Effectiveness of conservative treatment in the management of post-traumatic elbow stiffness: A systematic review

Background: Post-traumatic elbow stiffness is a common consequence following trauma or surgery, resulting in significant limb disability, with a negative impact on daily life. Although conservative treatment is the first-line approach, it is not yet known which is most suitable and effective. Objective: To investigate the effectiveness of conservative treatments in patients with post-traumatic elbow stiffness. Method: A protocol for this systematic review was published in PROSPERO (CRD42024517823). PRISMA standards were followed. An extensive systematic search was conducted in six databases (PubMed, CINHAL, Cochrane Library, Web of Science, Scopus, and PEDro), and the CENTRAL trial register. Two reviewers independently assessed, selected results, collected data, rated the risk of bias (RoB) of included studies with the Cochrane risk of bias tool, synthesized the available evidence, and rated it using GRADE methodology. Results: Five studies were included in the review, although high variability in interventions and comparators precluded the synthesis of results into a meta-analysis. Large effect sizes were observed when conservative treatment was initiated immediately after immobilization, improving elbow functionality (SMD 3.07; 95%CI 1.91 to 4.23), and pain (SMD 1.83; 95%CI 0.91 to 2.76). Results indicate that Proprioceptive Neuromuscular Facilitation (SMD = -1.22; 95%CI [-1.90, -0.54]) and Graded Motor Imagery (SMD = -2.79; 95%CI [-3.59, -2.00]) were more effective than comparisons in recovering elbow functionality and pain reduction. Conclusion: Although conservative treatment is recommended as a first-line approach, the best conservative treatment cannot be determined with certainty due to the low to very low confidence in the results.