Phys Med Rehab Kuror 2003

8/19/2019 Phys Med Rehab Kuror 2003

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Phys Med Rehab Kuror 2003; 13(4): 215-219DOI: 10.1055s-2003-413!"Wissenschaft und Forschung

# $eor% &h'ee er*a% +,u,,%ar, e/ or

Controlled Trial on Point Specificity of Acupuncture in the

Treatment of Lateral Epicondylitis (Tennis Elbow

Ko,ro**'er,e +,ud'e ur Pu,se'',6, der 7uu,ur ' der 8ehad*u% der 'ody*oa,h'a huer'*a,era*'s (&e'se**ebo%e)D. Ir'h1


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o &rea,e, a**oa,'o

o &rea,e, ro,oo*

o Ou,oe easures

o +,a,'s,'a* aa*ys's

• Resu*,s

• D'suss'o

• Eo*us'o

• Reerees

Gusaeassu%

Fragestellung! G'e* der @,ersuhu% /ar d'e Aa*ua,'o ur- ud ',,e*r's,'%er J'ru%e der7uu,ur be' der 8ehad*u% der 'ody*oa,h'a huer' *a,era*'s u,er besoderer8er?s'h,'%u% u,se''sher e,e. "ethodi#! 50 Pa,'e,e ', 'ody*oa,h'a huer'*a,era*'s /urde ab/ehse*d e'er erubehad*u% (? *ass'she 7uu,uru,e) oder e'er+he'behad*u% (? 'h, *ass'she Pu,e ', 6h*'her +,'h,'ee ud +,'u*a,'o) u%e,e'*,. D'ePa,'e,e d'e ' d'ese 'ahb*'ds,ud'e e'%esh*osse /urde erh'e*,e dre' 8ehad*u%e'erha*b Ao 10 &a%e. @,ersuhu%sarae,er /are: Drushersh/e**eessu% (PP&)Kra, be' aus,sh*uss ($+) ud d'e u,'oe**e 8ee',r6h,'%u% durh +her (IP). D'e Aa*ua,'o/urde durh e'e uabh6%'%e (Aerb*'de,e) @,ersuher Aor ud u',,e*bar ah der ers,e8ehad*u% so/'e u',,e*bar ud 14 &a%e ah der dr',,e 8ehad*u%durh%e?hr,.Ergebnisse! @',,e*bar ah der ers,e 8ehad*u% e'%,e d'e Pa,'e,e ' be'de$rue e'e 8esseru% der 8esh/erde. 14 &a%e ah der dr',,e 8ehad*u% /ar d'e *ass'she7uu,ur der +he'auu,ur ' a**e @,ersuhu%sarae,er s'%''a, ?ber*e%e. D'e',,*ere $+ o,e ' der eru%rue u 43 ' er%*e'h u 14 ' der +he'%rueAerbesser, /erde. D'e IP 14 &a%e ah de der 8ehad*u% /ar ' der eru%rue u 59 'der +he'%rue u 24 redu'er,. Fh*'he r%eb'sse /urde ?r d'e PP& %eesse Hedohu,ersh'ede s'h h'er d'e 7us%a%s/er,e. @er/?sh,e J'ru%e /urde 'h,beobah,e,. Schlussfolgerung! D'e r%eb'sse *e%e ahe dass d'e 7uu,ur u,se''sheJ'ru%e bes',, ud /'rsa ' der &hera'e der 'ody*oa,h'a huer' *a,era*'s se' a.

7bs,ra,

Purpose! 7' o ,h's s,udy /as ,o eAa*ua,e shor, ad 'dd*e ,er ee,s o auu,ure ' ,he,rea,e, o *a,era* e'ody*','s uder os'dera,'o o o', se''',y. "ethods! 50 a,'e,s /',h*a,era* e'ody*','s /ere a*,era,e*y a**oa,ed ,o Aeru ('Ae *ass'a* auu,ure o',s) or shaauu,ure ('Ae o-*ass'a* o',s /',h s''*ar de,h o 'ser,'o ad s,'u*a,'o). &he b*'deda,'e,s ree'Aed ,hree ,rea,e,s /',h' ,e days. Ou,oe easures '*uded ressure a'

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,hresho*d (PP&) a'-ree %r' s,re%,h ($+) ad 'a're, aused by a' (IP). 7ssesse,s /ereerored by a 'deede, (b*'ded) eBa'er beore 'ed'a,e*y a,er ,he 'rs, ,rea,e,'ed'a,e*y a,er ,he ,h'rd ,rea,e, ad 14 days a,er ,he ,h'rd ,rea,e,. $esults!Ied'a,e*ya,er a s'%*e ,rea,e, a,'e,s /ere 'roAed ' bo,h %rous ho/eAer 14 days a,er ,he ,h'rd,rea,e,s auu,ure /as s'%''a,*y suer'or ,o sha auu,ure ' a** ou,oe easures. I$+ ,he Aeru %rou sho/ed a 'roAee, o 43 oared ,o 14 ' ,he sha %rou

'ed'a,e*y a,er ,he ,h'rd ,rea,e,. 14 days a,er ,rea,e, ,here /as a ea derease ''a're, aused by a' (IP) o 59 ' ,he Aeru %rou oared ,o 24 ' ,he sha %rou.+''*ar resu*,s /ere ob,a'ed or PP& bu, base*'e Aa*ues d'ered be,/ee %rous. o adAerse ee,so auu,ure /ere reor,ed. Conclusion! &he resu*,s su%%es, ,ha, auu,ure ay haAe o',-se'' ee,s ad sees ,o be ee,'Ae ' ,he ,rea,e, o *a,era* e'ody*','s ' r'ary are ' ,heobHe,'Ae 's ,o ob,a' a' re*'e ad ,o 'roAe u,'o.

+h*?sse*/>r,er

'ody*oa,h'a huer' *a,era*'s - 7uu,ur - +he'auu,ur - Drushersh/e**e - +her

- &e'se**ebo%e

Key /ords

'ody*','s - auu,ure - sha auu,ure - ressure a' ,hresho*d - ressure a*%oe,er - %r's,re%,h

I,rodu,'o

=a,era* e'ody*','s 's a a'u* od','o /',h a ''dee o 4.2 er 1000 a,'e,s ' ,he %eera*

ou*a,'o L%. 7*,hou%h o/ as ,e's e*bo/ beause 50 er e, o ,e's *ayers oAer ,he a%e o 30 eBer'eed hara,er's,' sy,os o e'ody*','s L& ', 's a*so see ' /orers /hoseroess'os reNu're ree,','Ae ro,a,ory o,'os o ,he orear L'. Mos, ases are aa%ed ' r'aryare ad oo ,rea,e,s '*ude o-s,ero'da* a,'-'*aa,ory dru%s (+7ID) or,'os,ero'd'He,'os ad hys'a* ,heray. May o,her ,rea,e,s are aAa'*ab*e re*e,'% a *a o osesusabou, o,'a* aa%ee, L L). 7 'reas'%*y uber o a,'e,s see ,o use o*ee,arye,hods ' ,he oAe,'oa* ,rea,e, 's 'ee,'Ae or u*easa, L*. 7uu,ure 's oe o ,heseo*ee,ary e,hods ad o,ro**ed s,ud'es su%%es, ,ha, ', a be a ee,'Ae ,rea,e, o *a,era*e'ody*','s L+ L, L-. &h's has ,o be o'red by ore /e**-des'%ed s,ud'es %a''% ore 's'%h,',o oss'b'*','es ad *'',a,'os o auu,ure L%.. Par,'u*ar*y ,he 'or,ae o eed*e *aee,,o ah'eAe bee''a* ee,s 's s,'** u*ear. I, 's /e** o/ ,ha, 'ser,'o o auu,ure eed*es a,ay s',e a haAe a' a**eA'a,'% ee,s by d'use oB'ous 'h'b',ory o,ro*s L%%. 7ord'% ,o ,he

uder*y'% ,heory o &rad','oa* Eh'ese Med''e (&EM) ore se'' ee,s o eed*'% a,aa,o'a**y de'ed *ass'a* auu,ure o',s are *a'ed L%&. &o 'Aes,'%a,e ,h's Nues,'o /eoared d'ere, s',es o auu,ure us'% ,he sae de,h ad ,eh'Nue o aua* eed*es,'u*a,'o /',h' ,he sae dera,oe.

7's o ,he ,r'a* /ere ,o eAa*ua,e ee,s o auu,ure o a' ad hys'a* dysu,'o ' ,he,rea,e, o *a,era* e'ody*','s ad ,o oare shor, ad 'dd*e ,er ee,s o auu,ure a,*ass'a* o',s ,o auu,ure a, o-*ass'a* o',s.

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Me,hods

Sub/ects

50 a,'e,s suer'% ro *a,era* e'ody*','s /ere '*uded ' ,h's sha-o,ro**ed s'%*e-b*'ded,r'a* erored a, a %eera* ra,'e s',ua,ed ' a rura* ou',y ' sou,her $eray. Pa,'e,s /eree',her se*-reerred or reerred by %eera* ra,','oers ' ,he re%'o. &he '*us'o r',er'a /ere a'ad ,ederess ' ,he *a,era* re%'o o ,he e*bo/ or a, *eas, our /ees ad absee o ay 'd o,rea,e, dur'% ,he reed'% ,/o /ees. Pa,'e,s /ere eB*uded ' ,hey had '*aa,ory ar,hr','ss,ru,ura* abora*','es o ,he e*bo/ sur%ery re%ay or o,ra'd'a,'os ,o auu,ure suh ase'*esy or b*eed'% d'sorders. D'a%os's o *a,era* e'ody*','s /as o'red by hys'a*eBa'a,'o. I eessary *abora,ory ad rad'o*o%'a* 'd'%s /ere aa*ysed ,o eB*ude '*aa,oryae,'o*o%y or s,ru,ura* abora*','es. Pa,'e,s /ere 'ored abou, ,he s,udy roedures ad /r',,e'ored ose, /as ob,a'ed. &he s,udy /as aroAed by ,he *oa* e,h's o',,ee.

Pa,'e,s ro%ress ,hrou%h ,he ,r'a* 's sho/ ' '%. L%.

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'%. % Pa,'e,s ro%ress ,hrou%h ,he ,r'a*. uber o a,'e,s.

Treatment allocation

&he a,'e,s /ere a*,era,e*y a**oa,ed ,o Aeru or sha auu,ure. &he 'rs, a,'e, ree'AedAeru auu,ure ,he seod sha auu,ure ,he ,h'rd Aeru auu,ure ad so o (Nuas'-rado'sa,'o).

Treatment protocol

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7uu,ure /as erored by a eBer'eed *'esed auu,ur's, us'% s,er'*e s'%*e-useauu,ure eed*es. &he a,'e,s ree'Aed ,hree ,rea,e,s /',h' 10 days. I ,he Aeru %roueed*es /ere 'ser,ed a, 'Ae s',es orresod'% ,o ,rad','oa* Eh'ese auu,ure o',s (=I 4 =I10 +I 3 + 5 $8 34) /hereas ' ,he sha %rou eed*es /ere 'ser,ed oe bread,h o ,he a,'e,s,hub (oe Qu aord'% ,o &EM) a/ay ro ,he *ass'a* *oa*'sa,'o. &he de,h o eed*e 'ser,'o/as s''*ar ' bo,h %rous. I, /as hose aord'% ,o ,he reoeda,'os o ,rad','oa* Eh'ese

auu,ure or ,he *ass'a* o',s L%&. I,er',,e, eha'a* s,'u*a,'o /as erored ' bo,h%rous ad eed*es /ere reoAed a,er 25 'u,es. o se'a* a,,e,'o /as %'Ae ,o e*'', eed*esesa,'o (Qde N') L%&. Pa,'e,s /ere b*'ded or ,he ,rea,e, so ,ha, ,hey d'd o, o/ ' ,hey/ere ,rea,ed /',h rea* or sha auu,ure.

0utcome measures

Ou,oe assesse,s /ere erored by a b*'ded s,udy urse re-,rea,e, (base*'eeasuree, ,0) 'ed'a,e*y a,er ,he 'rs, ,rea,e, (,1) 'ed'a,e*y a,er ,he ,h'rd ,rea,e,(,2) ad 14 days a,er ,he ,h'rd ,rea,e, (,3). &he base*'e assesse, '*uded deo%rah'Aar'ab*es ad ed'a* h's,ory.

Pressure a' ,hresho*d (PP&) /as eAa*ua,ed by a Aa*'da,ed ressure a*%oe,er (Pa' D'a%os,' ad&hero%rahy 11021 @+7) a, ,/o aa,o'a**y de'ed s',es L%'. &he 'rs, easur'% o', (P1)/as *oa,ed a, ,he 'ser,'o o ,he oo ,edo o ,he eB,esor ar' rad'a*'s us*es a, ,he *a,era*e*bo/. &he seod easur'% o', (P2) /as *oa,ed a, ,he be**y o eB,esor ar' rad'a*'s breA'sus*e a, ,he ,ras','o be,/ee ,he roB'a* ,h'rd ad ,he d's,a* ,/o ,h'rds o ,he orear. Pa,'e,s/ere sea,ed oor,ab*y /',h ,he shou*der a, res, ad ,he e*bo/ *y'% o ,he ,ab*e /',h 45S *eB'o.&he ressure a*%oe,er /as a*'ed a, ,he easur'% o',s /',h 'reas'% ressure u,'* a'ourred. Measur'% o',s /ere ared o ,he s' /',h a /a,erroo e'* ,o %uara,ee ,ha, ,heo**o/'% easuree,s /ere erored a, ,he 'de,'a* s',e.

Pa'-ree %r' s,re%,h ($+) /as easured by a Eo**'s dyaoe,er L%. &es, os','o /as s''*ar,o ,he easuree,s o PP&. Pa,'e,s /ere 's,ru,ed ,o ress ,he dyaoe,er ad ,o s,o /he ay'd o a' /as eBer'eed oAer ,he *a,era* e'ody*e. &hree read'%s /ere erored addoue,ed.

I add','o 'a're, aused by a' (IP) /as eAa*ua,ed by a uer' ra,'% sa*e (R+ 0 - 10).Pa,'e,s /ere ased: Q


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Resu*,s

50 a,'e,s o*e,ed ,he ,r'a*. Oe a,'e, suered ro e'ody*','s b'*a,era**y. &he Nuas'-rado'sa,'o a**oa,ed h' ,o ,he Aeru %rou ad he ree'Aed auu,ure a, *ass'a* o',s o

bo,h s'des. &here /as o droou, or /',hdra/a* ro ,he s,udy ('%. L%). o ser'ous adAerse eAe,s/ere obserAed dur'% ,rea,e,.

8ase*'e hara,er's,'s /ere eNua**y ba*aed be,/ee %rous (&ab*e L%). 8ase*'e assesse, oou,oe easures ' bo,h %rous are suar'sed ' &ab*e L&. &he Ma-Jh',ey @-,es, reAea*ed as'%''a, d'eree be,/ee %rous ' PP&. &h's d'eree /as rooued ' bo,h d're,'os: 7, P1,he Aeru %rou had a h'%her a' ,hresho*d oared ,o ,he sha %rou ad a, P2 ,he sha %rouhad a h'%her a' ,hresho*d ,ha ,he Aeru %rou. &here /ere o s'%''a, d'erees be,/ee%rous ' $+ ad IP.

Table 1 Baseline characteristics of the patients according to treatment groups

Variable

Verum group

(n = 25)

Sham group

(n = 25)

Sex (male/female) 16/9 18/7

Mean Age (ear!)" (range) 5#$% (%1 & 7#) 51$5 (%8 & 65)

Mean 'uraion of pain (monh!)" (range) $5 (1 & 1) $8 (1 & 12)

*re+iou!&reamen 12 (8 ,) 11 ( ,)

& -o.al .ori.o!eroi' ine.ion 6 (2 ,) 6 (2 ,)

& Splin 5 (2# ,) (16 ,)

& 0SA (oral) 2 (8 ,) (16 ,)

& 0SA an' oher! (lo.al) 5 (2# ,) % (12 ,)

Table 2 Outcome measures: Baseline assessment (t0). Data are expressed as mean alues

(! "D)

Variable

Verum group

(n = 26)3

Sham group

(n = 25)

4roup .ompari!on

p&+alue33

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8/13

** a *1 (g/.m2) %$15 ( #$69) 2$68 ( #$65) #$#22

** a *2 (g/.m2) %$12 ( #$62) %$6 ( #$78) #$#52

4S (uni!" # & 2##) 6$7 ( %$#) 5%$7 ( 17$7) #$19%

* (0S" # & 1#) 8$19 ( #$8#) 7$72 ( 1$%7) #$15

3 ne paien in he +erum group !uffere' bilaerall from laeral epi.on'lii!$ :oh !i'e! ;ere

reae' an' e+aluae'$ 33


9/13

2##) 11$6% $21 9$

* (0S" # &

1#)

& 1$57 & #$8# & #$78 #$#61

2

** (*1) #$9% #$65 &

1$21

#$6% #$%9 &

#$87

#$%# & #$#6 &

#$67

#$178

** (*2) 1$#% #$7% &

1$%%

#$58 #$%2 &

#$8%

#$5 #$#7 &

#$8

#$#2

4S 21$5 1%$59 &29$9

8$5% %$5# &1%$57

1%$#1 %$7 &22$27

#$##8

* & $%1 & 2$# & 2$27 #$##%

%

** (*1) 1$%# #$96 &

1$6%

#$66 #$%7 &

#$95

#$6 #$2# &

1$#7

#$##6

** (*2) 1$# #$96 &

1$8

#$56 #$28 &

#$8

#$8 #$%2 &

1$%6

#$##

4S 27$95 19$2% &

%6$61

7$ 2$98 &

11$82

2#$55 1#$95 &

%#$15

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* & $77 & 1$88 & 2$89 #$##1

**? pre!!ure pain hre!hol'@ 4S? pain&free grip !rengh@ *? impairmen .au!e' b pain@ 0S?

numeri. raing !.ale$ 3 ne paien in he +erum group !uffere' bilaerall from laeralepi.on'lii!$ :oh !i'e! ;ere reae' an' e+aluae'$ 33


10/13

&here /as a ea derease ' 'a're, aused by a' (IP) o 59 ' ,he Aeru %rou oared,o 24 ' ,he sha %rou 14 days a,er ,rea,e,. V a,'e,s ' ,he Aeru sored o 'a're,(7+ 0) a,er ,rea,e, bu, o a,'e, ' ,he sha %rou sored o 'a're,.

D'suss'o&he resu*,s o ,h's ,r'a* 'd'a,e ,ha, auu,ure o *ass'a* auu,ure o',s a be ee,'Ae ',he r'ary are ,rea,e, o a,'e,s /',h *a,era* e'ody*','s. Pressure a' ,hresho*d a'-ree%r' s,re%,h ad ,he 'a're, aused by a' /ere *ear*y 'roAed 14 days a,er ,hree,rea,e,s. Pressure a' /as easured /',h a ressure a*%oe,er ad a'-ree %r' s,re%,h /aseasured /',h a dyaoe,er. 8o,h are Aa*'d ad re*'ab*e easur'% 's,rue,s. Je haAe hosea'-ree %r' s,re%,h beause ', sees ,o be ore Aa*'d ,ha ,he aB'u %r' s,re%,h L%).Resu*,s o a,'e,sW ra,'%s oer'% ,he 'a're, /ere ' a%reee, /',h ,he resu*,s easuredby obHe,'Ae ,oo*s. &h's 'd'a,es ,ha, ,he ee,s ah'eAed by auu,ure are o,e,'a**y useu* *''a*'d'%s.

&he eed or o,ro**ed auu,ure s,ud'es 's eA'de, ' order ,o ob,a' a re*'ab*e eAa*ua,'o o ,heee,s o auu,ure L%..


11/13

Je aa*ysed 2! ases o e'ody*oa,h'a ' ,he Aeru %rou beause oe a,'e, sueredb'*a,era**y. Da,a o bo,h s'des '%h, o, be 'deede, bu, resu*,s /ere s''*ar /he /e eB*udedda,a o oe s'de ro aa*yses.

7o,her *'',a,'o ,o dra/'% de'','Ae o*us'o o ,he e'ay o auu,ure ro ,h's s,udy 's ,hea, ,ha, a,'e,s ree'Aed o*y 3 ,rea,e,s. &here are Aar'a,'os ' ,he reoeda,'os abou, ,heo,'u uber o ,rea,e, ' ,he *',era,ure bu, ore ,ha 3 sess'os are reoeded ' os,ases L&&. Our obserAa,'o ,ha, d'erees be,/ee Aeru ad sha auu,ure 'reased oAer,'e shou*d be ,ae ',o aou, or u,ure researh. &EM a*so reoeds a 'd'A'dua* ho'e oauu,ure o',s L%& bu, %'Ae ,he a' o our s,udy ', /as eessary ,o use oru*a auu,ure.

Je oud ,hree reA'ous o,ro**ed ,r'a*s o auu,ure ' *a,era* e'ody*','s.


12/13

• 2 'rsh* R P. &e's e*bo/. Or,ho E*' or,h 7. 19V3; 4 V"V-"00

• 3 K'A' P. &he e,'o*o%y ad oserAa,'Ae ,rea,e, o huera* e'ody*','s. +ad Rehab'*

Med. 19"3; 15 3V-41

• 4 Ehard M D


13/13

• 1! Ir'h D. Deads oss'b'*','es ad *'',s o eA'dee-based eAa*ua,'o ' auu,ure.

L7orderu%e M>%*'he',e ud $ree der A'de-bas'er,e 7uu,ureAa*ua,'o. D,sh G

7uu,. 2000; 432 11V-125

• 1V 'e, E 7 R'hardso P

Phys Med Rehab Kuror 2003

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