The Trouble With Declarative Titles

In this recent RCT investigating the effectiveness of treatment for lateral epicondylitis is entitled "Steroid injection therapy is the best conservative treatment for lateral epicondylities: a prospective randomized trial" published in the International Journal of Clinical Practice.

The problem with a title like this for this trial that compared no treatment, "physiotherapy" (basically progressive resistive exercise),  and a combination of the two is that the declarative statement of effect for improving the primary measure (pain-free grip strength) doesn't apply to the 60% of subjects that either had co-existing cervial spine or other musculoskeletal pathology and were excluded from the study. And while relatively few complications occurred (skin depigmentation and muscle atrophy in one of the 48 patients successfully recruited), it is something to consider when recommendaing it as a first line of routine treatment and the complication rate is unknown.

These kind of titles can lead to uniformed judgements about treatment efficacy when taken at face value by casual readers.  They can also be embarrassing later on to the authors when a systematic review or more definitive study reports contrary findings.

Anyway, just something to think when one of your referring sources says that steroid injections are more effective than physical therapy for lateral epicondylitis.  Since you have to still treat these folks who often present with co-existing disorders like neck and upper-limb pain, you might consider an eclectic and intergrated physical therapy intervention approach similar to the one reported by Cleland and colleagues although this too needs further validating work.

 

Rob