Article
Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy1

Presented in part at the Canadian Physiotherapy Association’s 14th Annual National Orthopaedic Symposium, September 2002, Saskatoon, SK, Canada.
https://doi.org/10.1016/S0003-9993(03)00480-5Get rights and content

Abstract

Waugh EJ, Jaglal SB, Davis AM, Tomlinson G, Verrier MC. Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy. Arch Phys Med Rehabil 2004;85:308–18.

Objective

To identify key factors associated with outcomes of patients who underwent 8 weeks of physical therapy (PT) for lateral epicondylitis.

Design

Multicenter prospective design with inception cohort of lateral epicondylitis patients commencing PT. Baseline clinical examinations were conducted by 1 physical therapist; self-report outcome measures were completed at baseline and 8 weeks later.

Setting

Nine private sports medicine clinics and 2 hospital outpatient departments in Ontario, Canada.

Participants

Eighty-three patients with unilateral lateral epicondylitis identified by the treating physical therapists.

Interventions

Not applicable.

Main Outcome Measures

The final scores of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and a vertical pain visual analog scale (VAS) were used as the dependent variables.

Results

The final prognostic model for the 8-week DASH scores included the baseline score (95% confidence interval [CI], 0.34–0.66), sex (female) (95% CI, 3.3–14.5), and self-reported nerve symptoms (95% CI, 0.8–13.8). The model for the 8-week VAS scores included the baseline score (95% CI, 0.01–0.37), sex (female) (95% CI, 0.4–18.2), and self-reported nerve symptoms (95% CI, 4.7–25.5). A subanalysis indicated that women were more likely than men to have work-related onsets, repetitive keyboarding jobs, and cervical joint signs. Among women, these factors were associated with higher final DASH and VAS scores.

Conclusions

Women and patients who report nerve symptoms are more likely to experience a poorer short-term outcome after PT management of lateral epicondylitis. Work-related onsets, repetitive keyboarding jobs, and cervical joint signs have a prognostic influence on women.

Section snippets

Study design and participants

This was a multicenter prospective study with an inception cohort of lateral epicondylitis patients commencing PT treatment. Eighty-six people (49 women, 37 men), who were recruited from 9 urban sports medicine and orthopedic clinics and 2 hospital outpatient departments in Toronto, ON, Canada, over a 14-month period, volunteered to participate.

Participants were considered to have a diagnosis of lateral epicondylitis and were eligible for inclusion in the study if they had tenderness on or near

Participants

Of the 86 participants, 3 were lost to follow-up (96.5% response rate). All analysis was therefore conducted on 83 participants.

Discussion

This study showed that women and self-reported nerve symptoms were associated with higher DASH and VAS scores after 8 weeks of PT management for lateral epicondylitis.

Of the 2 previous studies that specifically investigated sex as a prognostic factor, Gerberich and Priest23 also found that significantly more men reported “complete recovery” than women. This is in contrast to Stratford et al26 who found no difference in recovery between men and women. Stratford measured outcome as a dichotomy of

Conclusions

Certain subgroups of participants who presented with specific demographic, injury, and physical characteristics experienced a poorer outcome after 8 weeks of PT management, as measured by disability and pain levels. In particular, participants who reported symptoms of pins and needles and/or numbness had higher DASH and pain VAS scores than those who reported the more common symptoms of aching or sharp pain. Women had a poorer outcome than did men. This was partly because women were more likely

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