Effect of Normal Saline Injections on Lateral Epicondylitis Symptoms: A Systematic Review and Meta-analysis of Randomized Clinical Trials
Background: Lateral epicondylitis, or tennis elbow, is a painful degenerative disorder that commonly occurs in adults between 40 and 60 years of age. Normal saline (NS) injections have been used as placebo through a large number of randomized controlled trials (RCTs) focused on the treatment of late...
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| Veröffentlicht in: | The American journal of sports medicine 2020-10, Vol.48 (12), p.3094-3102 |
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| container_title | The American journal of sports medicine |
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| creator | Acosta-Olivo, Carlos Alberto Millán-Alanís, Juan Manuel Simental-Mendía, Luis Ernesto Álvarez-Villalobos, Neri Vilchez-Cavazos, Félix Peña-Martínez, Víctor Manuel Simental-Mendía, Mario |
| description | Background:
Lateral epicondylitis, or tennis elbow, is a painful degenerative disorder that commonly occurs in adults between 40 and 60 years of age. Normal saline (NS) injections have been used as placebo through a large number of randomized controlled trials (RCTs) focused on the treatment of lateral epicondylitis.
Purpose:
This meta-analysis of RCTs aimed to assess the therapeutic effect of NS injections on lateral epicondylitis symptoms and compare results with established minimal clinically important difference criteria.
Study Design:
Systematic review and meta-analysis.
Methods:
MEDLINE, Embase, Web of Science, and Scopus databases were searched for clinical trials reporting pain and joint function with the visual analog scale, Patient-Rated Tennis Elbow Evaluation, and Disabilities of the Arm, Shoulder and Hand in patients with lateral epicondylitis. The meta-analysis was conducted with a random effects model and generic inverse variance method. Heterogeneity was tested with the I2 statistic index.
Results:
A total of 15 RCTs included in this meta-analysis revealed a significant improvement in pain (mean difference, 3.61 cm [95% CI, 2.29-4.92 cm]; P < .00001; I2 = 88%; visual analog scale) and function (mean difference, 25.65 [95% CI, 13.30-37.99]; P < .0001; I2 = 82%; Patient-Rated Tennis Elbow Evaluation / Disabilities of the Arm, Shoulder and Hand) after NS injection (≥6 months).
Conclusion:
NS injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis. New research should focus on better methods to diminish the potential confounders that could lead to this effect because NS injections could mask the real effect of an active therapeutic intervention in RCT.
Registration:
CRD42019127547 (PROSPERO). |
| doi_str_mv | 10.1177/0363546519899644 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2447817652</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0363546519899644</sage_id><sourcerecordid>2447817652</sourcerecordid><originalsourceid>FETCH-LOGICAL-c365t-cbf728ccf8461f70d8d9499f5186663bcff35ce9b2e03d4835f72bd80ce24c083</originalsourceid><addsrcrecordid>eNp1kEtLAzEUhYMoWqt7VxJwPZpMHpNxV0rVQlWouh4ymURSZiY1SZX6D_zXptQHCK5uuPe759wcAE4wOse4KC4Q4YRRznApypJTugMGmLE8I4SzXTDYjLPN_AAchrBACOGCi31wQHJEWS7QAHxMjNEqQmfgnfOdbOGDbG2v4bRfpL51fYCuhzMZtU_DydIq1zfr1kYb4MO6W0bXhUs4Su8QdSejVXCuX61-g7Jv4K2OMpO9bNch8clknrqus--6gePkY1USffRWtuEI7JlU9PFXHYKnq8nj-Cab3V9Px6NZptKnYqZqU-RCKSMox6ZAjWhKWpaGYcE5J7UyhjClyzrXiDRUEJb4uhFI6ZwqJMgQnG11l969rHSI1cKtfDoxVDmlhUgRsTxRaEsp70Lw2lRLbzvp1xVG1Sb76m_2aeX0S3hVd7r5WfgOOwHZFgjyWf-6_iv4CYQjjQE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2447817652</pqid></control><display><type>article</type><title>Effect of Normal Saline Injections on Lateral Epicondylitis Symptoms: A Systematic Review and Meta-analysis of Randomized Clinical Trials</title><source>MEDLINE</source><source>SAGE Complete</source><source>Alma/SFX Local Collection</source><creator>Acosta-Olivo, Carlos Alberto ; Millán-Alanís, Juan Manuel ; Simental-Mendía, Luis Ernesto ; Álvarez-Villalobos, Neri ; Vilchez-Cavazos, Félix ; Peña-Martínez, Víctor Manuel ; Simental-Mendía, Mario</creator><creatorcontrib>Acosta-Olivo, Carlos Alberto ; Millán-Alanís, Juan Manuel ; Simental-Mendía, Luis Ernesto ; Álvarez-Villalobos, Neri ; Vilchez-Cavazos, Félix ; Peña-Martínez, Víctor Manuel ; Simental-Mendía, Mario</creatorcontrib><description>Background:
Lateral epicondylitis, or tennis elbow, is a painful degenerative disorder that commonly occurs in adults between 40 and 60 years of age. Normal saline (NS) injections have been used as placebo through a large number of randomized controlled trials (RCTs) focused on the treatment of lateral epicondylitis.
Purpose:
This meta-analysis of RCTs aimed to assess the therapeutic effect of NS injections on lateral epicondylitis symptoms and compare results with established minimal clinically important difference criteria.
Study Design:
Systematic review and meta-analysis.
Methods:
MEDLINE, Embase, Web of Science, and Scopus databases were searched for clinical trials reporting pain and joint function with the visual analog scale, Patient-Rated Tennis Elbow Evaluation, and Disabilities of the Arm, Shoulder and Hand in patients with lateral epicondylitis. The meta-analysis was conducted with a random effects model and generic inverse variance method. Heterogeneity was tested with the I2 statistic index.
Results:
A total of 15 RCTs included in this meta-analysis revealed a significant improvement in pain (mean difference, 3.61 cm [95% CI, 2.29-4.92 cm]; P < .00001; I2 = 88%; visual analog scale) and function (mean difference, 25.65 [95% CI, 13.30-37.99]; P < .0001; I2 = 82%; Patient-Rated Tennis Elbow Evaluation / Disabilities of the Arm, Shoulder and Hand) after NS injection (≥6 months).
Conclusion:
NS injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis. New research should focus on better methods to diminish the potential confounders that could lead to this effect because NS injections could mask the real effect of an active therapeutic intervention in RCT.
Registration:
CRD42019127547 (PROSPERO).</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546519899644</identifier><identifier>PMID: 32045280</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Clinical trials ; Elbow ; Humans ; Injections, Intra-Articular ; Meta-analysis ; Pain ; Pain Measurement ; Randomized Controlled Trials as Topic ; Saline Solution - administration & dosage ; Saline Solution - therapeutic use ; Sports medicine ; Systematic review ; Tennis Elbow - drug therapy ; Treatment Outcome</subject><ispartof>The American journal of sports medicine, 2020-10, Vol.48 (12), p.3094-3102</ispartof><rights>2020 The Author(s)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-cbf728ccf8461f70d8d9499f5186663bcff35ce9b2e03d4835f72bd80ce24c083</citedby><cites>FETCH-LOGICAL-c365t-cbf728ccf8461f70d8d9499f5186663bcff35ce9b2e03d4835f72bd80ce24c083</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546519899644$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546519899644$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32045280$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Acosta-Olivo, Carlos Alberto</creatorcontrib><creatorcontrib>Millán-Alanís, Juan Manuel</creatorcontrib><creatorcontrib>Simental-Mendía, Luis Ernesto</creatorcontrib><creatorcontrib>Álvarez-Villalobos, Neri</creatorcontrib><creatorcontrib>Vilchez-Cavazos, Félix</creatorcontrib><creatorcontrib>Peña-Martínez, Víctor Manuel</creatorcontrib><creatorcontrib>Simental-Mendía, Mario</creatorcontrib><title>Effect of Normal Saline Injections on Lateral Epicondylitis Symptoms: A Systematic Review and Meta-analysis of Randomized Clinical Trials</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background:
Lateral epicondylitis, or tennis elbow, is a painful degenerative disorder that commonly occurs in adults between 40 and 60 years of age. Normal saline (NS) injections have been used as placebo through a large number of randomized controlled trials (RCTs) focused on the treatment of lateral epicondylitis.
Purpose:
This meta-analysis of RCTs aimed to assess the therapeutic effect of NS injections on lateral epicondylitis symptoms and compare results with established minimal clinically important difference criteria.
Study Design:
Systematic review and meta-analysis.
Methods:
MEDLINE, Embase, Web of Science, and Scopus databases were searched for clinical trials reporting pain and joint function with the visual analog scale, Patient-Rated Tennis Elbow Evaluation, and Disabilities of the Arm, Shoulder and Hand in patients with lateral epicondylitis. The meta-analysis was conducted with a random effects model and generic inverse variance method. Heterogeneity was tested with the I2 statistic index.
Results:
A total of 15 RCTs included in this meta-analysis revealed a significant improvement in pain (mean difference, 3.61 cm [95% CI, 2.29-4.92 cm]; P < .00001; I2 = 88%; visual analog scale) and function (mean difference, 25.65 [95% CI, 13.30-37.99]; P < .0001; I2 = 82%; Patient-Rated Tennis Elbow Evaluation / Disabilities of the Arm, Shoulder and Hand) after NS injection (≥6 months).
Conclusion:
NS injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis. New research should focus on better methods to diminish the potential confounders that could lead to this effect because NS injections could mask the real effect of an active therapeutic intervention in RCT.
Registration:
CRD42019127547 (PROSPERO).</description><subject>Clinical trials</subject><subject>Elbow</subject><subject>Humans</subject><subject>Injections, Intra-Articular</subject><subject>Meta-analysis</subject><subject>Pain</subject><subject>Pain Measurement</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Saline Solution - administration & dosage</subject><subject>Saline Solution - therapeutic use</subject><subject>Sports medicine</subject><subject>Systematic review</subject><subject>Tennis Elbow - drug therapy</subject><subject>Treatment Outcome</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEtLAzEUhYMoWqt7VxJwPZpMHpNxV0rVQlWouh4ymURSZiY1SZX6D_zXptQHCK5uuPe759wcAE4wOse4KC4Q4YRRznApypJTugMGmLE8I4SzXTDYjLPN_AAchrBACOGCi31wQHJEWS7QAHxMjNEqQmfgnfOdbOGDbG2v4bRfpL51fYCuhzMZtU_DydIq1zfr1kYb4MO6W0bXhUs4Su8QdSejVXCuX61-g7Jv4K2OMpO9bNch8clknrqus--6gePkY1USffRWtuEI7JlU9PFXHYKnq8nj-Cab3V9Px6NZptKnYqZqU-RCKSMox6ZAjWhKWpaGYcE5J7UyhjClyzrXiDRUEJb4uhFI6ZwqJMgQnG11l969rHSI1cKtfDoxVDmlhUgRsTxRaEsp70Lw2lRLbzvp1xVG1Sb76m_2aeX0S3hVd7r5WfgOOwHZFgjyWf-6_iv4CYQjjQE</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Acosta-Olivo, Carlos Alberto</creator><creator>Millán-Alanís, Juan Manuel</creator><creator>Simental-Mendía, Luis Ernesto</creator><creator>Álvarez-Villalobos, Neri</creator><creator>Vilchez-Cavazos, Félix</creator><creator>Peña-Martínez, Víctor Manuel</creator><creator>Simental-Mendía, Mario</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope></search><sort><creationdate>202010</creationdate><title>Effect of Normal Saline Injections on Lateral Epicondylitis Symptoms: A Systematic Review and Meta-analysis of Randomized Clinical Trials</title><author>Acosta-Olivo, Carlos Alberto ; Millán-Alanís, Juan Manuel ; Simental-Mendía, Luis Ernesto ; Álvarez-Villalobos, Neri ; Vilchez-Cavazos, Félix ; Peña-Martínez, Víctor Manuel ; Simental-Mendía, Mario</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-cbf728ccf8461f70d8d9499f5186663bcff35ce9b2e03d4835f72bd80ce24c083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Clinical trials</topic><topic>Elbow</topic><topic>Humans</topic><topic>Injections, Intra-Articular</topic><topic>Meta-analysis</topic><topic>Pain</topic><topic>Pain Measurement</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Saline Solution - administration & dosage</topic><topic>Saline Solution - therapeutic use</topic><topic>Sports medicine</topic><topic>Systematic review</topic><topic>Tennis Elbow - drug therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Acosta-Olivo, Carlos Alberto</creatorcontrib><creatorcontrib>Millán-Alanís, Juan Manuel</creatorcontrib><creatorcontrib>Simental-Mendía, Luis Ernesto</creatorcontrib><creatorcontrib>Álvarez-Villalobos, Neri</creatorcontrib><creatorcontrib>Vilchez-Cavazos, Félix</creatorcontrib><creatorcontrib>Peña-Martínez, Víctor Manuel</creatorcontrib><creatorcontrib>Simental-Mendía, Mario</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Acosta-Olivo, Carlos Alberto</au><au>Millán-Alanís, Juan Manuel</au><au>Simental-Mendía, Luis Ernesto</au><au>Álvarez-Villalobos, Neri</au><au>Vilchez-Cavazos, Félix</au><au>Peña-Martínez, Víctor Manuel</au><au>Simental-Mendía, Mario</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Normal Saline Injections on Lateral Epicondylitis Symptoms: A Systematic Review and Meta-analysis of Randomized Clinical Trials</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2020-10</date><risdate>2020</risdate><volume>48</volume><issue>12</issue><spage>3094</spage><epage>3102</epage><pages>3094-3102</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><abstract>Background:
Lateral epicondylitis, or tennis elbow, is a painful degenerative disorder that commonly occurs in adults between 40 and 60 years of age. Normal saline (NS) injections have been used as placebo through a large number of randomized controlled trials (RCTs) focused on the treatment of lateral epicondylitis.
Purpose:
This meta-analysis of RCTs aimed to assess the therapeutic effect of NS injections on lateral epicondylitis symptoms and compare results with established minimal clinically important difference criteria.
Study Design:
Systematic review and meta-analysis.
Methods:
MEDLINE, Embase, Web of Science, and Scopus databases were searched for clinical trials reporting pain and joint function with the visual analog scale, Patient-Rated Tennis Elbow Evaluation, and Disabilities of the Arm, Shoulder and Hand in patients with lateral epicondylitis. The meta-analysis was conducted with a random effects model and generic inverse variance method. Heterogeneity was tested with the I2 statistic index.
Results:
A total of 15 RCTs included in this meta-analysis revealed a significant improvement in pain (mean difference, 3.61 cm [95% CI, 2.29-4.92 cm]; P < .00001; I2 = 88%; visual analog scale) and function (mean difference, 25.65 [95% CI, 13.30-37.99]; P < .0001; I2 = 82%; Patient-Rated Tennis Elbow Evaluation / Disabilities of the Arm, Shoulder and Hand) after NS injection (≥6 months).
Conclusion:
NS injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis. New research should focus on better methods to diminish the potential confounders that could lead to this effect because NS injections could mask the real effect of an active therapeutic intervention in RCT.
Registration:
CRD42019127547 (PROSPERO).</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>32045280</pmid><doi>10.1177/0363546519899644</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0363-5465 |
| ispartof | The American journal of sports medicine, 2020-10, Vol.48 (12), p.3094-3102 |
| issn | 0363-5465 1552-3365 |
| language | eng |
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| source | MEDLINE; SAGE Complete; Alma/SFX Local Collection |
| subjects | Clinical trials Elbow Humans Injections, Intra-Articular Meta-analysis Pain Pain Measurement Randomized Controlled Trials as Topic Saline Solution - administration & dosage Saline Solution - therapeutic use Sports medicine Systematic review Tennis Elbow - drug therapy Treatment Outcome |
| title | Effect of Normal Saline Injections on Lateral Epicondylitis Symptoms: A Systematic Review and Meta-analysis of Randomized Clinical Trials |
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