Eleven RCTs were included. There were 6 parallel-group RCTs (n=213) and 2 repeated measures RCTs (n=64) in patients with lateral epicondylitis, and 5 repeated measures RCTs (n=85) in normal participants.
One Sackett level 1b study and 10 Sackett level 2b studies were included.
The methodological flaws included short-term follow-up, a lack of sample size calculations, and a failure to describe the methods used to select patients. Few studies (3 of 11) considered the reliability and validity of the methods used to measure the outcomes. Only one study reported the statistical package used, and most analyses did not adjust for duration of symptoms. The adjusted quality scores ranged from 44.5 to 16.5 (mean 26.3).
Elbow flexion, forearm neutral, wrist neutral immobilisation splint (1 RCT in patients).
The Sackett level 1b RCT (128 patients with lateral epicondylitis, quality score 44.5) found that cast immobilsation or cast plus NSAIDs for 14 days significantly increased grip strength and function, and reduced pain at 4 weeks. It found no significant difference in grip or function between splint plus NSAID and splint alone, but found that splint plus NSAID significantly improved pain compared with splint alone.
Elbow flexion restriction splint (1 RCT in patients and 1 RCT in normal people).
One RCT (50 patients) found no significant difference in pain between splint and no splint. One RCT (10 normal people) found no difference between two different elbow flexion splints, but found that both splints significantly decreased the load at the lateral epicondyle in comparison with no splint.
Nonarticular proximal forearm non elastic (3 RCTs in patients and 3 RCTs in normal people).
Two RCTs (14 and 16 patients, respectively) found that splints increased grip and wrist extension immediately and at 4 weeks, respectively, compared with no splint. Two RCTS found no significant immediate effect on pain with splint, although one of these RCTs found that splint plus either injection or NSAID reduced pain at 3 to 4 weeks (from baseline) and the other RCT found that splint reduced pain in comparison with no splint. One RCT (36 patients) found that splint plus local injection significantly improved grip strength in comparison with splint alone or splint plus NSAID. Studies in normal people (30, 17 and 15 people, respectively) found different results for wrist extension strength.
Nonarticular proximal forearm elastic (1 RCT in patients and 2 RCTs in normal people). One RCT (33 patients who all received manipulation) found no significant difference in wrist extension between splint, topical cream, splint plus topical cream, and manipulation alone. One RCT (17 normal people) found no significant difference in wrist extension/flexion or pronation/supination with splint. One RCT (10 normal people) found no significant difference between two different elastic splints and four other splints in load.
Nonarticular forearm splint (1 RCT in normal people).
The RCT (10 normal people) found that two different nonarticular forearm splints decreased load at the lateral epicondyl in comparison with four other splints.
Wrist immobilisation splint (1 RCT in normal people).
The RCT (13 normal people) compared three different wrist immobilisation splints and found that only the splint with semicircumferential design significantly reduced wrist extensor activity over 3 days when compared with no splint. All three splints significantly decreased grip force in comparison with no splint.