Abstract
Objectives
To improve outcomes of physiotherapy treatment for patients with Lateral Epicondylalgia.
Design
A systematic audit and quality improvement project over three phases, each of one year duration.
Setting
Salford Royal NHS Foundation Trust Teaching Hospital Musculoskeletal Physiotherapy out-patients department.
Participants
n = 182.
Interventions
Phase one — individual discretion; Phase two — strengthening as a core treatment however individual discretion regarding prescription and implementation; Phase three — standardised protocol using high load isometric exercise, progressing on to slow combined concentric & eccentric strengthening.
Main outcome measures
Global Rating of Change Scale, Pain-free grip strength, Patient Rated Tennis Elbow Evaluation, Tampa Scale of Kinesophobia-11.
Results
Phase three demonstrated a reduction in the average number of treatments by 42% whilst improving the number of responders to treatment by 8% compared to phase one. Complete cessation of non-evidence based treatments was also observed by phase three.
Conclusions
Strengthening should be a core treatment for LE. Load setting needs to be sufficient. In phase three of the audit a standardised tendon loading programme using patient specific high load isometric exercises into discomfort/pain demonstrated a higher percentage of responders compared to previous phases.