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The Patient-Rated Tennis Elbow Evaluation (PRTEE)© User Manual

  • January 2008
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Joy C Macdermid at The University of Western Ontario
Joy C Macdermid
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The Patient-Rated Tennis Elbow Evaluation (PRTEE)©
User Manual
December 2007
© Joy C. MacDermid, BScPT, MSc, PhD
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph’s Health Centre, London,
Ontario, Canada
E-mail: macderj@mcmaster.ca or jmacderm@uwo.ca
Page 2
Table of Contents
Introduction
What is the PRTEE?......................................................................................……… p. 3
Instrument Development
Designing the PRTEE……………………………………………………………… p. 4
Testing the PRTEE………………………………………………………………… p. 4
Recent Revisions…………………………………………………………………… p. 4
How to Score the PRTEE
Computing the subscales ………………………………………………………….. p. 5
Computing the total score……………………………………………...................... p. 5
Sample Scoring ……………………………………………………………………. p. 5
Interpretation ………………………………………………………………………. p. 6
Common Questions ………………………………………………………..……………….p. 7
Instrument Properties and Outcome Studies
Table 1 – Reliability …………………………………………………..................... p. 9
Table 2 – Validity …………………………………………………………………. p. 10
Table 3 – Responsiveness ………………………………………………………. p. 12
Table 4 – Comparative Data ………………………………………………………. p. 13
Bibliography of Published Studies …………………………………………........................p. 15
Page 3
Introduction
What is the Patient-Rated Tennis Elbow Evaluation (PRTEE)?
The PRTEE, formerly known as the Patient-Rated Forearm Evaluation Questionnaire
(PRFEQ), is a 15-item questionnaire designed to measure forearm pain and disability in patients
with lateral epicondylitis (also known as “tennis elbow”). The PRTEE allows patients to rate
their levels of tennis elbow pain and disability from 0 to 10, and consists of 2 subscales:
1) PAIN subscale (0 = no pain, 10 = worst imaginable)
¾ Pain - 5 items
2) FUNCTION subscale (0 = no difficulty, 10 = unable to do)
¾ Specific activities - 6 items
¾ Usual activities - 4 items
In addition to the individual subscale scores, a total score can be computed on a scale of 100
(0 = no disability), where pain and functional problems are weighted equally (see “How to Score
the PRTEE” for detailed scoring instructions).
Page 4
Instrument Development
Designing the PRTEE
Formerly known as the Patient-Rated Forearm Evaluation Questionnaire (PRFEQ), the
PRTEE was developed so that tennis elbow braces could be evaluated for a master’s project.
The PRTEE was based on the Patient-Rated Wrist Evaluation (PRWE) and also incorporated
information from a previous study that evaluated the psychometric properties of outcome
measures for patients with lateral epicondylitis.
The pain subscale consisted of 4 (out of 5) items from the PRWE with the term “arm”
replacing “wrist”. The “usual activities” items in the PRTEE’s function subscale were identical
to the PRWE’s “usual activities”, whereas the PRTEE’s “specific activities” were comprised of
activities that may be affected by tennis elbow.
To keep the instrument brief and easy to use in a clinic, the questionnaire format was
limited to five pain questions and ten function questions. A total score out of 100 can be
computed by equally weighting the pain score (sum of five items) and the disability score (sum
of ten items, divided by 2).
Testing the PRTEE
To test the PRTEE’s test-retest reliability, 47 patients with unilateral lateral epicondylitis
completed the PRTEE on two consecutive days. The pain (ICC = 0.89), function (1CC=0.83),
and the total (ICC = 0.89) scores all demonstrated excellent reliability. When the reliability was
assessed by subgroups (men vs. women; chronic vs. acute; work-related vs. non-work-related),
the ICCs were all greater than 0.75.
Concurrent validity was assessed by correlating the PRTEE scores with the pain-free grip
strength. The total PRTEE score (r = -0.36) and the pain subscale (r = -0.37) had a significant
moderate correlation with the pain-free grip strength but not the function subscale (r = -0.30).
(Reference: Overend et al., 1999 (5))
Recent Revisions
Since calling the instrument the Patient-Rated Forearm Evaluation Questionnaire was
misleading, the title was recently changed to the Patient-Rated Tennis Elbow Evaluation to
indicate that the measure was specifically designed for tennis elbow.
Minor modifications were also made on the wording of some of the items:
1) “turning a doorknob” is now “turn a doorknob and key”
2) “carry a plastic bag of groceries” is now “carry a grocery bag or briefcase by the handle”
3) “wringing out a facecloth or dishrag” is now “wring out a washcloth or wet towel”
Page 5
How to Score the PRTEE
*To minimize nonresponse, check forms once patients complete them.
Computing the Subscales
Pain Score = Sum of the 5 pain items (out of 50) Best Score = 0, Worst Score = 50
Function Score = Sum of the 10 function items,
Divided by 2 (out of 50) Best Score = 0, Worst Score = 50
Computing the Total Score
Total Score = Sum of pain + function scores Best Score = 0, Worst Score = 100
Note: responses to the fifteen items are totaled out of 100, where pain and disability are equally
weighted
Sample Scoring
Pain score = 2 + 8 + 7 + 5 + 9 = 31/50
Page 6
Function score = (1+ 3 + 0 + 5 + 0 + 3 + 1 + 5 + 4 + 6) / 2 = 14/50
Total score = 31 + 14 = 45/100
Interpretation
¾ The total PRTEE score rates pain and disability equally.
¾ Higher score indicates more pain and functional disability (e.g., 0 = no disability).
Page 7
Common Questions
1) How are missing data treated?
If there is an item missing, you can replace the item with the mean score of the subscale.
2) What if patients leave the question blank because they cannot do it?
Make sure the patients understand that they should have answered “10” for the item and make
corrections, if necessary.
3) What if patients rarely perform the task?
If patients are unsure about how to answer a task that is rarely performed, encourage them to
estimate their average difficulty. Their estimate will be more accurate than leaving the question
blank.
4) What if patients do not do the task?
If patients never do the task, they should leave the question blank.
Page 8
Instrument Properties and Outcome Studies
Reliability
Test-Retest Reliability: the stability of the instrument over time.
Standard Error of Measurement: the confidence around the value of the score.
Validity
Construct Validity: the extent to which the instrument corresponds to theoretical constructs.
Criterion/Concurrent Validity: the extent to which the instrument relates with a gold standard or
more established measure.
Responsiveness
Responsiveness: The ability of the instrument to detect change.
Page 9
Table 1 – Reliability of the PRTEE in published studies
Study Population Type PRTEE Results Comparators
Overend et
al., 1999 (5) 47 patients
(age=45.0; 24M,
23F)
T-R
reliability
SEM
Pain ICC = 0.89
Function ICC = 0.83
Total ICC = 0.89
Subgroup analyses:
ICC > 0.75
Pain = 0.6
Function = 0.9
Total = 0.6
Subgroup analyses:
ICC > 0.5
None
Leung et al.,
2004 (2) 74 patients
(age=28-69) with
lateral epicondylitis
T-R
reliability
SEM
(Hong Kong Chinese
PRFEQ)
Pain ICC = 0.99
Function ICC = 0.99
Total ICC = 0.99
Pain = 0.99
Function = 2.38
Total = 3.28
None
Newcomer et
al., 2005 (4) 94 patients (53.2%
F; age = 45.5) with
lateral epicondylitis
(n=22)
T-R
reliability (3
days)
(PRFEQ)
Pain ICC = 0.96
Function ICC = 0.92
Total ICC = 0.96
None
Legend: ICC = intraclass correlation coefficient; SEM = standard error of measurement; T-R reliability = test-retest reliability;
Abbreviations: F = female; M = male; PRFEQ = Patient-Rated Forearm Evaluation Questionnaire; PRTEE = Patient-Rated Tennis Elbow Evaluation
Page 10
Table 2 – Validity of the PRTEE in Published Studies
Study Population Type PRTEE Results Comparators
Overend et al.,
1999 (5) 47 patients
(age=45.0; 24M,
23F)
Criterion
r with pain-
free grip
Pain r = -0.36
Function r = -0.30
Total r = -0.30
None
Leung et al., 2004
(2) 74 patients (age=28-
69) with lateral
epicondylitis
Construct
rs with flexed
elbow
rs with
extended
elbow
(Hong Kong Chinese PRFEQ)
Pain rs = -0.39
Function rs = -0.38
Total rs = -0.40
Pain rs = -0.38
Function rs = -0.38
Total rs = -0.40
None
Newcomer et al.,
2005 (4) 94 patients (53.2% F;
age = 45.5) with
lateral epicondylitis
Concurrent
rs with VAS
rs with PFG
rs with DASH
rs with SF-36
SF
rs with SF-36
RP
(PRFEQ)
Pain rs = 0.62
Function rs = 0.64
Total rs = 0.66
Pain rs = -0.35
Function rs = -0.45
Total rs = -0.45
Pain rs = 0.56
Function rs = 0.74
Total rs = 0.72
Pain rs = -0.33
Function rs = -0.32
Total rs = -0.31
Pain rs = -0.32
Function rs = -0.37
Total rs = -0.38
None
Page 11
rs with SF-36
BP
rs with SF-36
PF
Pain rs = -0.60
Function rs = -0.62
Total rs = -0.65
Pain rs = -0.59
Function rs = -0.57
Total rs = -0.61
Legend: r = Pearson correlation coefficient; rs = Spearman’s correlation coefficient
Abbreviations: DASH = Disabilities of the Arm, Shoulder, Hand; F = female; M = male; PFG = Pain-Free Grip; PRFEQ = Patient-Rated Forearm Evaluation
Questionnaire; PRTEE = Patient-Rated Tennis Elbow Evaluation; SF-36 BP = SF=36 Bodily Pain; SF-36 PF = SF-36 Physical Function; SF-36 RP = SF-36 Role
Physical; SF-36 SF = SF-36 Social Function; VAS = Visual Analogue Scale
Page 12
Table 3 - Responsiveness to Change (or Longitudinal validation) of the PRTEE in published studies
Study Population Type PRTEE Results Comparators
Newcomer et al.,
2005 (4) 94 patients (53.2% F;
age = 45.5) with
lateral epicondylitis
6 weeks
SRM
ES
12 weeks
SRM
ES
(PRFEQ)
Pain = 1.2
Function = 0.8
Total = 1.0
Pain = 1.3
Function = 0.8
Total = 1.0
Pain = 1.8
Function = 1.6
Total = 1.9
Pain = 1.8
Function = 1.4
Total = 1.6
PFG
0.8
0.6
VAS
1.0
1.1
1.3
1.4
DASH
0.9
0.9
1.5
1.3
SF-36 BP
0.7
0.8
Legend: ES = effect size; SRM = standardized response mean
Abbreviations: DASH = Disabilities of the Arm, Shoulder, Hand; F = female; M = male; PFG = Pain-Free Grip; PRFEQ = Patient-Rated Forearm Evaluation
Questionnaire; PRTEE = Patient-Rated Tennis Elbow Evaluation; SF-36 BP = SF=36 Bodily Pain; VAS = Visual Analogue Scale
Page 13
Table 4 - Comparative Scores for the PRTEE
Study Population
Follow-up Time
PRTEE Results
Mean (SD) Comparators
Overend et al.,
1999 (5) 47 patients
(age=45.0; 24M,
23F)
Day 1
Total (n=47)
Males (n=24)
Females
Acute (n=35)
Chronic (n=12)
Work-related
(n=21)
Non-work-
related (n=26)
Pain = 4.1 (1.8)
Function = 3.4 (2.1)
Total = 3.8 (1.8)
Pain = 3.5 (1.4)
Function = 2.8 (1.9)
Total = 3.1 (1.6)
Pain = 4.7 (1.9)
Function = 4.1 (2.1)
Total = 4.4 (1.9)
Pain = 4.2 (1.6)
Function = 3.6 (2.0)
Total = 3.9 (1.7)
Pain = 3.6 (2.1)
Function = 3.1 (2.2)
Total = 3.3 (2.0)
Pain = 4.5 (1.6)
Function = 4.2 (2.3)
Total = 4.4 (1.8)
Pain = 3.7 (1.9)
Function = 2.8 (1.7)
Total = 3.3 (1.7)
None
Leung et al., 2004
(2) 74 patients (age=28-
69) with lateral
epicondylitis
(Hong Kong Chinese PRFEQ)
Pain = 27.96 (9.39)
Function = 47.50 (23.49)
Total = 75.46 (32.10)
None
Faes et al., 2005
(1) 63 patients with
lateral epicondylitis
Baseline PRFEQ
Brace = 5.2 (1.9) VAS
Brace = 4.3 (2.1)
Page 14
received: extensor
brace (n=30; age=46;
63% F) or no brace
treatment (n=33;
age=48; 48% F)
Control = 4.6 (1.7) Control = 4.3 (1.8)
Martinez-
Silvestrini et al.,
2005 (3)
94 patients (50M;
age=45.5) with
chronic lateral
epicondylitis treated
with one of:
stretching; concentric
strengthening with
stretching; eccentric
strengthening with
stretching
Baseline
Six weeks
(PRFEQ)
Stretching Total = 3.7 (1.7)
Concentric Total = 3.8 (1.7)
Eccentric Total = 3.3 (1.5)
Stretching Total = 1.5 (1.6)
Concentric Total = 1.3 (1.8)
Eccentric Total = 1.2 (1.7)
DASH
Stretching = 27 (14)
Concentric = 26 (13)
Eccentric = 25 (13)
Stretching = 15 (14)
Concentric = 17 (14)
Eccentric = 16 (15)
VAS
Stretching = 48 (21)
Concentric = 49 (21)
Eccentric = 46 (20)
Stretching = 25 (24)
Concentric = 35 (25)
Eccentric = 24 (24)
Pain-Free Grip
Stretching = 23 (15)
Concentric = 17 (9.7)
Eccentric = 22 (12)
Stretching = 30 (17)
Concentric = 25 (12)
Eccentric = 26 (14)
Abbreviations: DASH = Disabilities of the Arm, Shoulder, Hand; F = Female; M = Male; PRFEQ = Patient-Rated Forearm Evaluation Questionnaire; PRTEE =
Patient-Rated Tennis Elbow Evaluation; VAS = Visual Analogue Scale
Page 15
Bibliography of Published Studies
1. Faes M, van den Akker B, de Lint J, et al. Dynamic extensor brace for lateral
epicondylitis. Clinical Orthopaedics & Related Research 2006;442:149-157
2. Leung HB, Yen CH,Tse PYT. Reliability of Hong Kong Chinese version of the Patient-
rated Forearm Evaluation Questionnaire for lateral epicondylitis. Hong Kong Med
J 2004;10:172-177
3. Martinez-Silvestrini JA, Newcomer KL, Gay R, et al. Chronic lateral epicondylitis:
Comparative effectiveness of a home exercise program including stretching alone
versus stretching supplemented with eccentric or concentric strengthening. J Hand
Ther 2005;18:411-420
4. Newcomer KL, Martinez-Silvestrini JA, Schaefer MP, et al. Sensitivity of the Patient-
rated Forearm Evaluation Questionnaire in lateral epicondylitis. J Hand Ther
2005;18:400-406
5. Overend TJ, Wuori-Fearn JL, Kramer JF, et al. Reliability of a patient-rated forearm
evaluation questionnaire for patients with lateral epicondylitis. J Hand Ther
1999;12:31-37
... Sixty unique instruments were identified from the first systematic review and included in survey 1 (table 2). From survey 1, three measures: pain on gripping, Patient Rated Tennis Elbow Evaluation (PRTEE) [14][15][16] and Quick Disability of Arm, Shoulder and Hand Questionnaire (DASH), 17 were the only ones reaching ≥70% for both the patient and the clinician/researcher groups. The Patient Specific Function Scale 18 (function domain) and Tennis Elbow Functional Scale 19 (both pain domains) were voted to be in the COS-LET by patients who commented favourably on the scores' item level face validity-however, the lack of robust psychometric evaluation in LET populations precluded (8) 10 (26) 1 (14) 1 (14) 3 (43) ASES score ...
... The additional instruments proposed by responders in survey 1 had no psychometric data for the LET population and were not considered further in the development of the COS-LET. Seven instruments had an EMPRO score of ≥40 and received ≥70% of votes in survey 1 from either patients or clinicians/researchersthey were: DASH, 17 20-22 Quick DASH, 17 23 24 Oxford Elbow Score, 25 26 PRTEE, [14][15][16] Tennis Elbow Functional Scale, 19 as well as grip strength. [27][28][29] These were then independently assessed by the steering committee using the OMERACT truth (part b) and discrimination filters (results given in online supplemental file 2), which along with results from survey 1, were available to inform clinician's/researcher's decisions in survey 2. The results of survey 2 are presented in table 3-only the PRTEE met the threshold for inclusion in the COS-LET for the disability domain, which was ratified at the consensus meeting. ...
Development of a core outcome set for lateral elbow tendinopathy (COS-LET) using best available evidence and an international consensus process
Article
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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 mixed-methods 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.
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... The primary outcomes assessed in this study were the Patient-Rated Tennis Elbow Evaluation (PRTEE) score [12,13] and musculoskeletal US evaluation. PRTEE score is a validated patient outcome measure specifically designed for LE. ...
... Patients were asked to rank the degree of their pain during activities using a scale from 0 to 10, with a 10 score representing the worst pain. Also, higher scores on the function scale correspond to more difficulty accomplishing activities of daily living [12,13]. ...
Musculoskeletal ultrasonographic evaluation of perineural injection therapy versus therapeutic ultrasound in chronic lateral epicondylitis
Article
Full-text available
  • Dec 2021
Background Lateral epicondylitis (LE) is a common disorder causing pain and functional limitations especially in athletes and manual workers. There is a growing interest in regenerative injection therapies in chronic LE. One of those suggested is perineural injection (PNI) therapy. The present study aims to find out the efficacy of PNI therapy in the treatment of chronic LE as compared to therapeutic ultrasound (TUS) and to detect if any changes have happened after treatment to the common extensor tendon (CEO) as detected by diagnostic ultrasound (US) examination. Results Statistical analysis between the 2 groups at the start of the study as regards age, sex, and clinical parameters including visual analog scale (VAS), tenderness grading scale, and Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire revealed a non-significant difference between both groups ( p > 0.05). After 12 weeks, within-group analysis showed significant improvement in all clinical outcome measures in both groups compared to the initial assessment. Between-group analysis after 12 weeks showed that the tenderness grading scale and PRTEE score had more significant improvement in the PNI therapy group. However, the two groups were comparable regarding VAS. Within-group US evaluation at the 12th week post-treatment showed a highly significant decrease in hypoechoic areas ( p < 0.001) and a decrease in distributed fibrillar pattern in PNI group, while the TUS group demonstrated a significant decrease in hypoechoic areas and tendon thickness ( p < 0.005). Between-group US evaluation after 12 weeks showed no significant difference in all assessed US parameters. No complications were observed in both groups. Conclusions A short-term follow-up regimen of 1 session/week of PNI therapy is significantly more effective than 3 sessions/week of TUS regarding the improvement of pain and functional status. Yet both therapeutic modalities were able to produce significantly positive structural changes in the CEO. The current study highlights the neurogenic inflammation as the primary pain generator in chronic LE and the advantage of its treatment with PNI therapy in chronic and refractory cases.
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... The items are rated on a 11 point likert scale and the disability is rated from 0 -no disability to 100 -significant functional disability. It is a valid and reliable tool to measure functional disability in LE [19]. ...
Clinical and radiological effects of Corticosteroid injection combined with deep transverse friction massage and Mill's manipulation in lateral epicondylalgia-A prospective, randomized, single-blinded, sham controlled trial
Article
Full-text available
Background: The knowledge about the effective implementation of corticosteroid injection (CS) with deep transverse friction massage (DTFM) and Mill's manipulation (MM) on clinical and radiological changes (Magnetic resonance imaging-MRI and Ultra sound) in lateral epicondylalgia (LE) is lacking. Therefore, the objective of this study is proposed to find and compare the effects of corticosteroid injection (CS) DTFM and Mill's manipulation on clinical and radiological changes in lateral epicondylalgia. Design, setting, participants: Randomized, single-blinded, controlled study was conducted on 60 LE participants at university hospital. The active MM group (n = 30) received corticosteroid injection with DTFM and active Mill's manipulation (MM) three sessions a week for 4 weeks and the sham MM group received corticosteroid injection with sham manipulation. The primary outcome was pain intensity, measured with the visual analog scale. The other outcome measures were percentage of injury measured by MRI and ultrasound, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life which were measured at 4 weeks, 8weeks and at 6 months follow up. Results: The between-group difference in pain intensity at 4 weeks was 1.6 (CI 95% 0.97 to 2.22), which shows improvement in the active group than sham group. The similar effects have been noted after 8 weeks and at 6 months 2.0 (CI 95% 1.66 to 2.33) follow up in pain intensity. Similar improvements were also found on percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life (p = 0.001). Conclusion: Corticosteroid injection with DTFM and Mill's manipulation was superior to sham group for improving pain, percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life in people with lateral epicondylalgia. Trial registration: Clinical trial registration: CTRI/2020/05/025135 trial registered prospectively on 12/05/2020. https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2020/05/025135.
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... 6 Researchers have developed the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire to address the gap in outcome measures for LET disorder. 7,8 The PRTEE questionnaire is one of the most widely-used outcome measures that appraise elbow pain and functional capacity in the activities of daily living in individuals with LET. 9 Because this questionnaire is a brief and simple way to assess patients' pain and function, the goodness of the PRTEE questionnaire has been reported in several languages. [10][11][12] Clinicians and researchers are used to evaluate reliability, validity, and responsiveness as a prerequisite for patient-reported outcome measures. ...
Responsiveness and Minimally Important Changes for Persian-version of Patient-Rated Tennis Elbow Evaluation Questionnaire in Patients with Lateral Elbow Tendinopathy Following Physiotherapy Intervention
Article
  • Oct 2022
Background: Evaluating responsiveness and calculating minimally important change (MIC) for the Persian-version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire following physiotherapy in patients with lateral elbow tendinopathy (LET). Methods: We enrolled 82 patients with LET to complete the PRTEE. After completing four weeks of physiotherapy, all patients were reevaluated by the PRTEE. The patients also rated their changes on a 7-point global rating of change scale (GRoC). The receiver operating characteristic (ROC) curve and correlation analysis were used for evaluating the responsiveness. The MIC was determined by determining a desirable cutoff on the ROC curve. Results: The results showed a moderate relationship (Spearman's correlation coefficient= 0.43-0.56) of total PRTEE, pain subscale, and function subscale with the GRoC scale. The total PRTEE, pain subscale, and function subscale revealed an area under the curve of 0.87, 0.82, and 0.83, respectively. We found the MICs 31.33, 14.5, and 15.5 points for total PRTEE, pain subscale, and function subscale, respectively. Conclusion: The Persian-version of the PRTEE questionnaire has acceptable responsiveness and can measure changes in patients with LET following physiotherapy. We advocate using the PRTEE questionnaire in both clinical settings and research.
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... VAS is the most common scale used to observe the pain intensity. 21 In this research, a pain-free grip strength verified a better magnitude of change in the affected hand. The TheraBand flex bar and strengthening exercise results showed a substantial result in aching, functional status, and pain-free grip strength in the affected hand and ROM. ...
Effect of TheraBand Flex Bar versus Strengthening Exercise in Patients with Lateral Epicondylitis
Article
Full-text available
  • Aug 2022
Background Lateral epicondylitis (LE) is an exertion or sporting-connected aching condition of the extensor muscles of the forearm. The core warning signs are pain and soreness of the outside on the elbow and grip strength weakness. The investigation aims to differentiate the effect of TheraBand flex bar versus strengthening exercise on pain, grip strength, range of motion, and functional status. Objectives To find the effects of TheraBand flex bar, strengthening exercise, and compare the effects of Thera band flex bar versus strengthening exercise on the elbow pain, handgrip strength, elbow and wrist range of motion, and functional disability status in lateral epicondylitis. Design Quasi-experimental study. Methods Thirty (30) patients with lateral epicondylitis were enrolled, both male and female, randomly assigned to control or 6-week training groups. They were subdivided into two groups. Subjects were pre-tested and post-tested using a hand-held dynamometer, the VAS, PRTEE Questionnaire Functional status, and goniometer. Results The results showed a statistically significant difference between pre and post-treatment in the study batch. The results show that Batch-1 and Batch-2 were significantly improved with p -values of 0.000, 0.004, 0.000, 0.001, 0.001, 0.004 at p < 0.05. Conclusion In this study, the TheraBand flex bar and the strengthening exercise for lateral epicondylitis effectively reduced pain, enlarged the functional status, and improved the range of function within 30 subjects with lateral epicondylitis. The study concluded that TheraBand flex bar in Batch-1 and strengthening exercise in Batch-2 significantly improved VAS, PRTEE, handgrip strength, and ROM. The study's outcome suggests that TheraBand flex bar and strengthening exercise of extensors muscles of the wrist can be productive for the treatment among lateral epicondylitis (LE) sufferers.
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... Taping approximates skin elasticity but also stretches it to 140 % of its resting length. [10][11] This is why Mulligan MWM is known to be effective for not just reducing pain but improving functional performances also. Previous evidences also concluded that Mulligan and Cyriax improves functional status of patients but these were done individually. ...
Effects of Cyriax Manual Therapy versus Mulligan Technique on Grip Strength and Functional Outcomes in Patients with Lateral Epicondylitis
Article
Full-text available
  • Dec 2021
Objective: To examine the effects of Cyriax manual therapy and Mulligan technique on Grip strength and functional outcomes among the patients of lateral epicondylitis. Methodology: This was a randomized control trial conducted in a duration of eighteen months. 66 diagnosed patients from Gosha E Shifa Hospital were recruited for the study and were randomized through computer number generator into group A and B. The two primary outcomes were measured i.e. Dynamometer for grip strength and Patient-Rated Tennis Elbow Evaluation Questionnaire for functional outcomes. Research assessor assessed patients before treatment i.e. t1, between treatment i.e. t2 and after treatment i.e. t3.The response rate of overall study was 91.33% thus complying with rule of 85% follow up. Results: The patients who were in group A had mean age of 36.12 ± 7.56 years and 33.91 ± 3.4 years patients in group B. Grip strength measured by hand grip dynamometer was found to be 32.7 ± 1.41 and 33.3 ± 1.34 at Pre-treatment level (p=0.07 i.e. non-significant), 42.1 ± 1.30 and 38.6 ± 2.82 at mid treatment level (p=0.00 i.e. significant) and 53.5 ± 2.13&42.3 ± 1.97 at post treatment level (p=0.00 i.e. significant). Functional outcomes measured by Patient-Rated Tennis Elbow Evaluation Questionnaire was found to be 78.06 ± 2.76 and 76.93 ± 1.71 at Pre-treatment level (p=0.053 |i.e. non-significant), 60.61 ± 3.78 and 38.06 ± 5.73 at mid treatment level (p=0.00 i.e. significant), 26.86 ± 2.43 and 7.66 ± 1.64 at post treatment level (p=0.00 i.e. significant). Conclusion: The present study concluded that Grip strength was improved by Cyriax manual therapy better than mulligan technique, while Functional status was improved by Mulligan techniques better than Cyriax manual therapy. Keywords: Cyriax Manual Therapy, Lateral Epicondylitis, Mulligan Technique, Patient-Rated Tennis Elbow Evaluation
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Standardised Tendon Fenestration with ITEC-Technique for Lateral Epicondylosis with Injection of Betamethasone versus Autologous Blood
Article
  • Feb 2023
Background: Infiltration is one of the treatment options for lateral epicondylosis, a degenerative process in the tendon of the musculus extensor carpi radialis brevis. The aim of this study was to evaluate the clinical outcome of a standardised fenestration technique, the Instant Tennis Elbow Cure (ITEC) technique, with injection of betamethasone versus autologous blood. Methods: A prospective comparative study was performed. Twenty-eight patients received an infiltration with 1 mL betamethasone, in combination with 1 mL 2% lidocaine. Twenty-eight patients received an infiltration with 2 mL autologous blood. Both infiltrations were administered using the ITEC-technique. The patients were evaluated at baseline, 6 weeks, 3 months and 6 months using Visual Analogue Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE) and Nirschl staging. Results: At the 6-week follow-up, the corticosteroid group showed significantly better results for VAS. At the 3-month follow-up, no significant differences were observed for all three scores. At the 6-monthfollow-up, the autologous blood group showed significantly better results for all three scores. Conclusions: Standardised fenestration using the ITEC-technique with corticosteroid infiltration is more effective in reducing pain at the 6-week follow-up. At the 6-month follow-up, the use of autologous blood is more effective in pain reduction and functional recovery. Level of Evidence: Level II
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Comparing an optimised physiotherapy treatment package with usual physiotherapy care for people with tennis elbow — protocol for the OPTimisE pilot and feasibility randomised controlled trial
Article
Full-text available
  • Aug 2022
Background Physiotherapy is recommended for people with tennis elbow, but whilst a wide array of treatments is available, the optimal approach remains uncertain. We have therefore recently developed an optimised physiotherapy treatment package for tennis elbow based on a synthesis of the evidence, patient input and clinical consensus. It consists of detailed advice and education, a structured progressive exercise programme and provision of a counter-force elbow brace. Here, we report the protocol for our multicentre pilot and feasibility randomised controlled trial (RCT) designed to (a) examine the feasibility of our optimised physiotherapy treatment package and (b) to pilot trial processes for a future fully powered RCT to test clinical and cost-effectiveness compared with usual physiotherapy treatment. Methods A multicentre pilot and feasibility RCT will be conducted across three sites in England, recruiting up to 50 patients (or for a maximum of 12 months). Participants with tennis elbow, identified from physiotherapy clinic waiting lists and general practice surgeries, will be randomly allocated to receive the optimised physiotherapy treatment package or usual physiotherapy care. Analysis will focus on feasibility measures including consent rate, intervention fidelity, follow-up rate and outcome completion rate. A nested qualitative study will explore the acceptability of the study processes and patient and physiotherapist experiences of the new optimised intervention. Discussion This study will determine the feasibility of a new optimised physiotherapy treatment package for people with tennis elbow and pilot the processes for a future fully powered RCT. In the longer term, this treatment package may provide superior clinical outcomes for patients, in terms of pain and quality of life, and be more cost-effective for the health service. Trial registration Registered with the ISRCTN database 19/7/2021, https://www.isrctn.com/ISRCTN64444585
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Physiotherapy treatment of lateral epicondylitis: A systematic review
Article
Full-text available
  • Aug 2021
Background: Lateral epicondylitis is a tendinopathy with a prevalence of between 1-3% of the population aged 35-54 years. It is a pathology with a favorable evolution, but with frequent recurrences (which imply an economic extra cost). Objective: The objective of this review was to determine the efficacy of physiotherapy treatment for the treatment of epicondylitis and, if any, to identify the most appropriate techniques. Methods: A systematic search was carried out in October 2020 in the databases of PubMed, Cinahl, Scopus, Medline and Web of Science using the search terms: Physical therapy modalities, Physical and rehabilitation medicine, Rehabilitation, Tennis elbow and Elbow tendinopathy. Results: Nineteen articles were found, of which seven applied shock waves, three applied orthoses, three applied different manual therapy techniques, two applied some kind of bandage, one applied therapeutic exercise, one applied diacutaneous fibrolysis, one applied high intensity laser, and one applied vibration. Conclusions: Manual therapy and eccentric strength training are the two physiotherapeutic treatment methods that have the greatest beneficial effects, and, furthermore, their cost-benefit ratio is very favorable. Its complementation with other techniques, such as shock waves, bandages or Kinesio® taping, among others, facilitates the achievement of therapeutic objectives, but entails an added cost.
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Reliability of a patient-rated forearm evaluation questionnaire for patients with lateral epicondylitis
Article
Full-text available
To determine the reliability of a questionnaire designed to assess forearm pain and function in patients with lateral epicondylitis. Forty-seven patients with unilateral lateral epicondylitis completed a patient-related forearm evaluation questionnaire (PRFEQ) on two occasions. Intraclass correlation coefficients (ICC 2,1), standard error of measurement (SEM), and 95% confidence intervals (CIs) were determined for the whole group and for three subgroup comparisons of male vs. female subjects, subacute vs. chronic lateral epicondylitis, and work-related vs. non-work-related lateral epicondylitis. The test-retest reliability for the overall PRFEQ (ICC, 0.89), and its pain (ICC, 0.89) and function (ICC, 0.83) subscales was excellent. Test-retest reliability for patients with work-related lateral epicondylitis (ICC, 0.80) was significantly (p = 0.018) less than for patients with non-work-related lateral epicondylitis (ICC, 0.94). The PRFEQ can provide a simple, quick, and reliable estimate of arm pain and function in patients with lateral epicondylitis. However, large SEM and 95% CIs limit its ability to accurately predict individual scores.
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Reliability of Hong Kong Chinese version of the Patient-rated Forearm Evaluation Questionnaire for lateral epicondylitis
Article
Full-text available
To determine the reliability and validity of a dedicated assessment tool for lateral epicondylitis after translation into Hong Kong Chinese. Cross-sectional study. District hospital, Hong Kong. Seventy-four patients, 12 of whom were bilingual, were recruited (total of 82 elbows). Translation equivalence and reliability were measured with the test-retest method. Validity was measured against the Roles and Maudsley outcome score and mean maximal grip strength. The Patient-rated Forearm Evaluation Questionnaire had high English-Chinese equivalence (Spearman's rho correlation coefficient=0.926; P<0.001). It was also very reliable (intraclass correlation coefficient=0.99; P<0.001). Validity according to the Roles and Maudsley outcome score and mean of maximal grip strength was significant (P<0.01). The Hong Kong Chinese version of Patient-rated Forearm Evaluation Questionnaire is a reliable and valid assessment tool for chronic lateral epicondylitis. Its equivalence to the original English version makes outcome assessment across cultural barrier feasible.
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Chronic Lateral Epicondylitis: Comparative Effectiveness of a Home Exercise Program Including Stretching Alone versus Stretching Supplemented with Eccentric or Concentric Strengthening
Article
The objective of this study was to evaluate the effectiveness of eccentric strengthening. Ninety-four subjects (50 men) with chronic lateral epicondylitis were allocated randomly into three groups: stretching, concentric strengthening with stretching, and eccentric strengthening with stretching. Subjects performed an exercise program for six weeks. All three groups received instruction on icing, stretching, and avoidance of aggravating activities. The strengthening groups received instruction on isolated concentric and eccentric wrist extensor strengthening, respectively. At six weeks, significant gains were made in all three groups as assessed with pain-free grip strength, Patient-rated Forearm Evaluation Questionnaire, Disabilities of the Arm, Shoulder, and Hand questionnaire, Short Form 36, and visual analog pain scale. No significant differences in outcome measures were noted among the three groups. Although there were no significant differences in outcome among the groups, eccentric strengthening did not cause subjects to worsen. Further studies are needed to assess the unique effects of a more intense or longer eccentric strengthening program for patients with lateral epicondylitis.
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Sensitivity of the Patient-rated Forearm Evaluation Questionnaire in Lateral Epicondylitis
Article
The purpose of this study was to examine the sensitivity, reliability, and concurrent validity of the Patient-rated Forearm Evaluation Questionnaire (PRFEQ). Reliability on three consecutive days was evaluated with 22 of 94 subjects who had chronic lateral epicondylitis (LE) and who concomitantly participated in an outcome study. The PRFEQ results were compared with results of the Visual Analogue Scale; the Disabilities of the Arm, Shoulder, and Hand questionnaire; the Medical Outcomes Study 36-Item Short Form Health Survey; and the pain-free grip strength measurement. Questionnaires were completed at baseline, six weeks, and 12 weeks. Reliability was excellent using variance components and interclass correlation coefficients (PRFEQ function subscale, 0.92; PRFEQ pain subscale, 0.96; PRFEQ total scale, 0.96). Generally, correlations were moderate between the PRFEQ subscales and total scale and the other outcome scales. Effect size and standardized response mean were good in many outcome scales, being slightly higher in the PRFEQ than in the other outcome measures. The PRFEQ is reliable, reproducible, and sensitive for assessment of LE. It is at least as sensitive to change as the other outcome tools tested. The PRFEQ should be a standard primary outcome measure in LE research.
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Dynamic Extensor Brace for Lateral Epicondylitis
Article
  • Jan 2006
Unlabelled: Lateral epicondylitis (tennis elbow) is a common, often disabling ailment. Based on the failure of current therapies, a new dynamic extensor brace has been developed. In this study, the effects of application of this brace for 3 months on the most important and disabling symptoms of patients with lateral epicondylitis were assessed. After prestratification for the duration of complaints (ie, < or = 3 months and > or = 3 months), 63 patients initially were assigned randomly to 12 weeks of brace treatment (Group 1; n = 30) or no brace treatment (Group 2; n = 33). Outcome measures included pain (VAS), pain-free grip strength, maximum grip strength, and functionality of the arm. All outcomes were assessed at 6, 12, 18, and 24 weeks. Brace treatment resulted in significant pain reduction, improved functionality of the arm, and improvement in pain-free grip strength. The beneficial effects of the dynamic extensor brace observed after 12 weeks were significantly different from the treatment group that received no brace. The beneficial effects were sustained for another 12 weeks. No correlation between duration of symptoms and treatment effects of the brace was revealed. The dynamic extensor brace is an effective therapeutic tool for treating lateral epicondylitis. Level of evidence: Therapeutic study. Level I (randomized controlled trial with statistically significant difference). See the Guidelines for Authors for a complete description of levels of evidence.
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