Lateral epicondylalgia A new structured treatment program with an inter-disciplinary approach
Year: 2010
Type: dissertation
Study design: Clinical Trial
Abstract: \nBackground: Lateral epicondylalgia is a common musculoskeletal diagnosis, thus there\nexist no structured effective treatment program and no evaluative questionnaire specific for\nlateral epicondylalgia. Overall aim: This thesis evaluates a structured treatment program\nwith an interdisciplinary approach, and cross-culture adapts and translates a questionnaire\nfor lateral epicondylalgia.\nStudy I: Aim: To evaluate a new multidisciplinary structured home training program\nfor patients with lateral epicondylalgia compared to conventional attendance. Method:\nThe study had a prospective design. A total of 78 patients with lateral epicondylalgia\nwere recruited and were divided into two groups, 51 entered the intervention group and\n27 entered the control group. The intervention group was treated with a specific home\ntraining program, ergonomic advice and when necessary wrist and/or night bandages. The\ncontrol group was treated with conventional treatment. Pain and function were evaluated\nby the Patient Rated Forearm Questionnaire, PRFEQ and strength and stamina with an\nelectronic hand power gauge. Sick-leave absence was collected via the Regional Social\nInsurance Office. Results: After four weeks the intervention group experienced less sickleave,\nless pain, better function and returned to work earlier than the control group. After\n16 weeks the intervention group still had significantly better function and had less sickleave.\nTheir pain decreased but not significantly. No difference in grip strength between\nthe two groups. Conclusion: A structured home training programme can improve function\nand reduce sick-leave in patients with lateral epicondylitis.\nStudy II: Aim: To translate and cross-culturally adapt the questionnaire “Patient-rated\nTennis Elbow Evaluation” into Swedish PRTEE-S; (Patientskattad Utvärdering av\nTennisarmbåge), and to evaluate the reliability and validity of the questionnaire. Methods:\nThe Canadian questionnaire, “Patient-rated Tennis Elbow Evaluation” (PRTEE),\nwas cross-culturally adapted for the Swedish language according to well-established\nguidelines. Fifty-four patients with unilateral epicondylalgia were assessed using the\nPRTEE-S (Patientskattad Utvärdering av Tennisarmbåge), the Disabilities of the Arm,\nShoulder and Hand questionnaire (DASH), and the Roles & Maudsley score to establish\nthe validity and reliability of the PRTEE-S. Reliability was determined via calculation\nof the intra-class correlation coefficient (ICC) the internal consistency was assessed by\nCronbach's alpha, and validity was calculated using Spearman's correlation coefficient.\nResults: The test-retest reliability, using the ICC, was 0.95 and the internal consistency was\n0.94. The PRTEE-S correlated well with the DASH (r = 0.88) and the Roles & Maudsley\nscore (r = 0.78). Conclusion: The PRTEE-S represents a reliable and valid instrument to\nevaluate the subjective outcome in Swedish speaking patients with lateral epicondylalgia,\nand can be used in both clinical settings and research.\n5\nStudy III: Aim: To describe health care professionals´ treatment choices, their cooperation\nwith other professionals and their perceptions regarding the treatment of acute lateral\nepicondylalgia. Method: The study had a quantitative descriptive study design with\na summative approach to qualitative analysis using content analysis. All Orthopaedic\nSurgeons, General Practitioners, Physiotherapists and Occupational Therapists in a county\nwere asked to answer a questionnaire with 18 dichotomous, multiple response, multiplechoice\nquestions and three open-ended questions. Results: Participants n=321. The\nfindings of the qualitative analysis dealt with perceptions of interdisciplinary cooperation\nand treatment which resulted in five categories; Right level of care, Increased quality\nof care, Decreased quality of care, Side effects and Inadequate treatment. Almost half\nof the General Practitioners and Orthopedic Surgeons felt potential risks associated with\ntheir treatment methods. Advantages from interdisciplinary cooperation were higher rated\nthan disadvantages. Conclusion: Interdisciplinary cooperation in the treatment of patients\nwith acute lateral epicondylalgia benefits the patients by shortening the rehabilitation\nperiod and provides health care professionals the opportunity for an improved learning\nand exchanging experiences. There was a strong will to cooperate and the risks of side\neffects with corticosteroid injections and NSAID are well-known although they are the\nmost common treatments. Treating the patient at the right level of care could minimize\nside effects. These basic conditions must be met in order to improve health care quality.\nStudy IV: Aim: To evaluate whether patients with lateral epicondylalgia, two years after\nthey were treated by a structured program, had less pain or function loss and if recurrent\nepisodes and sick-leave days differed compared to a control group. Method: This study\nhad a prospective design with a two year follow-up. The intervention group (n=103)\nwere referred to a physiotherapist and an occupational therapist working together with\na structured treatment program. The control group, chosen from the same diagnose code\n(n=194) were treated with various treatments. The outcome measures were pain, function,\nrates of recurrences and sick-leave using a questionnaire two years after their visit at\nthe health care center. Result: More than half of the patients experienced some pain and\nfunction loss from their elbow. The intervention group had less sick-leave absence at the\ntime for the first visit, less pain and function loss and fewer periods of recurrences and\nneeded less additional therapy if a recurrence occurred. Conclusion: This disease is not\nalways a self-limiting condition and needs treatment. A structured treatment and to teach\nthe patients how to treat themselves if the symptoms re-occur, seems to be an effective\nway. The patient will not need additional treatment and do not need to be on the sick list.\nThe main findings: With a structured program and by using interdisciplinary cooperation\nin the treatment of lateral epicondylalgia, the absence from work could decrease, the pain\nand the function loss was less for the patient, side-effects were minimized and the program\ncould be an outlined and effective way for the health care professionals to treat the patient\nand to evaluate lateral epicondylalgia both clinical and in science.
Author: Pia Nilsson
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2106739566