Lateral Epicondyle Tendinopathy (Tennis Elbow) Toolkit

The BC Physical Therapy Tendinopathy Task Force

Dr. Joseph Anthony, Dr. Angela Fearon, Diana Hughes, Carol Kennedy, Dr. Alex Scott, Michael Yates, & Alison Hoens

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Introduction to the Lateral Epicondyle Tendinopathy (Tennis Elbow) Toolkit

The Lateral Epicondyle Tendinopathy Toolkit is an evidence informed clinical decision making aid to provide clinicians with information (both evidence-informed and expert-informed) to facilitate clinical decision-making regarding the management of tendinopathy of the lateral epicondyle or "Tennis Elbow".

The development of this toolkit is one of multiple Physical Therapy Knowledge Broker projects (including a similar toolkit focused on Achilles Tendinopathy) supported by the UBC Department of Physical Therapy (Faculty of Medicine), the Physiotherapy Association of BC, the Vancouver Coastal Research Institute and the Providence Healthcare Research Institute.

The following information is current as of June 2013.

Background to the Project

Translation of knowledge to practice in health care is a significant challenge[1][2][3]. A project was undertaken by a unique partnership of physical therapy researchers, educators and expert clinicians to address the gap between evidence and practice in the management of Lateral Epicondyle Tendinopathy.

Physiotherapy clinicians in British Columbia requested evidence-informed guidance on the management of tendinopathy. To address this need the provincial Physical Therapy Knowledge Broker assembled a team of researchers, educators and expert clinicians with the mandate to develop, disseminate and implement a toolkit of decision aids to guide clinical decision-making for Lateral Epicondyle Tendinopathy.

Toolkit Development

The process to develop the toolkit involved the following components[1][2][3][4]:

  1. Identification of the purpose and scope of the project
  2. Agreement on the processes for selection of content and format
  3. Creation of a mechanism for resolution of conflicting opinion
  4. An iterative feedback process with stakeholders
  5. The incorporation of concepts and strategies from the knowledge translation and implementation science literature to support the stages of knowledge synthesis, dissemination and implementation.

The Lateral Epicondyle Tendinopathy (Tennis Elbow) Toolkit

The ‘Lateral Epicondyle Tendinopathy (LET) Toolkit’[5] includes:

  • A tabulated summary of the evidence for manual therapy, exercise, acupuncture, low level laser therapy (LLLT), ultrasound (US), extracorporeal shock wave therapy (ESWT), iontophoresis using dexamethasone, iontophoresis using NSAID or lidocaine, orthotic devices, and taping, appropriate outcome measures for this population, as well as associated 'take home messages' and 'clinical implications'
  • An algorithm to assist clinicians in ascertaining when to incorporate specific interventions
  • And the following appendices:
    • A) Details of the Articles
    • B) Manual Therapy
    • C) Details of Exercise Prescription
    • D) LASER Dosage Calculation
    • E) Braces, Splints, and Taping
    • F) Outcome Measures
    • G) Medical and Surgical Interventions

Clinicians want to provide evidence-informed management of tendinopathy but many struggle with accessing, appraising and synthesizing the vast array of literature available on this topic. This KT initiative highlights the need for, challenges associated with, evidence-informed process for and positive response to the development of decision aids synthesizing the current evidence to guide clinical management of this patient population.

Access the Lateral Epicondyle Tendinopathy Toolkit

Summary of the Evidence

Treatment Algorithm

Appendix A: Details of the Articles

Appendix B: Manual Therapy

Appendix C: Details of Exercise Prescription

Appendix D: LASER Dosage Calculation

Appendix E: Braces, Splints, and Taping

Appendix F: Outcome Measures

Appendix G: Medical and Surgical Interventions

References

  1. 1.0 1.1 Groth G. Predicting intentions to use research evidence for carpal tunnel syndrome treatment decisions among certified hand therapists. J Occup Rehabil. 2011;21(4):559-72.
  2. 2.0 2.1 Mitton C, Adair CE, McKenzie E, Patten SB, Waye Perry B. Knowledge transfer and exchange: Review and synthesis of the literature. The Milbank Quarterly.2007;85(4):729-768.
  3. 3.0 3.1 Oborn E, et al: Knowledge translation in healthcare: A review of the literature. Cambridge Judge Business School. Cambridge. 2010.
  4. Menon A, Korner-Bitensky N, Kastner M, McKibbon KA, Straus S. Strategies for rehabilitation professionals to move evidence-based knowledge into practice: A systematic review. J Rehabil Med. 2009;41:1024-1032.
  5. http://physicaltherapy.med.ubc.ca/research/physical-therapy-knowledge-broker/projects/lateral-epicondyle-tendinopathy-let-toolkit//