Optimising physiotherapy treatment for people with lateral elbow tendinopathy: development and pilot/feasibility testing of an evidence-based treatment approach

Bateman, Marcus

Abstract

Background: There are a wide range of physiotherapy treatment options for people with lateral elbow tendinopathy (LET), however previous studies have reported inconsistent approaches to treatment and a lack of evidence demonstrating clinical effectiveness. The aim of this thesis was to develop an optimised physiotherapist-led treatment package before testing the feasibility of conducting a future, fully powered, multi-site randomised controlled trial (RCT) to compare the clinical and cost-effectiveness of the new intervention against usual physiotherapy treatment for adults diagnosed with LET.

Methods: The OPTimisE intervention was developed via consensus, using research evidence combined with the opinions of expert stakeholders. A mixed-methods pilot and feasibility RCT was then conducted, with patients receiving usual physiotherapy treatment or the OPTimisE intervention. Feasibility was assessed by meeting pre-specified thresholds for: consent rate, intervention fidelity, attendance rate of scheduled sessions, outcome measure completion at six months, as well as acceptability of the OPTimisE treatment package from both the perspective of patients and physiotherapists (qualitative investigation).

Results: The OPTimisE treatment package consisted of three elements: advice/education, an exercise regimen and counter-force orthosis. The pilot and feasibility RCT recruited to target and all feasibility progression criteria were met. Patients and physiotherapists found the OPTimisE treatment package to be acceptable but suggested improvements to the trial design. Analysis of secondary outcomes showed improvements in both groups over time with no signal that the OPTimisE intervention might be more effective than usual physiotherapy treatment.

Conclusions: It is methodologically feasible to conduct a fully powered RCT to compare the clinical and costeffectiveness of the OPTimisE intervention against usual physiotherapy treatment. However, both groups showed similar improvements over time, questioning whether a future comparative main trial would be a priority. Future research might instead compare diagnosis, reassurance and comprehensive self-help advice against usual physiotherapy care.

Citation

Bateman, M. (2024). Optimising physiotherapy treatment for people with lateral elbow tendinopathy: development and pilot/feasibility testing of an evidence-based treatment approach. (Thesis). Keele University. Retrieved from https://keele-repository.worktribe.com/output/853496

• Thesis Type: Thesis
• Deposit Date: Jun 21, 2024
• Publicly Available Date: Jun 21, 2024
• Public URL: https://keele-repository.worktribe.com/output/853496
• Award Date: 2024-06