Effectiveness of AstymŽ treatment vs traditional therapy to treat lateral epicondylitis: A retrospective comparative study
Eitan Melamed, MD1; April O'Connell, OTR/L, CHT, ACSM2; Matthew Gonzalez, MD3; Ricardo J. Bello, MD, MPH4; Anthony Sapienza, MD1; (1)Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, NY, (2)New York Univeristy Langone Medical Center, New York, NY, (3)NYU Hospital for Joint Diseases, New York, NY, (4)Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
Introduction: Astym is a non-invasive therapy approach that uses instruments, applied topically following defined protocols to generate specific shear forces in order to stimulate affected soft tissues to heal and regenerate at a cellular level. In contrast to common splinting and injection therapy practices for lateral epicondylitis, patients are not immobilized, but rather encouraged to be active during the course of Astym treatment, which is thought to allow the tissues to adapt to the patient's normal activity. The purpose of this study was to compare the outcome of Astym with traditional physical therapy in subjects with lateral epicondylitis.
Materials and Methods: Medical records of 156 consecutive patients seen for lateral epicondylitis between 2011 and 2016 were reviewed. 120 (77%) underwent Astym and 36 (23%) traditional physical therapy. The data collected include demographics, comorbidities, previous therapy, QuickDash and pain scores, and surgical treatment for recalcitrant symptoms. Median follow-up was 60 days (IQR: 37-96 days).
Results: QuickDash scores were improved in 16.8 points in the Astym group and 9 points in the physical therapy group. While both statistically significant, only Astym group was above the minimum clinically important difference. This difference remained statistically significant after adjusting for comorbidities, surgery, NSAIDs, corticosteroids, and splinting. Pain scores also improved significantly among patients in both groups. The difference in the change in pain scores between these two groups was not statistically significant, even after adjusting for confounding.
A multivariable logistic regression model controlling for comorbidities, NSAIDs, corticosteroids, and splinting, showed that the odds of undergoing surgery were 10.6 times higher in the physical therapy group (95% CI: 1.3-88.1; p=0.029) compared to the Astym group.
Conclusion: The present findings suggest that Astym results in significant and clinically meaningful improvement in functional outcomes for patients with lateral epicondylitis, and associated with lower odds of undergoing future surgery, compared to traditional physical therapy protocols.
Level of Evidence: Level III, retrospective comparative study.
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