Workplace use and outcomes of the dynamic orthosis for lateral epicondylitis: a comparative cohort study

Orthotic management of lateral epicondylitis remains suboptimal in working patients. Limited symptom relief and poor adherence to brace use during work are the key practical limitations. Therefore, the Dynamic Orthosis for Lateral Epicondylitis (DOLE) was developed for practical use at work. This study aimed to evaluate the work-related effectiveness of DOLE. We compared DOLE with conventional bracing (cock-up wrist splint and counterforce brace) in improving work-related function and pain.

This retrospective cohort comparison treatment study enrolled employed patients with lateral epicondylitis at a single center. Patients received either conventional bracing (a cock-up wrist splint worn together with a counterforce brace; C group) or DOLE (D group) after its introduction. The primary outcomes were work-related function (Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH] work module) and pain during work (visual analog scale) at 3 and 6 months. Outcomes were compared between groups using analysis of covariance with adjustment for the corresponding baseline value. In addition, at-work brace use was assessed using a questionnaire at 3 months.

Thirty-five patients were included in this study (C group, n = 18; D group, n = 17). At 3 months, at-work use was rare for the cock-up splint (1/18) but common for the counterforce brace (18/18) in the C group. Conversely, 15 of 17 patients in the D group reported wearing DOLE during work. Baseline-adjusted analyses showed significantly better primary outcomes in the D group than in the C group at both 3 and 6 months. At 6 months, the baseline-adjusted between-group differences (D - C) were -23.6 (95% confidence interval, -40.0 to -7.2) for the QuickDASH work module and -23.0 mm (95% confidence interval, -35.0 to -10.9) for work pain on the visual analog scale.

In working patients with lateral epicondylitis, DOLE use was associated with clinically meaningful improvements in the QuickDASH work module and work-related pain compared with conventional bracing. These findings suggest that DOLE may be a feasible work-compatible orthotic option and provide a rationale for larger prospective randomized studies.