Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT05696327 |
Other study ID # |
Riphah/RCRS/01222 Rimsha Jalil |
Secondary ID |
|
Status |
Completed |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
February 1, 2022 |
Est. completion date |
January 20, 2023 |
Study information
Verified date |
July 2023 |
Source |
Riphah International University |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
The purpose of the study is to compare the effects of Tyler twist wrist extensor
strengthening exercises in patients with lateral epicondylitis. A randomized control trial
was conducted at Cina medical center Rawalpindi and Midland Doctors Medical institute. The
sample size was 52 calculated through open-epi tool. The participants were divided into two
groups: the treatment group and the control group. The study duration was 1 year. Sampling
technique applied was non-probability purposive sampling. Only 20 to 40 years participants
with diagnosed condition were included in the study. Tools used in this study are Jamar
dynamometer for grip strength and PRTEE Questionnaire for pain and disability. Data was
collected at baseline, mid and immediately after the application of interventions. Data
analyzed through SPSS version 25
Description:
Lateral epicondylitis is the most common cause of pain in elbow, due to repetitive wrist
extension or gripping activities. This condition is also described as a chronic symptomatic
degeneration of the extensor tendon of forearm commonly extensor carpi radialis brevis at the
attachment area of humeral epicondyle. (1) Tennis elbow is common in individuals who undergo
repetitive wrist extension, radial deviation, and forearm supination. The histological
findings of lateral epicondylitis consist of granulation tissue, micro-rupture, fibroblasts
abundance, UN structured collagen, vascular hyperplasia, and lack of inflammatory cells
within the tissue (lymphocytes, macrophages, neutrophils). (2) Lateral epicondylitis can
occur in any age group but is more common between 30-50 years of age. (3) Many previous
reports conducted in different countries described that there is 2-14% prevalence of lateral
epicondylitis in working population and only 5% of people suffering from tennis elbow relate
this injury to the tennis. (4) Evidence from a systematic review published in 2019 described
the prevalence rate of 1-3% in the general population and 7% in the handy workers group with
equal gender distribution. (5) There are many treatment options for lateral epicondylitis.
Initially it is treated by conservative treatment (1) Recently in 2021, R Manandhar et al
conducted an RCT reported positive results using combination of Movement with mobilization
and Eccentric exercises regarding pain and functional disability.(8) BL Woodley et al in 2018
published his systematic review which concluded that limited level of evidence exists on the
effectiveness of eccentric strengthening exercises to standard physiotherapy protocols.
Twenty relevant studies were sourced, 11 of which met the inclusion criteria. These included
studies of tendinopathy of the common wrist extensor tendon of the lateral elbow (LET. (9) If
pain do not resolve with conservative treatment then further treatment options will be
extracorporeal shock wave therapy, cortisone injections and surgery.(6) In an RCT of Ju-hyun
Lee et all in 2018 ,the effects of eccentric control exercise for tennis elbow showed useful
effects for pain and functional activity was improved with a p value of 0.05.(7) Timothy
Tyler et al recently conducted a cross sectional study in 2021 to compare standard
physiotherapy treatment to Tyler twist exercises which are a new treatment protocol for wrist
extensor strengthening using 2-3 colored twistable rubber bands This study suggested that
Tyler twist exercise could be effective strength training protocol and once learnt can be
performed by the patient at home without any supervision.(9)
To treat lateral epicondylitis platelet rich plasma has gained popularity. To enhance wound
healing, bone healing and tendon healing, platelets release high concentration of
platelet-derived growth factors. It is difficult to draw clear conclusions on PRP for lateral
epicondylitis because some available studies have reported conflicting results. Manipulative
techniques fall into two basic varieties in the treatment of lateral epicondylitis; those
that will produce a thrust and those that seek full extension. To effect the contractile
element the manipulations performed in extension with pronation have the greatest chance.
Forced extension of elbow with the wrist and fingers fixed and the forearm promoted is the
most common procedure known as mill's manipulation. Manipulations are painful procedures and
require 2 weeks of rest after application.(11) With a high success rate, injections are one
of the most popular methods utilized .Physical therapy is initiated when the condition
becomes chronic or not responding to initial treatment. Ultrasound, phonophoresis, electrical
stimulation,, manipulation, soft tissue mobilization , neural tension, friction massage ,
augmented soft tissue mobilization and stretching and strengthening techniques are the common
rehabilitation modalities utilized for the treatment. (12) Proper evidence behind Tyler twist
wrist extensor exercises in the management of lateral epicondylitis is sparse and there are
less number of studies with limited methodological designs. There are no previous randomized
control trials conducted to see the effects of Tyler twist exercises in contrast to standard
physiotherapy treatment using combined tools for pain , grip strength and functional activity
According to the literature review, there had been lack of reporting of compliance and
adherence to the exercise programs, with only four studies documenting exercise adherence,
So, the additional benefit of this protocol is that it can be performed as part of a home
program and does not involve continued medical supervision when learned properly. So, this
study will focus on effects of Tyler twist exercise to standard physiotherapy protocol.