***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background To determine the effectiveness of three different local injection modalities in the treatment of lateral epicondilitis . Methods In a prospect i ve r and omized study on lateral epicondilitis , 75 patients were divided into three equal groups A , B and C ( n = 25 ) and were treated using three different method of local injection . The patients in group A were treated with local injection of a steroid ( 1 mL triamcinolone ) combined with local anaesthetic ( 1 mL lidocaine ) , those in group B were treated with injection of local anaesthetic ( 1 mL lidocaine ) combined with peppering technique and those in group C with local injection of a steroid ( 1 mL triamcinolone ) combined with local anaesthetic ( 1 mL lidocaine ) and peppering technique . The outcome was defined by measuring the elbow pain during the activity using a 10-cm visual analogue scale ( VAS ) and satisfaction with the treatment using a scoring system based on the criteria of the Verhaar et al. at 3 weeks and 6 months after the injection and compared with the pre-treatment condition . Results There were significant ( P = 0.006 ) differences in the successful outcomes between the three groups at 6 months . In group C in which local steroid + peppering injection technique were used ; excellent results were obtained in 84 % of patients comparing to 36 % and 48 % for patients in groups A and B , respectively . The successful outcomes were statistically higher in group C comparing to group A ( P = 0.002 ) and group B ( P = 0.011 ) . In all groups , there was a significantly lower pain ( VAS ) at the 3-week and 6-month follow-ups comparing to the pre-treatment condition . VAS measured at 6-month follow-up were significantly lower in group C comparing to other groups ( P = 0.002 ) . Conclusion In the treatment of lateral epicondilitis , combination of corticosteroid injections with peppering is more effective than corticosteroid injections or peppering injections alone and produces better clinical results To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results The treatment of lateral epicondylalgia , a widely-used model of musculoskeletal pain in the evaluation of many physical therapy treatments , remains somewhat of an enigma . The protagonists of a new treatment technique for lateral epicondylalgia report that it produces substantial and rapid pain relief , despite a lack of experimental evidence . A r and omized , double blind , placebo-controlled repeated- measures study evaluated the initial effect of this new treatment in 24 patients with unilateral , chronic lateral epicondylalgia .  Pain-free grip strength was assessed as an outcome measure before , during and after the application of the treatment , placebo and control conditions .  Pressure-pain thresholds were also measured before and after the application of treatment , placebo and control conditions . The results demonstrated a significant and substantial increase in pain-free grip strength of 58 % ( of the order of 60 N ) during treatment but not during placebo and control . In contrast , the 10 % change in pressure-pain threshold after treatment , although significantly greater than placebo and control , was substantially smaller than the change demonstrated for pain-free grip strength . This effect was only present in the affected limb . The selective and specific effect of this treatment technique provides a valuable insight into the physical modulation of musculoskeletal pain and requires further investigation Abstract Objective To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow . Design Single blind r and omised controlled trial . Setting Community setting , Brisbane , Australia . Participants 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks ' duration , who had not received any other active treatment by a health practitioner in the previous six months . Interventions Eight sessions of physiotherapy ; corticosteroid injections ; or wait and see . Main outcome measures Global improvement , grip force , and assessor 's rating of severity measured at baseline , six weeks , and 52 weeks . Results Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter ( 47/65 of successes subsequently regressed ) and significantly poorer outcomes in the long term compared with physiotherapy . Physiotherapy was superior to wait and see in the short term ; no difference was seen at 52 weeks , when most participants in both groups reported a successful outcome . Participants who had physiotherapy sought less additional treatment , such as non-steroidal anti-inflammatory drugs , than did participants who had wait and see or injections . Conclusion Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks , providing a reasonable alternative to injections in the mid to long term . The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks , with high recurrence rates , implying that this treatment should be used with caution in the management of tennis elbow Abstract Background . Chronic tennis elbow ( lateral epicondylosis ) is a common disorder . Like other chronic soft-tissue pain conditions it is often difficult to treat successfully . The effects of exercise have been discussed , but no convincing evidence has been put forward so far , and a simple protocol for exercise is lacking . Aims of the study . This study is a r and omized , controlled , clinical trial of the effect of exercise versus expectation ( wait-list ) on pain , muscle strength , function , and quality of life in patients with long-st and ing lateral epicondylosis . Methods . Eighty-one subjects with tennis elbow lasting for more than 3 months were r and omly allocated to an exercise group ( n = 40 ) or a reference group ( n = 41 ) . The exercise group performed daily exercise , with weekly load increase , for 3 months . The reference group was wait-listed , but otherwise followed in the same way . Outcome measures were pain during maximum voluntary muscle contraction ( Cozen 's test ) and pain during maximum muscle elongation with a load ( modified Empty-can-test ) ; muscle strength was measured with a Chatillon MSE 100 h and -held dynamometer , and the Disability of the Arm , Shoulder and H and ( DASH ) and the Gothenburg Quality of Life question naires . Results . The exercise group had greater and faster regression of pain , both during muscle contraction and muscle elongation , than the reference group ( p = 0.0005 and p = 0.0016 , respectively ) . There was a non-significant muscle strength difference between the groups , but no differences regarding DASH scores or quality of life measures . Conclusions . Exercise appears to be superior to expectation in reducing pain in chronic lateral epicondylosis OBJECTIVES To determine whether minimal intervention by occupational specialists involving information about the disorder , encouragement to stay active and instruction in grade d self-performed exercises could enhance the prognosis of lateral epicondylitis compared with the treatment usually given in general practice , to quantify workplace factors associated with the prognosis , and to consider treatments given in general practice . METHODS A r and omized controlled trial was performed in a cohort of 266 consecutive new cases of lateral epicondylitis diagnosed in general practice . Workplace factors were assessed with question naires at the time of inclusion , and patients completed follow-ups at 3 , 6 and 12 months . Status at 1 yr was assessed as overall improvement and pain reduction compared with the time of diagnosis . General practitioners ( GPs ) registered the treatments given for both cases and controls during follow-up . Numbers of contacts with GPs and physiotherapists were obtained from the National Health Insurance registry . Prognostic factors were analysed by multiple logistic regression analysis . RESULTS After 1 yr , 83 % of cases showed improvement in the condition , but the intervention was found to have had no advantage . Poor overall improvement was associated with employment in manual jobs [ odds ratio ( OR ) 3.0 , 95 % confidence interval ( CI ) 1.0 - 8.7 ] , a high level of physical strain at work ( OR 8.5 , CI 1.0 - 74.7 ) and a high level of pain at baseline ( OR 2.3 , CI 1.0 - 5.3 ) . Pain reduction less than 50 % was associated with manual jobs ( OR 2.3 , CI 1.1 - 5.1 ) , high physical strain at work ( OR 3.6 , CI 1.0 - 12.9 ) , high baseline distress ( OR 1.9 , CI 1.0 - 4.0 ) and tennis elbow on the dominant side ( OR 3.1 , CI 1.4 - 6.8 ) . The intervention group received less treatment and fewer treatment modalities , but the intervention was not followed by a reduction in the number of visits to GPs and physiotherapist clinics during 12 months of follow-up . CONCLUSIONS Poor prognosis at 1 yr of follow-up for lateral epicondylitis was related to manual work and high baseline pain , whilst no relation was found between the type of medical treatment given/chosen and prognosis . This may have implication s for the future management of lateral epicondylitis in terms of a greater focus on interaction with the workplace regarding job modification to reduce physical dem and s during recovery Abstract Objective : To compare the clinical effectiveness of local corticosteroid injection , st and ard non-steroidal anti-inflammatory drugs , and simple analgesics for the early treatment of lateral epicondylitis in primary care . Design : Multicentre pragmatic r and omised controlled trial . Setting : 23 general practice s in North Staffordshire and South Cheshire . Participants : 164 patients aged 18 - 70 years presenting with a new episode of lateral epicondylitis . Interventions : Local injection of 20 mg methylprednisolone plus lignocaine , naproxen 500 mg twice daily for two weeks , or placebo tablets . All participants received a st and ard advice sheet and co-codamol as required . Main outcome measures : Participants ' global assessment of improvement ( five point scale ) at four weeks . Pain , function , and “ main complaint ” measured on 10 point Likert scales at 4 weeks , 6 months , and 12 months . Results : Over 2 years , 53 subjects were r and omised to injection , 53 to naproxen , and 58 to placebo . Prognostic variables were similar between groups at baseline . At 4 weeks , 48 patients ( 92 % ) in the injection group were completely better or improved compared with 30 ( 57 % ) in the naproxen group ( P<0.001 ) and 28 ( 50 % ) in the placebo group ( P<0.001 ) . At 12 months , 43 patients ( 84 % ) in the injection group had pain scores ≤3 compared with 45 ( 85 % ) in the naproxen group and 44 ( 82 % ) in the placebo group ( P>0.05 ) . Conclusions : Early local corticosteroid injection is effective for lateral epicondylitis . Outcome at one year was good in all groups , and effective early treatment does not seem to influence this . Key messages Most lateral epicondylitis is managed by general practitioners , but optimum treatment is unclear This large pragmatic r and omised trial showed that corticosteroid injection was significantly better than non-steroidal anti-inflammatories or placebo tablets at four weeks A two week course of a st and ard non-steroidal anti-inflammatory was no better than placebo A few patients who respond well initially to injection relapse by six months . Long term outcome was good , irrespective of initial treatment BACKGROUND Lateral epicondylitis is generally treated with corticosteroid injections or physiotherapy . Dutch clinical guidelines recommend a wait- and -see policy . We compared the efficacy of these approaches . METHODS Patients with lateral epicondylitis of at least 6 weeks ' duration were recruited by family doctors . We r and omly allocated eligible patients to 6 weeks of treatment with corticosteroid injections , physiotherapy , or a wait- and -see policy . Outcome measures included general improvement , severity of the main complaint , pain , elbow disability , and patient satisfaction . Severity of elbow complaints , grip strength , and pressure pain threshold were assessed by a research physiotherapist who was unaware of treatment allocation . We assessed all outcomes at 3 , 6 , 12 , 26 , and 52 weeks . The principal analysis was done on an intention-to-treat basis . FINDINGS We r and omly assigned 185 patients . At 6 weeks , corticosteroid injections were significantly better than all other therapy options for all outcome measures . Success 
    Output:
    
For corticosteroid injection versus lidocaine injection , the evidence was conflicting .
At long-term follow-up , there was no difference on overall improvement and grip strength , with conflicting evidence for pain .
We found moderate evidence for short-term and long-term effects of eccentric exercise and stretching versus no intervention .
For exercise versus no intervention and eccentric or concentric exercise and stretching versus stretching alone , we found moderate evidence of no short-term effect .
Corticosteroid injections have a short-term beneficial effect on lateral epicondylitis , but a negative effect in the intermediate term .
Evidence on the long-term effect is conflicting .
Manipulation and exercise and exercise and stretching have a short-term effect , with the latter also having a long-term effect