title: The effectiveness of exercise for the management of musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.
abstract: OBJECTIVE
  The purpose of this systematic review was to evaluate the effectiveness of exercise compared to other interventions, placebo/sham intervention, or no intervention in improving self-rated recovery, functional recovery, clinical, and/or administrative outcomes in individuals with musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand.
  
  
  METHODS
  We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers independently screened studies for relevance and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network criteria. We synthesized the evidence using the best evidence synthesis methodology.
  
  
  RESULTS
  We identified 5 studies with a low risk of bias. Our review suggests that, for patients with persistent lateral epicondylitis, (1) adding concentric or eccentric strengthening exercises to home stretching exercises provides no additional benefits; (2) a home program of either eccentric or concentric strengthening exercises leads to similar outcomes; (3) home wrist extensor strengthening exercises lead to greater short-term improvements in pain reduction compared to "wait and see"; and (4) clinic-based, supervised exercise may be more beneficial than home exercises with minimal improvements in pain and function. For hand pain of variable duration, supervised progressive strength training added to advice to continue normal physical activity provides no additional benefits.
  
  
  CONCLUSIONS
  The relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. The current evidence shows that the addition of supervised progressive strength training does not provide further benefits over advice to continue normal physical activity for hand pain of variable duration.
authors.affiliation: Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Menta
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada. Electronic address: Kristi.randhawa@uoit.ca.
authors.forename: Kristi
authors.initials: K
authors.lastname: Randhawa
authors.affiliation: Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Oshawa, Ontario, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Instructor, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Wong
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Hainan
authors.initials: H
authors.lastname: Yu
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Adjunct Professor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Sutton
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Sharanya
authors.initials: S
authors.lastname: Varatharajan
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Research Coordinator, Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Southerst
authors.affiliation: Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: D'Angelo
authors.affiliation: Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Cox
authors.affiliation: Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Courtney
authors.initials: C
authors.lastname: Brown
authors.affiliation: Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dion
authors.affiliation: Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Adjunct Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
authors.forename: Silvano
authors.initials: S
authors.lastname: Mior
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Postdoctoral Fellow, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada.
authors.forename: Maja
authors.initials: M
authors.lastname: Stupar
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Clinical Research Manager, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Shearer
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
authors.forename: Gail M
authors.initials: GM
authors.lastname: Lindsay
authors.affiliation: Assistant Clinical Professor, Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; Director, Division of Clinical Education and Patient Care, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Taylor-Vaisey
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D003299:Cooperative Behavior; D019468:Disease Management; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005543:Forearm Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D006230:Hand Injuries / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000534:rehabilitation*; D009864:Ontario; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D020127:Recovery of Function; D000078202:Systematic Reviews as Topic; D013716:Tennis Elbow / Q000534:rehabilitation; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D014954:Wrist Injuries / Q000534:rehabilitation
keywords: Elbow; Exercise Therapy; Hand; Lateral Humeral Epicondylitis; Review; Systematic; Upper Extremity