Joseph M. Day, Robert Barry Dale, and Elizabeth Kennedy
Clinical Scenario: Lateral elbow tendinopathy (LE) is a common musculoskeletal condition that often results in pain and disability. An array of conservative interventions have been shown to improve patient outcomes in outpatient rehabilitation clinics. However, with the rise in health care costs, patients and rehabilitation specialists have opted to reduce the number of in-house visits and focus on home exercise programs (HEPs). As a result, many rehabilitation specialists and patients now depend on HEPs as the primary intervention to treat LE. Focused Clinical Question: For individuals with LE, is there evidence to suggest that HEPs are as effective as traditional on-site rehabilitation for reducing pain and disability? Summary of Search, Best Evidence Appraised, and Key Findings: The literature was searched for studies comparing HEP to on-site rehabilitation in the management of LE. Two clinical controlled trials (CCTs) were included. No studies suggested that HEPs demonstrated equal or improved outcomes in pain or disability. Both studies concluded that on-site rehabilitation services were more effective at reducing pain and disability in the short term. More research is needed to compare the cost effectiveness of both HEP and on-site rehabilitation. Clinical Bottom Line: Based on 2 CCTs, it can be concluded that there is moderate evidence to suggest that patients with LE experience decreased pain and disability scores with on-site rehabilitation compared to a guided HEP in the short term. The authors could not draw a conclusion regarding long-term effects of treatments or cost effectiveness of the 2 approaches. Strength of Recommendation: Based on the Centre for Evidence Based Medicine, there is level B evidence that a HEP only was not as effective as on-site rehabilitation services in patients with LE.