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Chiropractic & Manual Therapies
Published in: Chiropractic & Manual Therapies 1/2016

Open Access 01-12-2016 | Reviews

Multimodal care for the management of musculoskeletal disorders of the elbow, forearm, wrist and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Authors: Deborah Sutton, Douglas P. Gross, Pierre Côté, Kristi Randhawa, Hainan Yu, Jessica J. Wong, Paula Stern, Sharanya Varatharajan, Danielle Southerst, Heather M. Shearer, Maja Stupar, Rachel Goldgrub, Gabrielle van der Velde, Margareta Nordin, Linda J. Carroll, Anne Taylor-Vaisey

Published in: Chiropractic & Manual Therapies | Issue 1/2016

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Abstract

Background

Musculoskeletal disorders of the elbow, forearm, wrist and hand are associated with pain, functional impairment and decreased productivity in the general population. Combining several interventions in a multimodal program of care is reflective of current clinical practice; however there is limited evidence to support its effectiveness. The purpose of our review was to investigate the effectiveness of multimodal care for the management of musculoskeletal disorders of the elbow, forearm, wrist and hand on self-rated recovery, functional recovery, or clinical outcomes in adults or children.

Methods

We conducted a systematic review of the literature and best evidence synthesis. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from January 1990 to March 2015. Randomized controlled trials, cohort studies, and case–control studies were eligible. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were synthesized following best evidence synthesis principles.

Results

We screened 5989 articles, and critically appraised eleven articles. Of those, seven had a low risk of bias; one addressed carpal tunnel syndrome and six addressed lateral epicondylitis. Our search did not identify any low risk of bias studies examining the effectiveness of multimodal care for the management of other musculoskeletal disorders of the elbow, forearm, wrist or hand. The evidence suggests that multimodal care for the management of lateral epicondylitis may include education, exercise (strengthening, stretching, occupational exercise), manual therapy (manipulation) and soft tissue therapy (massage). The evidence does not support the use of multimodal care for the management of carpal tunnel syndrome.

Conclusions

The current evidence on the effectiveness of multimodal care for musculoskeletal disorders of the elbow, forearm, wrist and hand is limited. The available evidence suggests that there may be a role for multimodal care in the management of patients with persistent lateral epicondylitis. Future research is needed to examine the effectiveness of multimodal care and guide clinical practice.

Systematic review registration number

Appendix
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Literature
1.
2.
Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309(5):461–9.CrossRefPubMed
3.
Garg A, Kapellusch JM, Hegmann KT, Thiese MS, Merryweather AS, Wang YC, et al. The strain index and TLV for HAL: risk of lateral epicondylitis in a prospective cohort. Am J Ind Med. 2014;57(3):286–302.CrossRefPubMed
4.
5.
Shiri R, Viikari-Juntura E, Varonen H, Heliovaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006;164(11):1065–74.CrossRefPubMed
6.
Descatha A, Dale AM, Jaegers L, Herquelot E, Evanoff B. Self-reported physical exposure association with medial and lateral epicondylitis incidence in a large longitudinal study. Occup Environ Med. 2013;70(9):670–3.PubMedCentralCrossRefPubMed
7.
Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum. 2004;51(4):642–51.CrossRefPubMed
8.
Roquelaure Y, Ha C, Leclerc A, Touranchet A, Sauteron M, Melchior M, et al. Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. Arthritis Rheum. 2006;55(5):765–78.CrossRefPubMed
9.
Buchbinder R, Green S, Struijs P. Tennis elbow. Am Fam Phys. 2007;75(5):701–2.
10.
Sanders Jr TL, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med. 2015;43(5):1066–71.PubMedCentralCrossRefPubMed
11.
Smidt N, Lewis M, VAN DER Windt DA, Hay EM, Bouter LM, Croft P. Lateral epicondylitis in general practice: course and prognostic indicators of outcome. J Rheumatol. 2006;33(10):2053–59.PubMed
12.
13.
Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2012;7:CD006839.PubMed
14.
Mondelli M, Giannini F, Ballerini M, Ginanneschi F, Martorelli E. Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy). J Neurol Sci. 2005;234(1–2):5–10.CrossRefPubMed
15.
16.
Padua L, Aprile I, Caliandro P, Foschini M, Mazza S, Tonali P. Natural history of ulnar entrapment at elbow. Clin Neurophysiol. 2002;113(12):1980–4.CrossRefPubMed
17.
Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther. 2005;28(5):345.CrossRefPubMed
18.
Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153–8.CrossRefPubMed
19.
Werner RA, Franzblau A, Gell N. Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome. Arch Phys Med Rehabil. 2005;86(1):1–7.CrossRefPubMed
20.
Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom MC, Bouter LM. Splinting vs surgery in the treatment of Carpal tunnel syndrome: A randomized controlled trial. JAMA. 2002;288(10):1245–51.CrossRefPubMed
21.
Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments--a systematic review. Arch Phys Med Rehabil. 2010;91(7):981–1004.CrossRefPubMed
22.
Dale AM, Harris-Adamson C, Rempel D, Gerr F, Hegmann K, Silverstein B, et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health. 2013;39(5):495–505.PubMedCentralCrossRefPubMed
23.
Gold JE, d’Errico A, Katz JN, Gore R, Punnett L. Specific and non-specific upper extremity musculoskeletal disorder syndromes in automobile manufacturing workers. Am J Ind Med. 2009;52(2):124–32.PubMedCentralCrossRefPubMed
24.
Maghsoudipour M, Moghimi S, Dehghaan F, Rahimpanah A. Association of occupational and non-occupational risk factors with the prevalence of work related carpal tunnel syndrome. J Occup Rehabil. 2008;18(2):152–6.CrossRefPubMed
25.
Silverstein BA, Fan ZJ, Bonauto DK, Bao S, Smith CK, Howard N, et al. The natural course of carpal tunnel syndrome in a working population. Scand J Work Environ Health. 2010;36(5):384–93.CrossRefPubMed
26.
Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology. 2001;56(11):1459–66.CrossRefPubMed
27.
28.
Fisher B, Gorsche R, Leaker P. Diagnosis, Causation and Treatment of Carpal Tunnel Syndrome: An Evidence-Based Assessment. Alberta: Alberta Workers’ Compensation Board; 2004.
29.
Page MJ, Massy-Westropp N, O’Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;7:Cd010003.PubMed
30.
31.
Varatharajan S, Cote P, Shearer HM, Loisel P, Wong JJ, Southerst D, et al. Are Work Disability Prevention Interventions Effective for the Management of Neck Pain or Upper Extremity Disorders? A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. J Occup Rehabil. 2014;24(4):692–708.CrossRefPubMed
32.
33.
34.
35.
Sutton DA, Cote P, Wong JJ, Varatharajan S, Randhawa KA, Yu H, et al. Is multimodal care effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J. 2014
36.
37.
38.
Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000;342(25):1887–92.PubMedCentralCrossRefPubMed
39.
McGowan J, Sampson M, Lefebvre C. An evidence based checklist for the peer review of electronic search strategies (PRESS EBC). Evid Based Libr Inf Pract. 2010;5(1):149–54.
40.
Sampson M, McGowan J, Cogo E, Grimshaw J, Moher D, Lefebvre C. An evidence-based practice guideline for the peer review of electronic search strategies. J Clin Epidemiol. 2009;62(9):944–52.CrossRefPubMed
41.
42.
Thomas Reuters. ENDNOTE [cited 2016 Feb 4]. Available from: http://​endnote.​com/​
43.
44.
van der Velde G, van Tulder M, Côté P, Hogg-Johnson S, Aker P, Cassidy JD, et al. The sensitivity of review results to methods used to appraise and incorporate trial quality into data synthesis. Spine (Phila Pa 1976). 2007;32(7):796–806.CrossRef
45.
Carroll LJ, Cassidy JD, Peloso PM, Garritty C, Giles-Smith L. Systematic search and review procedures: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004(43 Suppl):11–4.
46.
Carroll LJ, Cassidy JD, Peloso PM, Giles-Smith L, Cheng CS, Greenhalgh SW, et al. Methods for the best evidence synthesis on neck pain and its associated disorders: the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976). 2008;33(4 Suppl):S33–8.CrossRef
47.
Hayden JA, Côté P, Bombardier C. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006;144(6):427–37.CrossRefPubMed
48.
Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med. 2013;158(4):280–6.CrossRefPubMed
49.
Slavin RE. Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol. 1995;48(1):9–18.CrossRefPubMed
50.
51.
Amirfeyz R, Pentlow A, Foote J, Leslie I. Assessing the clinical significance of change scores following carpal tunnel surgery. Int Orthop. 2009;33(1):181–5.PubMedCentralCrossRefPubMed
52.
Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009;18(6):927–32.CrossRefPubMed
53.
Carroll LJ, Jones DC, Ozegovic D, Cassidy JD. How well are you recovering? The association between a simple question about recovery and patient reports of pain intensity and pain disability in whiplash-associated disorders. Disabil Rehabil. 2012;34(1):45–52.CrossRefPubMed
54.
Poltawski L, Watson T. Measuring clinically important change with the Patient-rated Tennis Elbow Evaluation. Hand Ther. 2011;16(3):52–7.CrossRef
55.
56.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.CrossRef
57.
Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37(5):360–3.PubMed
58.
Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992;45(7):769–73.CrossRefPubMed
59.
Abrams KR, Gillies CL, Lambert PC. Meta-analysis of heterogeneously reported trials assessing change from baseline. Stat Med. 2005;24(24):3823–44.CrossRefPubMed
60.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. W64.CrossRefPubMed
61.
Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet. 2009;374(9695):1074–81.CrossRefPubMed
62.
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939.PubMedCentralCrossRefPubMed
63.
Bisset LM, Coppieters MW, Vicenzino B. Sensorimotor deficits remain despite resolution of symptoms using conservative treatment in patients with tennis elbow: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90(1):1–8.CrossRefPubMed
64.
Haahr JP, Andersen JH. Prognostic factors in lateral epicondylitis: a randomized trial with one-year follow-up in 266 new cases treated with minimal occupational intervention or the usual approach in general practice. Rheumatology. 2003;42(10):1216–25.CrossRefPubMed
65.
Nagrale AV, Herd CR, Ganvir S, Ramteke G. Cyriax physiotherapy versus phonophoresis with supervised exercise in subjects with lateral epicondylalgia: a randomized clinical trial. J Manipulative Physio Ther. 2009;17(3):171–8.CrossRef
66.
Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359(9307):657–62.CrossRefPubMed
67.
Struijs PA, Kerkhoffs GM, Assendelft WJ, Van Dijk CN. Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial. Am J Sports Med. 2004;32(2):462–9.CrossRefPubMed
68.
Khosrawi SM, Moghtaderi A, Haghighat S. Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study. J Res Med Sci. 2012;17(1):1–7.PubMedCentralPubMed
69.
Nilsson P, Baigi A, Sward L, Moller M, Mansson J. Lateral epicondylalgia: a structured programme better than corticosteroids and NSAID. Scand J Occup Ther. 2012;19(5):404–10.CrossRefPubMed
70.
Cai DF. Warm-needling plus Tuina relaxing for the treatment of carpal tunnel syndrome. J Tradit Chin Med. 2010;30(1):23–4.CrossRefPubMed
71.
Li X, Zhou K, Zhang E, Qi Z, Sun W, Xu L, et al. Therapeutic effect of electroacupuncture, massage, and blocking therapy on external humeral epicondylitis. J Tradit Chin Med. 2014;34(3):261–6.CrossRefPubMed
72.
Verhaar JA, Walenkamp GH, van Mameren H, Kester AD, van der Linden AJ. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. J Bone Joint Surg Br. 1996;78(1):128–32.PubMed
73.
Struijs PA, Smidt N, Arola H, Dijk vC, Buchbinder R, Assendelft WJ. Orthotic devices for the treatment of tennis elbow. Cochrane Database Syst Rev. 2002;1:CD001821.
74.
Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;6:Cd009899.PubMed
75.
Cullinane FL, Boocock MG, Trevelyan FC. Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clin Rehabil. 2014;28(1):3–19.CrossRefPubMed
76.
Olaussen M, Holmedal O, Lindbaek M, Brage S, Solvang H. Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review. BMJ Open. 2013;3(10):e003564.PubMedCentralCrossRefPubMed
77.
Juni PH, Holenstein F, Sterne J, Bartlett C, Egger M. Direction and impact of language bias in meta-analyses of controlled trials: empirical study. Int J Epidemiol. 2002;31(1):115–23.CrossRefPubMed
78.
Moher DF, Fortin P, Jadad AR, Jüni P, Klassen T, Le Lorier J, et al. Completeness of reporting of trials published in languages other than English: implications for conduct and reporting of systematic reviews. Lancet. 1996;347(8998):363–6.CrossRefPubMed
79.
Moher D, Pham B, Lawson ML, Klassen TP. The inclusion of reports of randomised trials published in languages other than English in systematic reviews. Health Technol Assess. 2003;7(41):1–90.CrossRefPubMed
80.
Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta-analyses. BMJ. 2000;320(7249):1574–7.PubMedCentralCrossRefPubMed
Metadata
Title
Multimodal care for the management of musculoskeletal disorders of the elbow, forearm, wrist and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
Authors
Deborah Sutton
Douglas P. Gross
Pierre Côté
Kristi Randhawa
Hainan Yu
Jessica J. Wong
Paula Stern
Sharanya Varatharajan
Danielle Southerst
Heather M. Shearer
Maja Stupar
Rachel Goldgrub
Gabrielle van der Velde
Margareta Nordin
Linda J. Carroll
Anne Taylor-Vaisey
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Chiropractic & Manual Therapies / Issue 1/2016
Electronic ISSN: 2045-709X
DOI
https://doi.org/10.1186/s12998-016-0089-8

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