A randomised control trial of physiotherapy and corticosteroid injections of lateral epicondylalgia in primary care.

肌肉骨骼疾病是澳大利亚卫生系统支出的第三大原因。外侧上髁痛(网球肘)就是这样一种情况，通常在初级护理中进行治疗。个人和社区都受到这种情况的影响：每1000名就诊的患者中就有7人患有这种情况。其中大多数与网球无关。平均10%-30%的患者会休12周的假。这种情况可能会持续6-48个月，而且往往会变得难以治疗并经常复发。两种常用的治疗方法是物理疗法和皮质类固醇注射。到目前为止，几乎没有证据支持物理治疗，特别是目前的最佳实践方法，如手动治疗和治疗性锻炼。缺乏证据在很大程度上是由于对物理疗法的少数研究，其中大多数研究的质量很差，而且目前被认为是不太理想的治疗方法。更多关于皮质类固醇注射的研究表明，皮质类固醇注射在短期内(3-6周)是有益的，但在12个月后不会有更高的复发率。手法疗法已被证明具有短期缓解疼痛的效果，而治疗性锻炼对这种情况起到了长期的改善作用。建议在治疗性运动的基础上加用手法治疗，具有较好的近期和远期效果。该项目将进行随机临床试验，以评估这一命题以及与成功、失败或复发率相关的因素。还将进行成本效益分析，以计算这些处理的相对经济效益。该项目的一个具体成果将是为初级卫生保健中治疗外侧上髁痛最有效的方法制定临床指南。

Musculoskeletal conditions account for the third leading cause of health systems expenditure in Australia. Lateral epicondylalgia (tennis elbow) is such a condition and is often treated in primary care. Both the individual and community are affected by this condition: 7 per 1000 patients seeing their medical doctor have this condition. Most are not tennis related. On average 10-30% of sufferers take 12 weeks off work. The condition may last 6-48 months and it tends to become stubborn to treatment and recurs often. Two popular treatment options that are commonly prescribed for the management of lateral epicondylalgia are physiotherapy and corticosteroid injections. To date there is little evidence supporting physiotherapy, especially current best practice methods such as manual therapy and therapeutic exercise. The lack of evidence is largely due to a small number of studies of physiotherapy, most of which are of poor quality and of treatments that are currently deemed to be less than optimal. A larger number of studies of corticosteroid injections have shown that corticosteroid injections are beneficial in the short term (3-6 weeks), but not over 12 months where they are associated with greater recurrence rates. Manual therapy has been shown to have short term pain relieving effects and therapeutic exercise exerts long standing improvements in this condition. It is proposed that the addition of manual therapy to therapeutic exercise will have superior short- and long-term effects. This project will conduct a randomised clinical trial to evaluate this proposition and also the factors associated with success, failure or recurrence rates. A cost-benefit analysis will also be conducted to calculate the relative economic merits of the treatments. A tangible outcome of this project will be the development of clinical guidelines for the most effective method of treating lateral epicondylalgia in primary health care.