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'''Toolkit Navigation'''  
'''Original Editor '''- [[User:Kim Jackson|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


*[[Lateral Epicondyle Tendinopathy (Tennis Elbow) Toolkit|''Introduction and Background'']]
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  &nbsp; 
*[[Lateral Epicondyle Tendinopathy Toolkit: Section D - Summary of the Evidence|''Summary of the Evidence'']]
*[[Lateral Epicondyle Tendinopathy Toolkit: Treatment Algorithm|''Treatment Algorithm'']]
*[[Lateral Epicondyle Tendinopathy Toolkit: Appendix A - Details of the Articles|''Appendix A: Details of the Articles'']]
*[[Lateral Epicondyle Tendinopathy Toolkit: Section F - Manual Therapy|''Appendix B: Manual Therapy'']]
*[[Lateral Epicondyle Tendinopathy Toolkit: Section E - Exercise Prescription|''Appendix C: Details of Exercise Prescription'']]
*[[Lateral Epicondyle Tendinopathy Toolkit: Section G - LASER Dosage Calculation|''Appendix D: LASER Dosage Calculation'']]
*[[Lateral Epicondyle Tendinopathy Toolkit: Section H - Braces, Splints, and Taping|''Appendix E: Braces, Splints, and Taping'']]
*[[Lateral_Epicondyle_Tendinopathy_Toolkit:_Section C_-_Outcome_Measures|''Appendix F: Outcome Measures'']]
*[[Lateral Epicondyle Tendinopathy Toolkit: Appendix G - Medical and Surgical Interventions|''Appendix G: Medical and Surgical Interventions'']]
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</div>  
''Note: The following outcome measures have been selected as they are commonly reported in the literature, supported by expert clinical opinion and used extensively clinically.''


<br>
== Orthopaedic Tests  ==
===== <u>'''Pain-free grip strength (PFGS)<ref>Stratford P, Levy D. Assessing valid change over time in patients with lateral epicondylitis at the elbow. Clinical Journal of Sport Medicine. 1994;4:88-91.</ref>'''</u>  =====
Using a hand held dynamometer such as a Jamar, the patient is instructed to squeeze slowly until they begin to feel discomfort. Both the physiotherapist and patient should be unable to read the dial of the dynamometer during testing. The pain free grip strength is measured 3 times, with a 20-second rest interval between each measurement. Record the mean value of 3 efforts. The research for this test was done with the elbow at 0° but could be done with the elbow at 90° if grip is very painful.
<br>


===== <u>'''Thomsen Test'''</u>  =====
== Introduction ==
An [[Outcome Measures|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.<ref>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.


With the shoulder flexed to 60°, the elbow extended, the forearm pronated and the wrist extended about 30°, pressure is applied to the dorsum of the second and third metacarpal bones in the direction of flexion and ulnar deviation to stress the extensor carpi radialis brevis and longus. A positive test is pain elicited in the region of the lateral epicondyle.
</ref>


<br>
=='''Patient Reported Outcome Measures (PROMs)'''==
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.


===== <u>'''Maudsley Test'''</u> =====
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.


Resisted extension of the middle finger with the elbow extended. A positive test causes pain in the region of the lateral epicondyle.
=== Patient Rated Tennis Elbow Evaluation (PRTEE) ===
The PRTEE  is a population specific 15-item questionnaire designed to measure forearm pain and disability associated with (LET)


<br>  
* 15 item questionnaire
* Two subcales :Pain (5 items)and Function (10 items)
* Score converted to 100% max score
* Minimum Clinically Important Difference (MCID) =11<ref>Poltawski L, Watson T. Measuring clinically important change with the Patient-rated Tennis Elbow Evaluation. Hand Therapy. 2011 Sep;16(3):52-7.</ref>, Minimal Detectable Change (MDC)=9<ref>Poltawski L, Watson T. Measuring clinically important change with the Patient-rated Tennis Elbow Evaluation. Hand Therapy. 2011 Sep;16(3):52-7.</ref>


''Both the Thomsen and Maudsley tests can be measured using a hand held dynamometer. The score should be the mean of three readings of the amount of pressure needed for the patient to start to feel discomfort.''
Paper version of the test available [https://www.ace-pt.org/wp-content/uploads/2019/10/PF-Tennis-Elbow.pdf here]


<br>  
==='''Numeric Pain Rating Scale (NPRS)'''===
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|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.<ref>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.</ref>
* MCID=2 , MDC=2


== Pain Rating Scales<ref>Downie W, Leatham P, Rhind V, Wright V, Branco J, Anderson J . Studies with pain rating scales. Ann Rheum Dis. 1978;37:378-381.</ref>  ==
== Performance Based Outcome Measure (Clinician-Reported) ==
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).


===== <u>'''Numeric Pain Rating Scale (NPRS)'''</u>  =====
=== Pain Free Grip Test ===
The Pain Free Grip Test (PFGT)<ref name=":0">Lim EC. Pain free grip strength test. Journal of physiotherapy. 2013 Mar;59(1):59.</ref> 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 patient is asked to rate their pain on a scale of zero to ten with zero being no pain and ten being the worst pain they can imagine.  
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.  


''The NPRS can be used to rate pain during the Thomsen or Maudsley's tests or while doing a specific activity such as picking up a full cup of coffee or a milk bottle.''
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.<ref name=":0" /> Normalized data for grip strength is reported in sitting postures.
 
<br>
 
===== <u>'''Visual Analog Scale (VAS)'''</u>  =====
 
The scale consists of a line, usually 10 cm long, whose ends are labeled 'no pain' and 'unbearable pain'. The rest of the line is blank. The patient is asked to mark the line at a position that best describes their pain.  
 
<br>
 
== Download Lateral Epicondyle Tendinopathy Toolkit: Appendix F - Outcome Measures  ==
 
http://physicaltherapy.med.ubc.ca/files/2013/07/Appendix-F.-Lateral-Epicondyle-Tendinopathy-Outcome-Measures-June-2013.pdf
 
<br>


== Acknowledgements  ==
PFGT has also been described in supine lying with a neutral shoulder, elbow extended, forearm pronated.<ref name=":0" />


Developed by the BC Physical Therapy Tendinopathy Task Force: Dr. Joseph Anthony, Dr. Angela Fearon, Diana Hughes, Carol Kennedy, Dr. Alex Scott, Michael Yates, &amp; Alison Hoens.  
When used before/after a treatment intervention, PFGT assists in evaluating treatment effect and monitoring progress.  


A Physical Therapy Knowledge Broker project supported by: UBC Department of Physical Therapy, Physiotherapy Association of BC, Vancouver Coastal Research Institute and Providence Healthcare Research Institute.
== Resources ==


June 2013
*[[Lateral Epicondyle Tendinopathy (Tennis Elbow) Toolkit|Lateral Epicondyle Tendinopathy (LET) Toolkit.]]
*[[Lateral Epicondyle Tendinopathy Toolkit: Section B - Clinical Assessment|Section B - Clinical Assessment]]
*[[Lateral Epicondyle Tendinopathy Toolkit: Section D - Summary of the Evidence|Section D: Summary of Evidence]]
*[[Lateral Epicondyle Tendinopathy Toolkit: Section E - Exercise Prescription|Section E- Exercise prescription]]
*[[Lateral Epicondyle Tendinopathy Toolkit: Section F - Manual Therapy|Section F- Manual therapy]]
*[[Lateral Epicondyle Tendinopathy Toolkit: Section G - LASER Dosage Calculation|Section G- Laser dosage]]
*[[Lateral Epicondyle Tendinopathy Toolkit: Section H - Braces, Splints, and Taping|Section H-Braces , Splints and Taping]]
* UBC Lateral Epicondyle Tendinopathy (LET) Toolkit


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[[Category:Elbow - Guidelines]]
[[Category:Elbow - Guidelines]]
[[Category:Elbow - Outcome Measures]]
[[Category:Elbow - Outcome Measures]]
[[Category:PT Knowledge Broker Project]]

Latest revision as of 17:16, 1 December 2022

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.
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