Original article
The Effects of Splinting on Outcomes for Epicondylitis

https://doi.org/10.1016/j.apmr.2004.11.029Get rights and content

Abstract

Derebery VJ, Devenport JN, Giang GM, Fogarty WT. The effects of splinting on outcomes for epicondylitis. Arch Phys Med Rehabil 2005;86:1081–8.

Objective

To evaluate the effects of splinting on outcomes for injured workers with epicondylitis.

Design

Retrospective cohort study using propensity score methodology to statistically control for all observed pretreatment differences between patients with and without splints.

Setting

Nationwide network of 253 occupational medicine clinics.

Participants

All injured workers (N=4614) receiving primary care for lateral or medical epicondylitis (International Classification of Diseases, 9th Revision, codes 726.31 or 726.32).

Interventions

Not applicable.

Main Outcome Measures

Physician-prescribed rates of duty restrictions and lost time, treatment duration, specialist referrals, and medical and physical therapy (PT) visits and charges.

Results

Overall, patients with splints had higher rates of limited duty (P<.001), more medical visits and charges (P<.001), higher total charges (medical and PT, P<.001), and longer treatment durations (P<.01) than patients without splints. Evaluating differences for patients who did and did not receive PT, significant differences remained for rates of limited duty (P<.05), medical visits (P<.01), and medical charges (P<.01).

Conclusions

Splinting patients with epicondylitis may not optimize outcomes, including rates of limited duty, treatment duration, and medical costs.

Section snippets

Participants

The patient population in this study consisted of patients receiving primary care for lateral or medial epicondylitis (International Classification of Diseases, 9th Revision, codes 726.31 or 726.32) at any clinic within a nationwide network of 253 occupational medical centers. This network, owned and operated by Concentra Inc, sees approximately 7% of US workers’ compensation patients. Patient records were retrieved from the proprietary internal information management system, which contains

Splinting Main Effect

Table 3 summarizes differences in outcome measures for patients with and without splints. Means and SEs for each outcome measure are presented for splinted versus nonsplinted patients within propensity score subclasses and averaged across subclasses. Significance test results, noted in the last row of the table, refer to the overall mean difference observed for splinting versus not splinting (calculated as a 2-tailed z test, significant at P<.05).

Overall significant differences between splint

Discussion

A treating provider’s main reasons for prescribing a splint are, presumably, to rest the arm and to alleviate pain or discomfort. However, no good correlation between a patient’s subjective pain ratings and his/her ability to work or to perform certain physical activities has been established, nor has a correlation been found between the decrease in symptoms and the rate of return to work.34, 35 In addition, prescribing a splint is likely to necessitate movement restrictions that may further

Conclusions

The challenge in occupational medicine, particularly with respect to workers’ compensation, is for providers to maximize the health and well-being of their patients while showing their cost-effectiveness to employers and payers in the present environment of ever-escalating medical costs. Critical to the success of such efforts is an evaluation of “what works” because cheaper procedures are not cost-effective if they inflate total medical and indemnity costs by prolonging treatment duration and

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