Lateral Epicondyle Tendinopathy Toolkit: Section C - Outcome Measures

Original Editor - Kim Jackson uploaded for the BC Tendinopathy Task Force Dr. Joseph Anthony, Paul Blazey, Dr. Allison Ezzat, Dr. Angela Fearon, Diana Hughes, Carol Kennedy, Dr. Alex Scott, Michael Yates and Alison Hoens

Top Contributors - Evan Thomas, Kim Jackson, Nupur Smit Shah, Admin, Wanda van Niekerk, Vidya Acharya and Rishika Babburu  

Introduction[edit | edit source]

An outcome measure is a tool used to assess a patient’s current status. Outcome measures may provide a score, an interpretation of results and at times a risk categorization of the patient. Prior to providing any intervention, an outcome measure provides baseline data. The initial results may help determine the course of treatment intervention. Once treatment has commenced, the same tool may be used in serial assessments to determine whether the patient has demonstrated change. With the move towards Evidence Based Practice (EBP) in health care, outcome measures provide credible and reliable justification for treatment on an individual patient level. The following outcome measures are recommended for consistency in clinical settings.[1]

Patient Reported Outcome Measures (PROMs)[edit | edit source]

PROMs are an important tool in today's physiotherapy practice. They provide feedback on a patient's health condition that comes directly from the patient and does not take into account any interpretation of the patient's response by a health professional. PROMs can take the form of questionnaires (in paper or electronic form) that include instructions and can be completed independently by the patient.

In lateral epicondyle tendinopathy (LET) there are two commonly used patient reported outcome measures - the Patient Rated Tennis Elbow Evaluation (PRTEE), which is population specific and has been designed and validated for LET, and the other is the Numeric Pain Rating Scale (NPRS). The NPRS is not specially designed for lateral Epicondyle Tendinopathy and is considered a generic one.

Patient Rated Tennis Elbow Evaluation (PRTEE)[edit | edit source]

The PRTEE is a population specific 15-item questionnaire designed to measure forearm pain and disability associated with (LET)

  • 15 item questionnaire
  • Two subcales :Pain (5 items)and Function (10 items)
  • Score converted to 100% max score
  • Minimum Clinically Important Difference (MCID) =11[2], Minimal Detectable Change (MDC)=9[3]

Paper version of the test available here

Numeric Pain Rating Scale (NPRS)[edit | edit source]

This is a generic outcome measure and not designed specifically for LET. The Numeric Pain Rating Scale (NPRS) is a segmented numeric version of the Visual Analogue Scale (VAS) and is used to measure pain intensity only in adults. Although it is not validated for let, the psychometric properties of the NPRS are consistent across a variety of other musculoskeletal conditions  and for people who experience chronic pain.

  • 15 item Questionnaire (0-10)
  • It is not validated for lateral epicondylitis but psychometric properties are consistent across a variety of musculoskeletal disorders.[4]
  • MCID=2 , MDC=2

Performance Based Outcome Measure (Clinician-Reported)[edit | edit source]

Performance-Based clinical reported outcome measures require the patient to perform a task or set of movements that are supervised by a health care professional. Scores for performance-based measures can be either an objective measurement (e.g., time to complete a task) or a qualitative assessment that is assigned a score (e.g., normal or abnormal mechanics for a given task).

Pain Free Grip Test[edit | edit source]

The Pain Free Grip Test (PFGT)[5] is used to measure pain-free grip. This is considered more clinically relevant than maximum grip testing, as gripping is a common pain provoking functional activity associated with LET. Measurements are recorded using a hand-held dynamometer.

The NPRS can also be used during PFGT to measure pain intensity, recording grip score at onset of pain. The test should be performed 3 times, with up to a minute rest between tests, with the best of the 3 scores recorded.

It is important to consider a standardized posture and arm position for clinical assessment and treatment (eg. sitting, neutral shoulder, flexed elbow 90o, neutral forearm supination/pronation) as grip score may vary according to test position.[5] Normalized data for grip strength is reported in sitting postures.

PFGT has also been described in supine lying with a neutral shoulder, elbow extended, forearm pronated.[5]

When used before/after a treatment intervention, PFGT assists in evaluating treatment effect and monitoring progress.

Resources[edit | edit source]

References[edit | edit source]

  1. Bateman, M., Evans, J.P., Vuvan, V., Jones, V., Watts, A.C., Phadnis, J., Bisset, L.M. and Vicenzino, B., 2022. Development of a core outcome set for lateral elbow tendinopathy (COS-LET) using best available evidence and an international consensus process. British Journal of Sports Medicine, 56(12), pp.657-666.
  2. Poltawski L, Watson T. Measuring clinically important change with the Patient-rated Tennis Elbow Evaluation. Hand Therapy. 2011 Sep;16(3):52-7.
  3. Poltawski L, Watson T. Measuring clinically important change with the Patient-rated Tennis Elbow Evaluation. Hand Therapy. 2011 Sep;16(3):52-7.
  4. Shafiee E, MacDermid JC, Walton D, Vincent JI, Grewal R. Psychometric properties and cross-cultural adaptation of the Patient-Rated tennis elbow evaluation (PRTEE); a systematic review and meta-analysis. Disability and Rehabilitation. 2022 Sep 11;44(19):5402-17.
  5. 5.0 5.1 5.2 Lim EC. Pain free grip strength test. Journal of physiotherapy. 2013 Mar;59(1):59.