Comparative effectiveness of botulinum toxin versus non-surgical treatments for treating lateral epicondylitis: a systematic review and meta-analysis

Yu-Ching Lin, Wei Ting Wu, Yu Chun Hsu, Der Sheng Han, Ke Vin Chang

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: To explore the effectiveness of botulinum toxin compared with non-surgical treatments in patients with lateral epicondylitis. Methods: Data sources including PubMed, Scopus, Embase and Airity Library from the earliest record to February 2017 were searched. Study design, patients’ characteristics, dosage/brand of botulinum toxin, injection techniques, and measurements of pain and hand grip strength were retrieved. The standardized mean differences (SMDs) in pain relief and grip strength reduction were calculated at the following time points: 2-4, 8-12, and 16 weeks or more after injection. Results: Six randomized controlled trials (321 participants) comparing botulinum toxin with placebo or corticosteroid injections were included. Compared with placebo, botulinum toxin injection significantly reduced pain at all three time points (SMD, -0.729, 95% confidence interval [CI], -1.286 to -0.171; SMD, -0.446, 95% CI, -0.740 to -0.152; SMD, -0.543, 95% CI, -0.978 to -0.107, respectively). Botulinum toxin was less effective than corticosteroid at 2-4 weeks (SMD, 1.153; 95% CI, 0.568-1.737) and both treatments appeared similar in efficacy after 8 weeks. Different injection sites and dosage/brand did not affect effectiveness. Botulinum toxin decreased grip strength 2-4 weeks after injection, and high equivalent dose could extend its paralytic effects to 8-12 weeks. Conclusions: When treating lateral epicondylitis, botulinum toxin was superior to placebo and could last for 16 weeks. Corticosteroid and botulinum toxin injections were largely equivalent, except the corticosteroid injections were better at pain relief in the early stages and were associated with less weakness in grip in the first 12 weeks.

Original languageEnglish
Pages (from-to)131-145
Number of pages15
JournalClinical Rehabilitation
Volume32
Issue number2
DOIs
Publication statusPublished - 2018 Feb 1

Fingerprint

Tennis Elbow
Botulinum Toxins
Meta-Analysis
Hand Strength
Injections
Adrenal Cortex Hormones
Confidence Intervals
Placebos
Therapeutics
Pain
Information Storage and Retrieval
Pain Measurement
PubMed
Libraries
Randomized Controlled Trials

All Science Journal Classification (ASJC) codes

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

@article{84385d1097694bb5ab7e2f1420a60e9e,
title = "Comparative effectiveness of botulinum toxin versus non-surgical treatments for treating lateral epicondylitis: a systematic review and meta-analysis",
abstract = "Objectives: To explore the effectiveness of botulinum toxin compared with non-surgical treatments in patients with lateral epicondylitis. Methods: Data sources including PubMed, Scopus, Embase and Airity Library from the earliest record to February 2017 were searched. Study design, patients’ characteristics, dosage/brand of botulinum toxin, injection techniques, and measurements of pain and hand grip strength were retrieved. The standardized mean differences (SMDs) in pain relief and grip strength reduction were calculated at the following time points: 2-4, 8-12, and 16 weeks or more after injection. Results: Six randomized controlled trials (321 participants) comparing botulinum toxin with placebo or corticosteroid injections were included. Compared with placebo, botulinum toxin injection significantly reduced pain at all three time points (SMD, -0.729, 95{\%} confidence interval [CI], -1.286 to -0.171; SMD, -0.446, 95{\%} CI, -0.740 to -0.152; SMD, -0.543, 95{\%} CI, -0.978 to -0.107, respectively). Botulinum toxin was less effective than corticosteroid at 2-4 weeks (SMD, 1.153; 95{\%} CI, 0.568-1.737) and both treatments appeared similar in efficacy after 8 weeks. Different injection sites and dosage/brand did not affect effectiveness. Botulinum toxin decreased grip strength 2-4 weeks after injection, and high equivalent dose could extend its paralytic effects to 8-12 weeks. Conclusions: When treating lateral epicondylitis, botulinum toxin was superior to placebo and could last for 16 weeks. Corticosteroid and botulinum toxin injections were largely equivalent, except the corticosteroid injections were better at pain relief in the early stages and were associated with less weakness in grip in the first 12 weeks.",
author = "Yu-Ching Lin and Wu, {Wei Ting} and Hsu, {Yu Chun} and Han, {Der Sheng} and Chang, {Ke Vin}",
year = "2018",
month = "2",
day = "1",
doi = "10.1177/0269215517702517",
language = "English",
volume = "32",
pages = "131--145",
journal = "Clinical Rehabilitation",
issn = "0269-2155",
publisher = "SAGE Publications Ltd",
number = "2",

}

Comparative effectiveness of botulinum toxin versus non-surgical treatments for treating lateral epicondylitis : a systematic review and meta-analysis. / Lin, Yu-Ching; Wu, Wei Ting; Hsu, Yu Chun; Han, Der Sheng; Chang, Ke Vin.

In: Clinical Rehabilitation, Vol. 32, No. 2, 01.02.2018, p. 131-145.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparative effectiveness of botulinum toxin versus non-surgical treatments for treating lateral epicondylitis

T2 - a systematic review and meta-analysis

AU - Lin, Yu-Ching

AU - Wu, Wei Ting

AU - Hsu, Yu Chun

AU - Han, Der Sheng

AU - Chang, Ke Vin

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objectives: To explore the effectiveness of botulinum toxin compared with non-surgical treatments in patients with lateral epicondylitis. Methods: Data sources including PubMed, Scopus, Embase and Airity Library from the earliest record to February 2017 were searched. Study design, patients’ characteristics, dosage/brand of botulinum toxin, injection techniques, and measurements of pain and hand grip strength were retrieved. The standardized mean differences (SMDs) in pain relief and grip strength reduction were calculated at the following time points: 2-4, 8-12, and 16 weeks or more after injection. Results: Six randomized controlled trials (321 participants) comparing botulinum toxin with placebo or corticosteroid injections were included. Compared with placebo, botulinum toxin injection significantly reduced pain at all three time points (SMD, -0.729, 95% confidence interval [CI], -1.286 to -0.171; SMD, -0.446, 95% CI, -0.740 to -0.152; SMD, -0.543, 95% CI, -0.978 to -0.107, respectively). Botulinum toxin was less effective than corticosteroid at 2-4 weeks (SMD, 1.153; 95% CI, 0.568-1.737) and both treatments appeared similar in efficacy after 8 weeks. Different injection sites and dosage/brand did not affect effectiveness. Botulinum toxin decreased grip strength 2-4 weeks after injection, and high equivalent dose could extend its paralytic effects to 8-12 weeks. Conclusions: When treating lateral epicondylitis, botulinum toxin was superior to placebo and could last for 16 weeks. Corticosteroid and botulinum toxin injections were largely equivalent, except the corticosteroid injections were better at pain relief in the early stages and were associated with less weakness in grip in the first 12 weeks.

AB - Objectives: To explore the effectiveness of botulinum toxin compared with non-surgical treatments in patients with lateral epicondylitis. Methods: Data sources including PubMed, Scopus, Embase and Airity Library from the earliest record to February 2017 were searched. Study design, patients’ characteristics, dosage/brand of botulinum toxin, injection techniques, and measurements of pain and hand grip strength were retrieved. The standardized mean differences (SMDs) in pain relief and grip strength reduction were calculated at the following time points: 2-4, 8-12, and 16 weeks or more after injection. Results: Six randomized controlled trials (321 participants) comparing botulinum toxin with placebo or corticosteroid injections were included. Compared with placebo, botulinum toxin injection significantly reduced pain at all three time points (SMD, -0.729, 95% confidence interval [CI], -1.286 to -0.171; SMD, -0.446, 95% CI, -0.740 to -0.152; SMD, -0.543, 95% CI, -0.978 to -0.107, respectively). Botulinum toxin was less effective than corticosteroid at 2-4 weeks (SMD, 1.153; 95% CI, 0.568-1.737) and both treatments appeared similar in efficacy after 8 weeks. Different injection sites and dosage/brand did not affect effectiveness. Botulinum toxin decreased grip strength 2-4 weeks after injection, and high equivalent dose could extend its paralytic effects to 8-12 weeks. Conclusions: When treating lateral epicondylitis, botulinum toxin was superior to placebo and could last for 16 weeks. Corticosteroid and botulinum toxin injections were largely equivalent, except the corticosteroid injections were better at pain relief in the early stages and were associated with less weakness in grip in the first 12 weeks.

UR - http://www.scopus.com/inward/record.url?scp=85040805769&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040805769&partnerID=8YFLogxK

U2 - 10.1177/0269215517702517

DO - 10.1177/0269215517702517

M3 - Article

C2 - 28349703

AN - SCOPUS:85040805769

VL - 32

SP - 131

EP - 145

JO - Clinical Rehabilitation

JF - Clinical Rehabilitation

SN - 0269-2155

IS - 2

ER -