Table 1.

Data extraction.

Review Year Country	Review Aim	Search Strategy	Studies and Participants	Patients, Interventions, Comparison, Outcome, and Study Type (PICOS)	Risk of Bias	Limits	Author’s Conclusion
van der Windt et al. (1999) [21] The Netherlands	To evaluate the effectiveness of ultrasound therapy in the treatment of musculoskeletal disorders and lateral epicondylitis (LE).	MEDLINE, EMBASE No search start date. Last search date in July 1997. Search terms defined. No limitation described. RCTs were screened. No evidence of reference checking. Eligibility criteria: patients with pain and/or restriction of range of motion associated with musculoskeletal disorders, RCTs, English.	RCT s= 4 N = 123	Population: patients with lateral epicondylitis Intervention: US Comparison: US sham, low-level laser, exercise Study type: RCTs	No evidence of quality assessment	Only RCTs in the US and LE were included.	The findings reported for lateral epicondylitis were less consistent and may warrant further evaluation.
Struijs et al. (2002) [22] Australia	To determine the efficacy of treatment of lateral epicondylitis by an orthotic device.	MEDLINE, EMBASE, CINAHL. No search start date. Last search date in 1999. Search terms defined. No limitations described. RCTs were screened. No evidence of reference checking. Eligibility criteria: patients with lateral epicondylitis of the humerus (tennis elbow), RCTs, English.	RCTs = 5 N = 300	Population: patients with lateral epicondylitis Intervention: orthotic devices Comparison: corticosteroid injection, anti-inflammatory cream, splintage, physiotherapy Study type: RCTs	Clear quality appraisal of the studies	A standard set of valid and reliable outcome measures should be incorporated into the RCTs.	No definitive conclusions can be drawn concerning the effectiveness of orthotic devices for lateral epicondylitis. More well-designed and well-conducted RCTs of sufficient power are warranted.
Green et al. (2002) [23] Australia	To determine the effectiveness of acupuncture in the treatment of patients with lateral elbow pain with respect to symptom reduction, including pain, improvement in function, grip strength, and adverse effects.	MEDLINE, EMBASE, CINAHL No search start date. Last search date in June 2001. Search terms defined. No limitations described. RCTs were screened. Evidence of reference checking. Eligibility criteria: lateral elbow pain and acupuncture, RCTs, English.	RCTs = 4 N = 239	Population: patients with lateral epicondylitis Intervention: acupuncture Comparison: sham acupuncture, low-level laser, vitamin B12 Study type: RCTs	Quality assessment completed but criteria and explanation unclear.	Trials should be adequately powered, attempt to blind both participants, including outcome measures of pain and function and adverse effects.	There is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral elbow pain.
Borkholder et al. (2004) [24] USA	To confirm or refute the efficacy of using splints in the treatment of lateral epicondylitis.	CINAHL, EMBASE, PEDro, and Cochrane databases. No search start date. Last search date in December 2003. Search terms defined. No limitations described. RCTs were screened. Evidence of hand searching. Eligibility criteria: splint and lateral elbow pain, RCTs, English.	RCTs = 8 N = 347	Population: patients with lateral epicondylitis Intervention: splinting Comparison: other splint, manipulation, anti-inflammatory cream, diclofenac Study type: RCTs	Clear quality appraisal of the studies.	Duration of symptoms was not considered in the majority of the included studies.	Early positive, but not conclusive, support for the effectiveness of splinting lateral epicondylitis.
Trudel et al. (2004) [25] Canada	To determine the effectiveness of conservative treatments for lateral epicondylitis and to provide recommendations based on this evidence.	CINAHL, EMBASE, PEDro, and Cochrane databases. Search start date 1983. Last search date in March 2003. Search terms defined. No limitations described. RCTs were screened. Evidence of hand searching. Eligibility criteria: English, adults (age 18+), humans, RCTs or quasi-RCTs, lateral epicondylitis, and rehabilitation.	RCTs = 21 N = 1666	Population: patients with lateral epicondylitis Intervention: US, acupuncture, rebox, wait-and-see, exercise, mobilisation, ionisation, laser, pulsed electromagnetic field Comparison: phonophoresis, sham, injection Study type: RCTs	Clear quality appraisal of the studies.	No adequate blinding measures, follow-up, and standardised outcome measures in RCTs.	There is a number of good-quality studies on various therapeutic interventions for lateral epicondylitis that demonstrate a variety of effective treatment options.
Buchbinder et al. (2004) [26] Australia	To determine the effectiveness and safety of shockwaves (ESWT) in the treatment of adults with lateral elbow pain.	MEDLINE, CINAHL, EMBASE, SCISEARCH, Cochrane Clinical Trials trial database. No search start and finish date. Search terms defined. No limitations described. RCTs were screened. No eligibility criteria.	RCT = 2 N = 372	Population: patients with lateral epicondylitis Intervention: ESWT Comparison: placebo ESWT Study type: RCTs	Quality assessment completed but criteria and explanation unclear.	Unclear allocation procedures in the trial of Rompe et al. and the treatment allocation of those who dropped out of the trial (13% of participants) was not reported.	The effectiveness of ESWT is unclear. The two trials included in this review yielded conflicting results. Further trials are needed to clarify the value of ESWT for lateral elbow pain.
Bisset et al. (2005) [27] Australia	To look at the effectiveness of physical interventions on clinically relevant outcomes for LE.	MEDLINE, CINAHL, EMBASE, Web of Science, Allied and Complimentary Medicine, SPORTDiscus, PEDro. Last search date in September 2003. Search terms defined. No limitations described. RCTs were screened. Eligibility criteria: RCT, English, patient with lateral elbow pain.	RCTs = 24 N = 1760	Population: patients with lateral epicondylitis Intervention: laser, ESWT, manipulation, mobilisation, exercise tape, orthotics, acupuncture, laser, iontophoresis Comparison: sham ESWT, sham tape, sham acupuncture Study type: RCTs	Clear quality appraisal of the studies.	Duration of symptoms and follow-up was not considered in the majority of included studies.	Evidence is accruing that does not support the use of ESWT, but there is indication for further research with long-term follow-up into manipulation and exercise as forms of treatment for LE.
Herd, (2008) [28] The Netherlands	To review the effectiveness of manipulation in treating lateral epicondylalgia.	MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Health Source, SPORTDiscus, Physiotherapy Evidence Database. Search start date 1929. Last search date in November 2007. Search terms defined. No limitations described. RCTs were screened. No evidence of reference checking. Eligibility criteria: English, experimental design, subjects with lateral epicondylitis, manipulative treatment.	RCTs = 13 N = 639	Population: patients with lateral epicondylitis Intervention: manipulative therapy, Cyriax, MWM Comparison: exercise, injection, wait-and-see, US, friction massage Study type: RCTs	Clear quality appraisal of the studies.	Variability regarding manipulative technique, comparison interventions, follow-up, and outcome measures. Only one reviewer determined appropriateness for inclusion.	Current evidence supports Mulligan’s mobilisation with movement not only in providing immediate benefits but also improving outcomes at short- and long-term follow-up. A subgroup of patients with LE exists who would benefit from treatment directed at the cervical spine.
Barr et al. (2009) [29] UK	To compare the effectiveness of corticosteroid injections with physiotherapeutic interventions for the treatment of lateral epicondylitis (tennis elbow).	AMED, MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Clinical Trials, Metaregister of Controlled Clinical Trials, PEDro. Search start date 1966. Last search date in March 2009. Search terms defined. No limitations described. RCTs were screened. Evidence of hand searching. Eligibility criteria: English, RCTs, lateral epicondylitis and corticosteroid injection.	RCTs = 3 N = 596	Population: patients with lateral epicondylitis Intervention: corticosteroid injection, corticosteroid injection with exercise and manipulation Comparison: exercise, US, wait-and-see, paracetamol, no treatment Study type: RCTs	Clear quality appraisal of the studies.	No follow-up in RCTs, no similar outcome measures.	Corticosteroid injections are effective at short-term follow-up, and physiotherapeutic interventions are effective at intermediate- and long-term follow-up. However, any conclusions drawn must be interpreted with caution.
Coombes et al. (2010) [30] Australia	To review the clinical efficacy and risk of adverse events of injections (including corticosteroids) for treatment of tendinopathy in the short term, intermediate term, and long term, and in different areas of tendinopathy.	MEDLINE, CINAHL, EMBASE, Web of Knowledge, Allied and Complementary Medicine, SPORTDiscus, Cochrane Controlled Trial Register, and Physiotherapy Evidence Database. No starting data search. Last search date in March 2010. Search terms defined. No limitations described. RCTs were screened. Evidence of hand searching. Eligibility criteria: RCTs, tendinopathy, and injection.	RCTs = 12 N = 1034	Population: patients with tendinopathy Intervention: corticosteroid injection, corticosteroid injection with exercise Comparison: physiotherapy, wait-and-see, NSAIDs, manipulation. Study type: RCTs	Clear quality appraisal of the studies.	No concealed allocation and similar outcome measures in the majority of included RCTs.	Despite the effectiveness of corticosteroid injections in the short term, non-corticosteroid injections might be of benefit for long-term treatment of lateral epicondylalgia. However, response to injection should not be generalised because of variation in effect between sites of tendinopathy.
Tumilty et al. (2010) [31] New Zealand	To assess the clinical effectiveness of low-level laser therapy (LLLT) in the treatment of tendinopathy.	MEDLINE, PubMed, CINAHL, AMED, EMBASE, All EBM (Evidence-Based Medicine) reviews, PEDro (Physiotherapy Evidence Database), SCOPUS. No starting data search. Last search date in August 2008. Search terms defined. No limitations described. RCTs were screened. No evidence of reference checking. Eligibility criteria: RCT, tendinopathy, and LLLT.	RCTs = 12 (10) N = 422	Population: patients with tendinopathy Intervention: LLLT Comparison: placebo, Tecar, friction massage, corticosteroid injection Study type: RCTs	Clear quality appraisal of the studies.	Only RCTs on LLLT and LE were included. Poor blinding procedures and reliable outcome measures.	LLLT can potentially be effective in treating tendinopathy when recommended dosages are used. The 12 positive studies provide strong evidence that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.
Kalichman et al. (2011) [32] Israel	To determine the efficacy of botulinum toxin for the treatment of chronic lateral epicondylitis.	PubMed, MEDLINE, CINAHL, Google Scholar, EMBASE, PEDro, ISI web of Science databases. No starting data search. Last search date in November 2009. Search terms defined. No limitations described. RCTs were screened. Evidence of hand searching. Eligibility criteria: botulinum toxin A for treatment of lateral epicondylitis, RCTs.	RCTs = 4 N = 278	Population: patients with lateral epicondylitis Intervention: botulinum toxin A injection Comparison: placebo (saline solution) Study type: RCTs	Clear quality appraisal of the studies.	No concealed allocation, description of adverse effect, and similar outcome measures in the majority of included RCTs.	Current literature provides support for use of botulinum toxin A injections into the forearm extensor muscles (60 units Disport or equivalent) for the treatment of chronic treatment-resistant lateral epicondylitis.
Buchbinder at al. (2011) [33] Australia	To determine the benefits and safety of surgery for lateral elbow pain.	CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and Web of Science. Search start date 1966. Last search date in December 2010. Search terms defined. No limitations described. RCTs were screened. No evidence of hand searching. Eligibility criteria: lateral elbow pain and surgery.	RCTs = 5 N = 193	Population: patients with lateral epicondylitis Intervention: “open” surgery, percutaneous surgery Comparison: percutaneous surgery, botulinum toxin, ESWT Study type: RCTs	Clear quality appraisal of the studies.	Trials were susceptible to bias and hampered by inadequate reporting and small sample size.	Due to a small number of studies, large heterogeneity in interventions across trials, small sample sizes, and poor reporting of outcomes, there is insufficient evidence to support or refute the effectiveness of surgery for lateral elbow pain.
Raman et al. (2012) [34] Canada	To synthesise the quality and content of clinical research addressing type and dosage of resistance exercises in lateral epicondylosis	MEDLINE, EMBASE, CINAHL, SCOPUS. Search start date 1966. Last search date in December 2010. Search terms defined. Studies that investigated surgery, orthoses (splints), shock wave therapy, electrical stimulation, steroid injections, or casts were excluded. RCTs were screened. No evidence of hand searching. Eligibility criteria: lateral epicondylosis and exercise (strength, resistance, eccentric, concentric)	RCTs = 9 N = 697	Population: patients with lateral epicondylitis Intervention: resistance training (isometric, eccentric, concentric, isokinetic) Comparison: static stretching, ice, manipulation, forearm band; US Study type: RCTs	Clear quality appraisal of the studies.	Lack of high-quality trials that compared different exercise types or dosage, and a lack of detailed descriptions of exercise parameters in many published studies.	Strengthening using resistance exercises is effective in reducing pain and improving function for lateral epicondylosis, but optimal dosing is not defined.
Ahmad et al. (2013) [35] UK	To evaluate the evidence for the application of platelet-rich plasma (PRP) in lateral epicondylitis.	MEDLINE, EMBASE, CINAHL PubMed. Search start date 1966. Last search date in 2011. Search terms defined. No limitations described. RCTs were screened. No evidence of hand searching. Eligibility criteria: Human, RCTs, English, PRP in patients with lateral epicondylitis.	RCTs = 8 N = 507	Population: patients with lateral epicondylitis Intervention: PRP Comparison: saline injection, placebo Study type: RCTs	Clear quality appraisal of the studies.	Heterogeneity of patient population, variation of PRP preparation, and lack of standard outcome measures.	Limited but evolving evidence for the use of PRP in lateral epicondylitis; however, further research is required to understand the concentration and preparation that facilitate the best clinical outcome.
Pattanittum et al. (2013) [36] Australia	To assess the benefits and harm of topical and oral NSAIDs for treating people with lateral elbow pain.	MEDLINE, EMBASE, CINAHL, Cochrane. Search start date 1966. Last search date in 2011. Search terms defined. No limitations described. RCTs were screened. No evidence of hand searching. Eligibility criteria: Human, RCTs, NSAIDs in lateral elbow pain.	RCTs = 14 N = 938	Population: patients with lateral epicondylitis Intervention: NSAIDs Comparison: placebo Study type: RCTs	Clear quality appraisal of the studies.	RCTs did not provide enough published data, or did not provide data in a form that could be extracted for meta-analysis.	Limited evidence from which to draw firm conclusions about the benefits or harm of topical or oral NSAIDs in treating lateral elbow pain.
Cullinane et al. (2014) [37] New Zealand	To establish the effectiveness of eccentric exercise as a treatment intervention for lateral epicondylitis.	ProQuest, Medline via EBSCO, AMED, Scopus, Web of Science, CINAHL No starting search date. Last search date in 2011. Search terms defined. Limits: corticosteroid injections prior to the intervention or as part of the treatment or comparative therapy. RCTs were screened. No evidence of hand searching. Eligibility criteria: English, RCTs, tennis elbow, and eccentric exercise.	RCTs = 12 (3) N = 611	Population: patients with lateral epicondylitis Intervention: Eccentric exercise, eccentric exercise with other therapies Comparison: iontophoresis, US, stretching Study type: RCTs	Quality assessment completed but criteria and explanation unclear.	Lack of blinding of participants and treatment providers, lack of control group and standardised diagnostic criteria.	The majority of consistent findings support the inclusion of eccentric exercise as part of a multimodal therapy programme for improved outcomes in patients with lateral epicondylitis.
Tang et al. (2015) [38] China	To assess the effectiveness and safety of acupuncture for lateral epicondylitis (LE).	EMBASE, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database), Wanfang Database, and Chinese Biomedical Literature Database (Sinomed). No starting search date. Last search date in 2015. Search terms defined. Limitations: no laser stimulation, no acupressure, no other type of acupuncture. RCTs were screened. No evidence of reference and hand searching. Eligibility criteria: RCTs, acupuncture, and lateral epicondylitis.	RCTs = 4 N = 309	Population: patients with lateral epicondylitis Intervention: acupuncture, electro-acupuncture Comparison: sham acupuncture, blockage therapy Study type: RCTs	Quality assessment completed but criteria and explanation unclear.	No detailed definition on random sequence generation, allocation concealment, and blinding of participants and personnel.	For the small number of included studies with poor methodological quality, no firm conclusion can be drawn regarding the effect of acupuncture on elbow functional status and myodynamia for LE.
Tsikopoulos et al. (2016) [39] Greece	To compare the efficacy of autologous whole blood with that of corticosteroid injections on epicondylopathy and plantar fasciopathy (PF).	PubMed, Web of Science, CENTRAL, and Scopus. No starting search date. Last search date on 6 May 2015. Search terms defined. No limitations described. Evidence of reference and hand searching. Eligibility criteria: Human, English, RCTs, autologous venous blood with that of corticosteroids on either epicondylopathy or PF.	RCTs = 9 (5) N = 447 (209)	Population: patients with lateral epicondylitis Intervention: autologous whole-blood intervention, corticosteroid injection Comparison: autologous whole-blood intervention, corticosteroid injection, placebo Study type: RCTs	Clear quality appraisal of the studies.	Eight RCTs were conducted in Asia. The follow-up in eight studies did not exceed six months.	Corticosteroids were marginally superior to autologous whole blood in relieving pain on plantar fasciopathy at 2–6 weeks. Autologous whole blood provided significant clinical relief on epicondylopathy at 8–24 weeks. Conclusions were limited by the risk of bias.
Mattie et al. (2017) [40] USA	To analyse currently available controlled studies on percutaneous tenotomy and its efficacy for the treatment of lateral epicondylitis.	MEDLINE, EMBASE, CINAHL, Cochrane, Web of Science. No starting search date. Last search date in November 2015. Search terms defined. No limitations described. Evidence of reference and hand searching. Eligibility criteria: English, RCTs, tennis elbow, and percutaneous tenotomy.	RCTs = 6 N = 242	Population: patients with lateral epicondylitis Intervention: percutaneous tenotomy Comparison: / Study type: prospective studies	Quality assessment completed but criteria and explanation unclear.	The included RCTs had a small sample size and patient self-selection for The procedure. The studies included variability of time in follow-up and in duration of symptoms.	Percutaneous tenotomy presents an alternative to surgical release of the common extensor tendon for the treatment of chronic tendinosis at the lateral epicondyle of the elbow. Current research supporting the efficacy of this procedure, however, is of low quality (level II to level IV).
Burn et al. (2017) [41] USA	To determine whether the choice of surgical technique (open, percutaneous, or arthroscopic) would lead to significantly different clinical outcomes in lateral epicondylitis (LE).	PubMed, Cochrane Central Register of Controlled Trials, and Google Scholar. No starting search date. Last search date in July 2016. Search terms defined. No limitations described. Evidence of reference and hand searching. Eligibility criteria: English, RCTs, tennis elbow, and surgery treatment.	RCTs = 5 N = 179	Population: patients with lateral epicondylitis Intervention: open, percutaneous or arthroscopic intervention Comparison: open, percutaneous or arthroscopic intervention Study type: RCTs	Quality assessment completed but criteria and explanation unclear.	Performance bias is present as the surgical interventions and postoperative protocols were not identical for all studies. There was a wide heterogeneity in surgical procedures and outcome measures used in the included studies.	There are no clinically significant differences between the 3 surgical techniques (open, arthroscopic, and percutaneous) in terms of functional outcome (DASH), pain intensity (VAS), and patient satisfaction at 1-year follow-up in subjects with LE.
Lucado et al. (2018) [42] USA	To determine whether joint mobilisations are effective in improving pain, grip strength, and disability in adults with LET.	CINAHL, PubMed, and PEDro. No starting search date. Last search date in June 2017. Search terms defined. No limitations described. Evidence of reference and hand searching. Eligibility criteria: RCTs, English, mobilisation or manipulation, and lateral elbow tendinopathy.	RCTs = 6 (3) N = 461 (205)	Population: patients with lateral epicondylitis Intervention: MWM, manipulation, mobilisation Comparison: US, corticosteroid, placebo injection, traditional treatment Study type: RCTs	Clear quality appraisal of the studies.	There were very few studies with similar research design, outcomes, or follow-up time periods.	There is compelling evidence that joint mobilisations have a positive effect on both pain and/or functional grip scores across all time frames compared to control groups in the management of LET.
Lin et al. (2018) [43] Taiwan	To explore the effectiveness of botulinum toxin compared with non-surgical treatments in patients with lateral epicondylitis.	PubMed, Scopus, Embase, and Airity Library. No starting search date. Last search date in February 2017. Search terms defined. No limitations described. Evidence of reference and hand searching. Eligibility criteria: RCTs, English and Chinese, lateral epicondylitis, and botulinum toxin.	RCTs = 6 N = 310	Population: patients with lateral epicondylitis Intervention: botulinum toxin injection Comparison: placebo injection Study type: RCTs	Clear quality appraisal of the studies.	Not all the RCTs documented other possible adverse events, including infection, tingling sensation, and tenderness related to injections.	When treating lateral epicondylitis, botulinum toxin was superior to placebo and could last for 16 weeks. Corticosteroid and botulinum toxin injections were largely equivalent, except the corticosteroid injections were better at pain relief in the early stages and were associated with less weakness in grip in the first 12 weeks.
Navarro-Santana et al. (2020) [44] Spain	To evaluate the effect of dry needling alone or combined with other treatment interventions on pain, related-disability, pressure pain sensitivity, and strength in people with lateral epicondylalgia of musculoskeletal origin.	MEDLINE, CINAHL, PubMed, PEDro, Cochrane Library, SCOPUS, and Web of Science databases from their inception to 5 April 2020.	RCTs = 7 N = 320	Population: patients with lateral epicondylitis Intervention: trigger-point dry needling Comparison: low-level laser, manipulation, ultrasound, ESWT Study type: RCTs	Clear quality appraisal of the studies.	The number of included trials was small (n = 7). Additionally, needling interventions were applied with different dosages. Another potential limitation is the heterogeneity and imprecision of the results of some of the trials.	The current meta-analysis found low evidence supporting the application of dry needling for the treatment of lateral epicondylalgia of musculoskeletal origin; however, some questions remain to be elucidated in future studies.
Karanasios et al. (2021) [45] Greece	To evaluate the effectiveness of exercise compared with other conservative interventions in the management of LET.	MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, Cochrane Library, and Grey literature databases were systematically searched from inception to November 2019.	RCTs = 30 N = 2123	Population: patients with lateral epicondylitis Intervention: exercise Comparison: exercise, manipulation, corticosteroid, wait-and-see Study type: RCTs	Clear quality appraisal of the studies.	Despite including 30 studies with over 2000 participants, there were no studies with a low risk of bias.	Low and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.