Optimising Physiotherapy for people with Tennis Elbow – a mixed methods pilot & feasibility randomised controlled trial
Tennis elbow
Once consented and prior to randomisation, participants will complete a baseline set of patient-reported outcome measures and demographic data. Patients will then be randomly allocated to receive either the optimised physiotherapy treatment package, by physiotherapists specifically trained to deliver this, or usual physiotherapy care delivered by other physiotherapists not trained in the optimised intervention but trained in the trial procedures. Usual physiotherapy will not be standardised in this pragmatic study but the details of the content and number of treatments given will be captured at the end of a patient’s course of physiotherapy. Usual physiotherapy may involve a range of different treatments including advice and education, exercise, taping, manual therapy, acupuncture, ice therapy, orthotics and massage. Evidence suggests that there is inconsistency of approach and a wide range of variation within treatment categories, for example the dosing of exercise therapy. Whilst the optimised physiotherapy treatment package also includes patient advice and education, exercise therapy and provision of a counterforce brace, it will differ from usual care by providing a detailed and consistent approach to treatment based upon best available evidence and omitting treatments lacking evidence of efficacy. The advice and education component is detailed and supported by high-quality written and videographic materials, developed in consultation with patients. The topics covered not only relate to Tennis Elbow but incorporate modifiable lifestyle factors that may improve treatment response and reduce risk of recurrence: • What tennis elbow is • Activity modification • Pacing • Promotion of self-efficacy • Ergonomics for work or sport • Medication advice • Basic pain science • General exercise advice • Smoking cessation (if applicable) • Sleep advice • General diet advice • Diabetes management (if applicable) The exercise therapy component consists of a progressiv
1. Aged 18 years or over 2. Lateral elbow pain 3. Pain reproduced on palpation of the common extensor origin and on gripping 4. Positive Cozen’s, Mills’ or Maudsley’s tests (at least one positive)
1. Recent history of significant trauma to the affected limb e.g. a fall on an outstretched hand 2. Previous diagnosis of inflammatory arthritis or gout 3. Previous diagnosis of osteoarthritis of the affected elbow 4. Neurological symptoms in the affected limb correlating with onset of elbow pain e.g. loss of sensation in the hand 5. Co-existing neck pain and stiffness that started at a similar time to the elbow symptoms 6. Unable to understand English or lacking capacity for informed consent