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Chronic pain is a frequent and debilitating comorbidity of SCI (Ravenscroft et al., 2000). Although exercise is an effective strategy for managing pain in other chronic pain populations (e.g., Ettinger et al., 1997), exercise training has not been previously examined in the SCI population. In a RCT of 34 sedentary men and women with traumatic SCI, the effects of exercise on perceived pain and physical and psychological well-being were examined. Additionally, the efficacy of exercise as a pain management strategy was assessed. Exercisers performed aerobic and resistance training twice weekly over 9-months. Controls maintained their usual level of activity. Measures of pain (Ware & Sherbourne, 1992), physical well-being (Reboussin et al., 2000), stress (Cohen et al., 1992), depression (Radlof, 1977) and subjective well-being (Cantril 1965; Patrick et al., 1988) were administered at baseline and at the 3, 6 and 9 months points of the intervention. A series of ANCOV As adjusted for baseline scores revealed a significant group main effect for the measures of pain, stress, depression and subjective well-being which reflected improvement in all of these domains for the exercisers (i.e., decreased pain, stress and depression and increased subjective well-being) and decrement in all of these domains for the controls (ps<.05). Hierarchical linear regression analyses (cf. Baron & Kenny, 1986) revealed that change in physical well-being partially mediated change in pain, change in pain mediated change in stress and subjective well-being and change in stress mediated change in depression. These findings suggest that variables mediating exercise-induced change should be targeted to maximize the effectiveness of exercise as a pain management strategy for individuals with SCI. The therapeutic and theoretical implications of these findings are discussed. / Thesis / Master of Science (MS)

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Syfte Syftet med föreliggande studie var att försöka klargöra om stötvågsbehandling har någon effekt på smärta och handgreppstyrka hos patienter med lateral epikondylalgia. Frågeställningar 1. Har stötvågsbehandling någon effekt på smärta hos patienter med lateral epikondylalgia, i så fall vilken? 2. Har stötvågsbehandling någon effekt på handgreppsstyrka hos patienter med lateral epikondylalgia, i så fall vilken? Metod Sökning av litteratur utfördes i PubMed, Cochrane, Cinahl och PEDro. Detta resulterade i 14 artiklar, som granskades och bedömdes enligt PEDro Scale. Poängbedömningen utifrån PEDro Scale omsattes till Statens Beredning för medicinsk Utrednings (SBU) mall för bevisvärde. Utifrån artiklarnas sammantagna bevisvärde bestämdes evidensnivån enligt SBU:s fyra nivåer. Resultat Enligt GRADE-systemet förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling har en smärtlindrande effekt vid lateral epikondylalgia. Studier av likartad vetenskaplig kvalitet påvisar motsägande resultat avseende om stötvågsbehandling är bättre än placebo, kortison eller tenotomi. Detta innebär att det vetenskapliga underlaget är otillräckligt och att mer forskning behövs. Enligt GRADE-systemet förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling leder till förbättrad handgreppsstyrka vid lateral epikondylalgia. Vidare förelåg det ett starkt vetenskapligt belägg för att stötvågsbehandling inte är bättre än någon annan behandling gällande ökning av handgreppsstyrka vid lateral epikondylalgia. Slutsats Stötvågsbehandling har en smärtlindrande effekt hos patienter med lateral epikondylalgia. Det finns dock ingen evidens för att stötvågsbehandling är bättre ur smärthänseende än någon annan behandling såsom placebo, kortison eller tenotomi. Stötvågsbehandling leder till förbättrad handgreppsstyrka men är inte bättre än placebo, kortison eller tenotomi på att öka handgreppsstyrkan hos patienter med lateral epikondylalgia. / Aim The aim of the present study was to try to find out whether shock wave therapy has any effect on pain and grip strength in patients with lateral epicondylitis. Objectives 1. Does shock wave therapy reduce pain in patients with lateral epicondylitis? 2. Does shock wave therapy improve grip strength in patients with lateral epicondylitis? Method A literature review was performed in the databases PubMed, Cochrane, Cinahl and PEDro. Fourteen articles were found and critically reviewed. These articles were scored according to the PEDro scale and the scores were translated into a scale of evidence by the Statens Beredning för medicinsk Utredning (SBU) and the level of evidence was determined based on the four different grades presented by the SBU. Results According to the GRADE-system there was a strong scientific evidence for a reduction of pain using shock wave therapy in patients with lateral epicondylitis. Contradictory results whether shock wave therapy was better than placebo, corticosteoroid injection or tenotomy have been reported in studies of similar scientific quality. This means that more research is needed in this field. According to the GRADE-system there was a strong scientific evidence for an improvement of grip strength using shock wave therapy. Furthermore, there was a strong scientific evidence for that shock wave is not better than any other therapy in terms of improving grip strength in patients with lateral epicondylitis. Conclusion Shock wave therapy reduces pain in patients with lateral epicondylitis. There is, however, no evidence for shock wave therapy to be superior to any other treatment such as placebo, corticosteoroid injection or tenotomy. Shock wave therapy improves grip strenght but is not better than placebo, corticoidsteroid injection or tenotomy in increasing grip strength in patients with lateral epicondylitis.