A Systematic Review of Randomized Control Trials to Assess Exercise Prescription Practice in Tennis Elbow

Abstract

Background: Aims: 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 - Control trials with randomization Patients with acute or chronic TE participating in any exercise interventions Exercise interventions with a focus of improving function, strength, endurance, quality of life (QoL). Intervention outcome report Patient reported pain: 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 English language text only. Exclusion Criteria - Case reports, preclinical studies, studies reported as abstracts only, systematic review Population, Intervention, Comparator, Outcome Population, Male and female patients diagnosed with TE Intervention, Any intervention involving exercise and stretching Comparison. Comparison of various exercise models and their outcomes. Outcomes, Physical function, ADL, muscle strength, QoL 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. We also involved patient and public in this systematic review.