The Effect of Scapular Muscle Strengthening on Functional Recovery in Patients With Lateral Elbow Tendinopathy: A Pilot Randomized Controlled Trial (original) (raw)
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British Journal of Sports Medicine, 2022
Objectives To develop a core outcome set for lateral elbow tendinopathy (COS-LET) and to provide guidance for outcome evaluation in future studies. Methods We implemented a multi-stage mixedmethods design combining two systematic reviews, domain mapping of outcome measurement instruments to the core domains of tendinopathy, psychometric analysis of instruments, two patient focus groups and a Delphi study incorporating two surveys and an international consensus meeting. Following the OMERACT guidelines, we used a 70% threshold for consensus. Results 38 clinicians/researchers and 9 patients participated. 60 instruments were assessed for inclusion. The only instrument that was recommended for the COS-LET was Patient Rated Tennis Elbow Evaluation (PRTEE) for the disability domain. Interim recommendations were made to use: the PRTEE function subscale for the function domain; PRTEE pain subscale items 1, 4 and 5 for the pain over a specified time domain; pain-free grip strength for the physical function capacity domain; a Numerical Rating Scale measuring pain on gripping for the pain on activity/loading domain; and time off work for the participation in life activities domain. No recommendations could be made for the quality-of-life, patient rating of condition and psychological factors domains. Conclusions The COS-LET comprises the PRTEE for the disability domain. Interim-use recommendations included PRTEE subscales, time off work, pain-free grip strength and a Numerical Rating Scale measuring pain on gripping. Further work is required to validate these interim measures and develop suitable measures to capture the other domains.
Protocol for the Development of a Core Outcome Set for Lateral Elbow Tendinopathy (COS-LET)
Research Square (Research Square), 2021
Background Lateral elbow tendinopathy (LET) is a common condition that can cause signi cant disability and associated socioeconomic cost. Although it has been widely researched, outcome measures are highly variable which restricts evidence synthesis across studies. In 2019 a working group of international experts, health care professionals and patients, in the eld of tendinopathy (International Scienti c Tendinopathy Symposium Consensus (ICON) Group) published the results of a consensus exercise de ning the nine core domains that should be measured in tendinopathy research. The aim of this study is to develop a Core Outcome Set (COS) for LET mapping to these core domains. The primary output will provide a template for future outcome evaluation of LET. In this protocol we detail the methodological approach to the COS-LET development. Methods This study will employ a three-phase approach. (1) A systematic review of studies investigating LET will produce a comprehensive list of all instruments currently employed to quantify treatment effect or outcome. (2) Instruments will be matched to the list of nine core tendinopathy outcome domains by a Steering Committee of clinicians and researchers with a specialist interest in LET resulting in a set of candidate instruments. (3) An International three-stage Delphi Study will be conducted involving experienced clinicians, researchers and patients. Within this Delphi Study candidate instruments will be selected based upon screening using the Outcome Measures in Rheumatology (OMERACT) truth, feasibility and discrimination lters with a threshold of 70% agreement set for consensus. Conclusions There is currently no COS for the measurement or monitoring of LET in trials or clinical practice. The output from this project will be a minimum COS recommended for use in all future English-language studies related to LET. The ndings will be published in a high-quality journal and disseminated widely using professional networks, social media and via presentation at international conferences. Key Points There is wide variability in the outcome measures used in lateral elbow tendinopathy research. This protocol outlines the methodology used to derive a standardised set of validated outcome measures. The Core Outcome Set-Lateral Elbow Tendinopathy (COS-LET) will provide guidance on the minimum recommended outcomes to be used in future research, which, If implemented broadly, with
Disability and Rehabilitation, 2020
Purpose: To evaluate the longitudinal validity and responsiveness of the Persian version of Patient-Rated Tennis Elbow Evaluation (PRTEE) and the Disabilities of the Arm, Shoulder, and Hand (DASH) in patients with lateral elbow tendinopathy (LET). Methods: Sixty-four patients with LET completed the PRTEE, DASH, and Global Rating of Change Scale (GRC) at baseline and six weeks. The external and internal responsiveness, floor and ceiling effects, minimal detectable change (MDC) and minimal clinically important difference (MCID) were calculated. Results: No ceiling and floor effects were detected for either the PRTEE or DASH. External responsiveness as an indicator to detect the relationship between change in the measured and external indicator of change was acceptable for both, but higher for the PRTEE (AUC ¼ 0.90; CI: 0.83-0.97) vs. DASH (AUC ¼ 0.80; CI: 69-90). Internal responsiveness to detect intervention related changes indicated slightly superiority in responsiveness for PRTEE. The relative efficiency (1.21), standard effect size (1.14 PRTEE vs. 1.03 DASH), and standard response mean (1.34 PRTEE vs. 1.10 DASH). The MDC were 11 and 12, and MCID were 20 and 18 for the PRTEE and DASH, respectively. Conclusions: Both the DASH and PRTEE were responsive in detecting improvement in patients with LET. The PRTEE was shorter, more efficient, and slightly more responsive which supports its use as a core outcome measure in evaluating patients with LET. ä IMPLICATIONS FOR REHABILITATION The Patient-Rated Tennis Elbow Evaluation (PRTEE) compared with the Disability of the Arm, Shoulder, and Hand (DASH) is a shorter questionnaire with higher psychometric and clinimetric properties for evaluating the patients with lateral elbow tendinopathy. This supports the use of the PRTEE in evaluating patients with elbow tendinopathy.
Journal of Hand Therapy, 2020
Study Design: This is an observational study. Introduction: Because isometric wrist extension minimizes the effects of other muscles, the sensitivity of wrist extension strength testing on patients with lateral elbow tendinopathy (LET) should be evaluated. Purpose of the Study: The purpose of the study was to compare the effects of the elbow position on wrist extension and grip strength in patients with LET. Methods: Patients were screened for at least 2 of 5 clinical tests for LET. Between-day intraclass correlation coefficients (ICC 3, 1) for healthy individuals were examined for both grip and wrist extension strength at 0 and 90. To compare the effects of elbow position on wrist extension strength to grip strength, a repeated measure analysis of variance was run using 2 within-group factors, test angles (0 and 90), and the test type (wrist extension and grip). Results: Nineteen patients with LET and twenty-one healthy participants were included. The betweenday intrarater reliability for both wrist extension and grip strength was excellent for the healthy subjects across the 0 and 90 positions (ICC > .95). The analysis of variance yielded a significant interaction between the type of test and the angle of testing (P ¼ .00). Discussion: Both wrist extension strength and grip strength are reliable between-day measures. For patients with LET, there was a significant decrease in grip strength when testing at 0 compared with 90. Conclusion: In patients with LET, clinicians can expect wrist extension strength at 0 and 90 to be similar. Grip strength testing may be a more relevant clinical test at the initial evaluation.
Clinical Rehabilitation, 2014
Objective: To analyse treatment effects of eccentric vs. concentric graded exercise in chronic tennis elbow. Design: Randomized controlled trial. Setting: Primary care in Uppsala County, Sweden. Subjects: A total of 120 subjects with tennis elbow lasting more than three months were recruited from primary care and by advertisement. Intervention: Eccentric ( n = 60) or concentric exercise ( n = 60), by lowering or lifting a weight, at home daily, for three months with gradually increasing load. Main measures: Pain during muscle contraction and muscle elongation, as well as strength, was assessed at baseline and after one, two, three, six, and 12 months. Function and quality of life was assessed at baseline and after three, six and 12 months. Results: The eccentric exercise group had faster regression of pain, with an average of 10% higher responder rate at all levels of pain reduction, both during muscle contraction and elongation, ( p < 0.0001 and p = 0.006, respectively). Signifi...
Effectiveness of scapular muscle strengthening in management of lateral epicondylalgia
Lateral epicondylalgia appears to be multifactorial in origin, while the clinical picture is fairly uniform. Furthermore, only 5% of the people suffering from tennis elbow actually play tennis, and therefore, the condition may rather be referred to as lateral epicondylalgia (LE). There are many studies done for physiotherapeutic management of LE. Ultrasound and wrist extensor exercises remain a mainstay in the management of LE. There are some studies suggesting a relationship between scapular muscles & LE. AIM: To assess the additional effect of scapular muscle strengthening over conventional treatment in the management of Lateral epicondylalgia. METHODOLOGY: Subjects who met with inclusion & exclusion criteria were divided into 2 groups. The experimental group was given scapular muscle strengthening exercises in addition to conventional treatment and the control group was given conventional treatment for LE. Grip strength measurement was done using Jamar's hand-held dynamometer & pain intensity and functional ability was scored using patient-rated tennis elbow evaluation (PRTEE) score on 1stday & after 3 weeks. RESULTS & CONCLUSION: Significant improvement was found in both the groups. Scapular muscle strengthening showed significantly more reduction in pain, functional disability and more improvement in grip strength than conventional treatment. Thus, scapular muscle strengthening must be included in rehabilitation plan of a patient with LE.
Unsupervised Isometric Exercise versus Wait-and-See for Lateral Elbow Tendinopathy
Medicine and Science in Sports and Exercise, 2019
This study aimed to investigate the effect of unsupervised isometric exercise compared to a wait-and-see approach on pain, disability, global improvement and pain-free grip strength in individuals with lateral elbow tendinopathy (LET). METHODS: Forty participants with unilateral LET of at least 6 weeks" duration were randomised to either wait-and-see (N=19) or a single supervised instruction session by a physiotherapist, followed by an 8-week unsupervised daily program of progressive isometric exercise (N=21). Primary outcomes were Patient-Rated Tennis Elbow Evaluation (PRTEE), global rating of change on a 6-point scale (GROC, dichotomised to success and no success) and pain-free grip strength at 8 weeks. Secondary outcomes were resting and worst pain on an 11-point numerical rating scale (NRS), and thermal and pressure pain thresholds as a measure of pain sensitivity. RESULTS: Thirtynine (98%) participants completed 8-week measurements. The exercise group had lower PRTEE scores compared to wait-and-see at 8 weeks (standardised mean difference (SMD)-0.92, 95% CI-1.58 to-0.26). No group differences were found for success on GROC (29% exercise vs 26% wait-and-see (risk difference 2.3%, 95% CI-24.5 to 29.1)), or pain-free grip strength (SMD-0.33, 95% CI-0.97 to 0.30). No differences were observed for all secondary outcomes except for worst pain, which was moderately lower in the exercise group (SMD-0.80, 95% CI-1.45 to-0.14). CONCLUSION: Unsupervised isometric exercise was effective in improving pain and disability, but not perceived rating of change and pain-free grip strength when compared to waitand-see at 8 weeks. With only one out of the three primary outcomes being significantly different following isometric exercises, it is doubtful if this form of exercise is efficacious as a sole treatment.
https://www.ijhsr.org/IJHSR\_Vol.8\_Issue.4\_April2018/IJHSR\_Abstract.014.html, 2018
Background: Tennis elbow is an overuse injury of common Extensor tendon of wrist which occurs due to repetitive micro trauma. Although the uses of Wrist Manipulation and Progressive Exercises have been established as suitable treatment methods separately in Tennis Elbow Patients in terms of pain relief and rapid restoration of function, but the benefit of one over the other has not been exclusively explored and also the combined efficacy of Wrist Manipulation and Progressive Exercises is yet to be established. Therefore, the aim of the study is to compare the efficacy of Wrist Manipulation versus Progressive Exercises versus both together to improve Pain, Grip Strength and Functional Disability of Tennis Elbow. Methods: Both gender (n = 90), age 30-65 years, presented with Chronic Tennis Elbow were selected based on inclusion and exclusion criteria and randomly allocated into 3 groups. All groups received treatment for total duration of 6 weeks. The outcome measures were assessed using 101 Numerical Pain Rating Scale, Jamar Hand-held Dynamometer and Patient Rated Tennis Elbow Evaluation to measure difference between pre and post intervention Pain intensity, Grip Strength and Functional Disability of Tennis Elbow. Result: ANOVA was used to compare the difference among three groups. The level of significance was set at critical F-value >4. Within group analysis showed significant improvement over elbow Pain and Functional Disability after 6 weeks of intervention who received combined of wrist manipulation and progressive exercise program. Conclusion: This study concluded that both group showed improvement in Elbow Pain, Grip Strength and Functional Disability in Tennis Elbow patients. However it was found that the Group who received combined treatment showed better improvement than the group of Wrist Manipulation and group of Progressive Exercises.
Current Physical Therapies Available for the Rehabilitation of Tennis Elbow: A Review Article
International Journal of Physiotherapy Research and Clinical Practice
This literature review article has drawn attention to the current available physical therapies which can be applied in managing Tennis Elbow or lateral epicondylitis (LET) whose prevalence is about 3% in general population and about 20% in elderly population. This condition is characterised by lesions in Extensor Carpi Radialis Brevis muscle leading to painful and debilitating musculoskeletal condition and affecting the overall quality of life of a patient. The review has also discussed the updated pathophysiological findings in this condition. The study has discussed that tennis elbow is degenerative disorder and initially caused by inflammation. The typical pathology found is presence of disorderly arrangement of immature collagen fibers consisting of fibroblastic and vascular components. Finally, the review has discussed several methods of physical therapies to manage tennis elbow. This includes counterforce bracing, Soft tissue techniques, various modalities , various exercises ...