The Effectiveness of Exercise for the Management of Musculoskeletal Disorders and Injuries of the Elbow, Forearm, Wrist, and Hand: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

• Published in: Journal of manipulative and physiological therapeutics 2015-09, Vol.38 (7), p.507-520
• Main Authors: Menta, Roger, DC, Randhawa, Kristi, MPH, Côté, Pierre, DC, PhD, Wong, Jessica J., DC, Yu, Hainan, MBBS, MSc, Sutton, Deborah, MEd, MSc, Varatharajan, Sharanya, MSc, Southerst, Danielle, DC, D'Angelo, Kevin, DC, Cox, Jocelyn, DC, Brown, Courtney, MSc, DC, Dion, Sarah, DC, Mior, Silvano, DC, PhD, Stupar, Maja, DC, PhD, Shearer, Heather M., DC, MSc, Lindsay, Gail M., RN, PhD, Jacobs, Craig, DC, MSc, Taylor-Vaisey, Anne, MLS
• Format: Article
• Language: English
• Subjects: Accidents, Traffic; Adult; Cooperative Behavior; Disease Management; Elbow; Exercise Therapy; Exercise Therapy - methods; Female; Forearm Injuries - diagnosis; Forearm Injuries - rehabilitation; Hand; Hand Injuries - rehabilitation; Humans; Lateral Humeral Epicondylitis; Male; Middle Aged; Musculoskeletal Diseases - diagnosis; Musculoskeletal Diseases - rehabilitation; Ontario; Pain Measurement; Physical Medicine and Rehabilitation; Practice Guidelines as Topic; Recovery of Function; Review; Systematic; Tennis Elbow - rehabilitation; Treatment Outcome; Upper Extremity; Wounds and Injuries - diagnosis; Wounds and Injuries - rehabilitation; Wrist Injuries - rehabilitation
• ISSN: 0161-4754; 1532-6586
• DOI: 10.1016/j.jmpt.2015.06.002

Abstract Objective The purpose of this systematic review was to evaluate the effectiveness of exercise compared to other interventions, placebo/sham intervention, or no intervention in improving self-rated recovery, functional recovery, clinical, and/or administrative outcomes in individuals with musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand. Methods We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers independently screened studies for relevance and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network criteria. We synthesized the evidence using the best evidence synthesis methodology. Results We identified 5 studies with a low risk of bias. Our review suggests that, for patients with persistent lateral epicondylitis, (1) adding concentric or eccentric strengthening exercises to home stretching exercises provides no additional benefits; (2) a home program of either eccentric or concentric strengthening exercises leads to similar outcomes; (3) home wrist extensor strengthening exercises lead to greater short-term improvements in pain reduction compared to “wait and see”; and (4) clinic-based, supervised exercise may be more beneficial than home exercises with minimal improvements in pain and function. For hand pain of variable duration, supervised progressive strength training added to advice to continue normal physical activity provides no additional benefits. Conclusion The relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. The current evidence shows that the addition of supervised progressive strength training does not provide further benefits over advice to continue normal physical activity for hand pain of variable duration.