Measuring clinically important change with the Patient-rated Tennis Elbow Evaluation (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.
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.
Validation of the Patient-rated Tennis Elbow Evaluation Questionnaire
Journal of Hand Therapy, 2007
The aim of this study was to determine the reliability, validity, and sensitivity of the Patient-rated Tennis Elbow Evaluation (PRTEE) Questionnaire in 78 tennis playing subjects who had chronic, unilateral, MRI-confirmed lateral elbow tendinopathy and who concomitantly participated in an outcome study. The PRTEE results were compared with results of the Visual Analog Scale (VAS); the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire; the Roles and Maudsley score; and the Upper Extremity Function Scale. Questionnaires were completed at baseline and 12 weeks. Reliability and internal consistency were excellent (PRTEE pain subscale, 0.94; PRTEE specific activities subscale, 0.93; PRTEE usual activities, 0.85). Correlations were good between the PRTEE subscales and total scale and the VAS and DASH. Standardized response means (SRM) were higher in the PRTEE (SRM ¼ 2.1) than in the other outcome measures (SRM, 1.5e1.7). The PRTEE was a reliable, reproducible, and sensitive instrument for assessment of chronic lateral elbow tendinopathy in a tennis playing cohort. It was at least as sensitive to change as the other outcome tools tested. The PRTEE may become the standard primary outcome measure in research of tennis elbow.
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
A comparison of two primary care trials on tennis elbow: issues of external validity
Annals of the Rheumatic Diseases, 2005
Objective: To assess clinical heterogeneity across two studies with respect to study population, interventions, and outcome measures, and to evaluate the influence of these sources of heterogeneity on the results of the studies. Methods: The individual patient data were used from two randomised controlled trials investigating the effectiveness of conservative treatments in patients with tennis elbow in primary care. Patients were allocated at random to treatment with steroid injection, wait and see policy, non-steroidal antiinflammatory drugs, placebo tablets, or physiotherapy. Outcome measures included severity of the main complaint, inconvenience of the elbow complaints, pain during the day, elbow disability, pain-free grip strength, and global improvement. All outcomes were assessed at 1, 6, and 12 months after randomisation. Results: The two study populations were similar with respect to age, sex, comorbid neck/shoulder complaints, and baseline scores for the severity of pain. However, significant differences were observed for employment status, duration of elbow complaints, dominant side affected, previous history of elbow complaints, and use of analgesics. Local injections differed between the two studies with respect to volume, number, and steroid preparation. However, after 1, 6, and 12 months, the treatment effects of steroid injections were very similar between the study populations. Conclusions: Despite large differences in study population at baseline, the responses to steroid injections were remarkably similar. Also the responses to other conservative interventions and the placebo treatment were very consistent, suggesting a uniform course of a tennis elbow and a lack of influence of clinical heterogeneity.
Innovative publication, 2016
Introduction: Tennis Elbow is very common condition and affects approximately 1% to 3% of the population and is more common (affecting 15%) in individuals involved in repeated forceful activities with forearm. Various methods have been advocated for the treatment of Tennis elbow with variable success. The aim of this study was to compare the functional outcome of commonly available modalities of treatment in patients with Tennis elbow. Methods: 163 Patients diagnosed as Tennis elbow and treated at our institute between July 2013 to February 2015 and those who were followed up in Out Patient Department or on telephone up to February 2016 were retrospectively studied. All patients with a new episode of Tennis elbow were included in the study. Patients with polyarthritis, arthritis of the Elbow, previous fracture of the elbow and patients with neurological condition were excluded. 52 patients were treated with Local Injection of Corticosteroid, 58 patients were treated with Brace and 53 patients were treated with Local Ultrasound Therapy. All Patients were followed as per routine protocol and at each follow up visit functional assessment was done. The end point of the study was 1 year after completion of treatment. Overall success was defined as a 20% difference between treatment groups in the primary outcome measure. We compared groups with χ2 test. Results: In all three groups patient characteristics were comparable. At the end of first week of treatment recovery or improvement was reported in 48 patients (92.3%) in the Injection group, 28 patients (48.2%) in the Brace group and 30 patients (56.6%) in the Local Ultrasound group. At second week Injection group was better than in the Local Ultrasound and Brace groups. After four weeks 4 (7.6%) patients in Injection Group complained of recurrence of pain, 11 (21%) patients complained of moderate pain during work and 8 patients complained of mild pain during work. Pain relief and average functional outcome of Local Ultrasound Group was better as compared to other two groups at 4 weeks follow up examination and thereafter till end point of the study. Conclusions: Our results demonstrated Good Functional outcome in patients treated with Local Ultrasound Therapy and it was sustained over long period of time. Initial results in patients treated with Local Injection of Corticosteroid were better as compared to other modalities of treatment till first 4 weeks of follow up but they were not sustained over further follow up visits till one year.
BMC Musculoskeletal Disorders, 2014
Background: Lateral Epicondylalgia (LE) is a common injury for which no reliable and valid measure exists to determine severity in the Dutch language. The Patient-Rated Tennis Elbow Evaluation (PRTEE) is the first questionnaire specifically designed for LE but in English. The aim of this study was to translate into Dutch and cross-culturally adapt the PRTEE and determine reliability and validity of the PRTEE-D (Dutch version).
Physical therapy, 2012
P atellar tendinopathy is an injury related to structural damage in the distal and proximal regions of the patellar tendon. This injury generally occurs in individuals who engage in sports and recreational activities that require sudden acceleration and deceleration, and in athletes who perform repetitive movements such as jumping, climbing, and kicking. These activities are known to have the potential to overload the extensor apparatus of the knee. Lian et al, 13 in a study that included 612 athletes from different sports, reported a prevalence of patellar tendinopathy of 14.2%. This injury is twice as prevalent in men as it is in women 11 and keeps 33% of athletes away from their sports activities for more than 6 months, forcing 50% of these athletes into early retirement. 2 Furthermore, it affects approximately 45% of volleyball athletes, as this is a sport with actions that involve several risk factors for patellar tendinopathy. Due to the high prevalence of patellar tendinopathy in athletes, early diagnosis and treatment are essential to avoid extended periods away from sports activities. Clinical instruments to determine the severity and the level of disability resulting from patellar tendinopathy are highly useful because they can assess the evolution of the condition and serve as T T STUDY DESIGN: Clinical measurement. T T OBJECTIVES: To translate, adapt, and test the measurement properties of the Brazilian Portuguese version of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire.