the treatment of idiopathic carpal tunnel syndrome.

BACKGROUND

Carpal tunnel syndrome is the most common compression neuropathy, but no satisfactory conservative treatment is available at present.

METHOD

An uncontrolled experimental study was conducted in patients who visited our clinic from mid-2001 to mid-2002. A total of 25 patients (22 women and three men) with unilateral idiopathic carpal tunnel syndrome, mild to moderate nocturnal pain, and paraesthesia lasting >3 months participated in the study. The average age of the patients was 47.4 years and the average duration of patients' symptoms was 5.2 months. Polarized polychromatic noncoherent light (Bioptron light) was administered perpendicular to the carpal tunnel area. The irradiation time for each session was 6 min at an operating distance of 5-10 cm from the carpal tunnel area, three times weekly for 4 weeks. Outcome measures used were the participants' global assessments of nocturnal pain and paraesthesia, respectively, at 4 weeks and 6 months.

RESULTS

At 4 weeks, two patients (8%) had no change in nocturnal pain, six (24%) were in slightly less nocturnal pain, 12 (48%) were much better in regard to nocturnal pain and five (20%) were pain-free. At 6 months, three patients (12%) were slightly better in regard to nocturnal pain, 13 (52%) were much better regarding nocturnal pain, and nine patients (36%) were pain-free. At 4 weeks, four patients (16%) had no change in paraesthesia, five (20%) were slightly better, 13 patients (52%) were much better, and three patients (12%) were without paraesthesia. At 6 months, two patients (8%) had no change in paraesthesia, two (8%) were slightly better, 14 (56%) were much better, and seven (28%) were without paraesthesia.

CONCLUSIONS

Nocturnal pain and paraesthesia associated with idiopathic carpal tunnel syndrome improved during polarized polychromatic noncoherent light (Bioptron light) treatment. Controlled clinical trials are needed to establish the absolute and relative effectiveness of this intervention.

Greek adaptation and validation of the Patient-Rated Tennis Elbow Evaluation (PRTEE)

PURPOSE OF THE STUDY

To cross-culturally adapt and validate the Greek version of the Patient-Rated Tennis Elbow Evaluation (PRTEE-G) Questionnaire.

METHODS

Four bi-lingual translators were involved in the translation and cultural adaptation procedures. Eighty-two patients (61 women and 21 men) with Lateral Elbow Tendinopathy (LET) participated in the study. To establish test - retest reliability, the patients were asked to complete the PRTEE-G Questionnaire before and after the first physiotherapy treatment. Internal consistency of the translated instrument was measured using Cronbach 'alpha'. An intraclass correlation coefficient was used to assess the test - retest reliability of the PRTEE-G Questionnaire. Concurrent validity was measured by correlating the PRTEE-G Questionnaire scores with the Greek version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) scores using Pearson's correlation coefficient.

RESULTS

The Greek PRTEE questionnaire has acceptable internal consistency (Cronbach 'alpha' = 0.95), excellent test - retest reliability (ICC = 0.94) and demonstrates expected concurrent validity (r > 0.72).

CONCLUSION

The Greek version of PRTEE Questionnaire is a reliable and valid measure when administered to patients with LET.

The use of Bioptron light (polarized, polychromatic, non-coherent) therapy for the treatment of acute ankle sprains

Purpose The purpose of this study was to investigate the efficacy of Bioptron light therapy for the treatment of acute ankle sprains. Method A parallel group, single-blind, controlled study was carried out in patients with grade II acute ankle sprains. Patients were randomly allocated into two treatment groups (n = 25 for each). Both groups received cryotherapy, and the test group also received Bioptron light therapy. All treatments were performed daily for 5 d. Evaluations included self-reported pain via a visual analogue scale, degree of ankle edema, and ankle range of motion via goniometry carried out before the treatment and at the end of the treatment. Results The test group showed the largest magnitude of improvement for all evaluations at treatment five, and the between-group differences observed were statistically significant (p < 0.0005 for each). Conclusions These data provide preliminary evidence of the efficacy of Bioptron light therapy supplemented with cryotherapy for the treatment of acute ankle sprains; however, larger studies are required to confirm these results. Implications for Rehabilitation Ankle sprains are common acute injuries among professional and recreational sports players but also among people in general. Cryotherapy is the first-standard treatment of acute ankle sprains. Phototherapy such as Bioptron light has been recommended supplement to cryotherapy to reduce the symptoms of ankle sprains. The results of the present trial showed that using BIOPTRON LIGHT and cryotherapy the rehabilitation period of acute ankle sprains can be reduced.

Development of a core outcome set for lateral elbow tendinopathy (COS-LET) using best available evidence and an international consensus process

OBJECTIVES

To develop a core outcome set for lateral elbow tendinopathy (COS-LET) and to provide guidance for outcome evaluation in future studies.

METHODS

We implemented a multi-stage mixed-methods design combining two systematic reviews, domain mapping of outcome measurement instruments to the core domains of tendinopathy, psychometric analysis of instruments, two patient focus groups and a Delphi study incorporating two surveys and an international consensus meeting. Following the OMERACT guidelines, we used a 70% threshold for consensus.

RESULTS

38 clinicians/researchers and 9 patients participated. 60 instruments were assessed for inclusion. The only instrument that was recommended for the COS-LET was Patient Rated Tennis Elbow Evaluation (PRTEE) for the disability domain. Interim recommendations were made to use: the PRTEE function subscale for the function domain; PRTEE pain subscale items 1, 4 and 5 for the pain over a specified time domain; pain-free grip strength for the physical function capacity domain; a Numerical Rating Scale measuring pain on gripping for the pain on activity/loading domain; and time off work for the participation in life activities domain. No recommendations could be made for the quality-of-life, patient rating of condition and psychological factors domains.

CONCLUSIONS

The COS-LET comprises the PRTEE for the disability domain. Interim-use recommendations included PRTEE subscales, time off work, pain-free grip strength and a Numerical Rating Scale measuring pain on gripping. Further work is required to validate these interim measures and develop suitable measures to capture the other domains.

The use of polarized polychromatic non-coherent light as therapy for acute tennis elbow/lateral epicondylalgia: a pilot study

OBJECTIVE

The aim of this study was to assess the efficacy of polarized, polychromatic, non-coherent, low energy light (Bioptron 2, Bioptron AG, Switzerland) in the treatment of acute tennis elbow.

BACKGROUND

Tennis elbow, or lateral epicondylitis, is one of the most common lesions affecting the arm. A plethora of treatment regimes have been described for this condition, but no specific therapy has emerged as a gold standard.

METHODS

A pilot study was carried out with 25 patients who had acute tennis elbow. Bioptron 2 device was applied over lateral epicondyle three times per week for 4 weeks. Pain on VAS, function on VAS, and painfree grip strength were measured at the beginning (week 0) and at the end of the study (week 4).

RESULTS

The pain on VAS was reduced at the end of treatment (t(24) = 3.84, p = 0.001). Function on VAS was increased at the end of treatment (t(24) = 4.23, p < 0.001). Pain-free grip strength was increased at the end of treatment (t(24) = 4.23, p < 0.004).

CONCLUSION

Although the results suggested that the Bioptron 2 could reduce patients' symptoms with acute tennis elbow, future controlled studies are needed to establish the relative and absolute effectiveness of Bioptron 2.

Effectiveness of Low Level Laser Therapy (LLLT) in the treatment of Lateral elbow tendinopathy (LET): an umbrella review

PURPOSE

The aim of this umbrella review is to determine the effectiveness of LLLT in the treatment of LET and to provide recommendations based on this evidence.

METHODS

A comprehensive and systematic review was undertaken using Medline, EBSCO and EMBASE. Systematic reviews or meta-analysis were included if they compared Laser with at least one of the following: (i) placebo, (ii) no treatment, (iii) another treatment, conservative (physical therapy intervention or medical) or operative of LET. Principal outcomes included the assessment of short and long-term effect on functional status, pain, grip strength (pain-free or maximum) and a global measure (overall improvement).

RESULTS

Seven papers met the inclusion criteria for the umbrella review, Five papers were of moderate and two of low methodological quality. All reviews reported benefits associated with laser therapy Vs other intervention or placebo, however the significance of the identified benefits differed between studies and reviews. No review reported negative effects of laser therapy or harm to patients. All reviews noted significant variance between included studies with 2 reviews citing statistically significant heterogeneity. It is essential to consider this in the interpretation of these data.

CONCLUSION

This umbrella review found poor results for the effectiveness of LLLT in the management of LET. Therefore, further research with well-designed RCTs is required to provide meaningful evidence on the effectiveness (absolute and relative) of LLLT for the management of LET.

The effects of cognitive behavioural therapy delivered by physical therapists in knee osteoarthritis pain: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Recent evidence suggests that knee osteoarthritis (KOA) chronic pain can result in brain structural and organizational changes. Thus, patients' pain level, emotional status, and perception of their condition might be negatively altered. An approach to reverse such adaptations to chronic pain is cognitive behavioural therapy (CBT). Combining CBT with exercise might enhance therapy outcomes.

OBJECTIVES

To identify the effect of combining exercise and CBT when delivered by a physical therapist in KOA pain.

METHODS

A systematic search in PubMed, Cochrane, and Medline Complete (EBSCO) databases was conducted from their inception to March 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study risk of bias and quality were assessed through the Risk-of-bias 2 (ROB2) and PEDro scales.

RESULTS

Six primary studies met eligibility criteria. All studies had a low risk of bias and were divided into two sub-groups, in-person interventions and distance interventions. Both groups of studies showed within group participant improvements. In regards of WOMAC pain subscale, our meta-analysis revealed an overall deduction of -1.42 (95% CI: -1.76, -1.09; I2 = 58%), -1.62 (95% CI: -1.97, -1.27; I2 = 0%) in centre-based intervention, and -1.28 (95% CI: -1.75, -0.81; I2 = 73%) in distance delivered intervention.

CONCLUSION

Combining exercise and CBT seems to be an effective method to reduce KOA pain, although it is based on a small number of studies. Further studies are needed to reveal any differences when each intervention is applied separately.