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The Research Question

The Research Question. Lateral epicondylosis (tennis elbow) is common, debilitating and often refractory to routine care. Prolotherapy , an injection-based “regenerative” therapy, and guided physical therapy (PT) are safe, evidence-based modalities, but have not been compared.

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The Research Question

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  1. The Research Question • Lateral epicondylosis (tennis elbow) is common, debilitating and often refractory to routine care. • Prolotherapy, an injection-based “regenerative” therapy, and guided physical therapy (PT) are safe, evidence-based modalities, but have not been compared. • Study question: Among adults with tennis elbow, what is the effect of prolotherapy, PT and the two combined on disease-specific quality of life as assessed by a validated questionnaire?

  2. Research Design and Method • Design: 12 month randomized controlled trial (N=120). • Participants: Adults with chronic tennis elbow. • Intervention: Participants were allocated to: • 4 monthly sessions of prolotherapy with hypertonic dextrose, OR… • 4 weekly sessions of PT, OR… • Prolotherapy and PT combined. • Assessment: Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. The outcomes assessor was blinded to group.

  3. What the Research Found • 120 participants • Adherence to treatment and 12-month questionnaire adherence were high: 93% and 88% respectively. • All groups reported PRTEE score improvements of approximately 28 points on this 100-point scale. • Meets clinical importance standard. • There was not a difference between groups at 12 months; combined care did not improve outcomes. • Participants in all groups were satisfied. • There were no adverse events.

  4. What this means for Clinical Practice • Prolotherapy, PT and combined therapy resulted in safe, significant, substantial and sustained improvement of PRTEE-based elbow pain and function by 52 weeks. • Clinicians can feel comfortable recommending prolotherapy and supervised PT to patients who are refractory to other non-surgical care. • Combination therapy did not add improvement to either therapy alone.

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