Table 3

Pain intensity, pain-free grip strength and elbow disability (DASH) for eccentric exercise compared with concentric (±eccentric) exercises with or without physiotherapy or home exercise programme

OutcomesNo of studiesComparisonsEffects estimate (95% CI),
P value
Certainty (GRADE)Heterogeneity
Average estimate/assumed risk in eccentric groupAverage estimate/assumed risk in concentric (±eccentric) group
Mean change in pain rating
Short-term follow-up
3Mean pain score was 22.6 (range 13.0 to 29.0) in 49 participantsMean pain score was 35.7 (range 26.0 to 49.0) in 48 participants SMD −0.49*
(−1.17 to 0.19), p=0.16

Very low†‡§¶
I2=58%, p=0.09
Short-term follow-up
2Mean pain-free grip strength was 37.0 (range 26.0 to 64.0) in 38 participantsMean pain-free grip strength was 38.4 (range 25.0 to 67.5) in 38 participants MD −1.99
(−6.15 to 2.18), p=035
I2=6%, p=0.30
Elbow disability
Very short-term follow-up
2Mean score was 14.0 (range 9.0 to 16.0) in 38 participantsMean score was 21.4 (range 17.0 to 33.0) in 36 participants MD −10.92
(−33.25 to 11.4), p=0.34

Very Low†‡§
I2=80%, p=0.02
  • Values for PFGS are presented in pounds (lb).

  • *Pooled weighted baseline pain was 55.8—clinically significant difference 16.7 points change on pain scale (0–100); pooled weighted SD at short-term was 21.0 points.

  • †High risk of bias.

  • ‡Inconsistent results between included studies.

  • §Indirect comparison in one or more included studies.

  • ¶Substantial differences at baseline pain among included studies.

  • DASH, Disability of the Arm, Shoulder and Hand; GRADE, Grading of Recommendations Assessment, Development and Evaluation; HEP, home exercise programme; MD, mean difference; PFGS, pain free grip strength; PT, physiotherapy; SMD, standardised mean difference.