Assessing Valid Change over Time in Patients with Lateral Epicondylitis at the Elbow

Stratford, Paul W.; Levy, David

doi:10.1097/00042752-199404000-00004

Cited by 68 publications

(37 citation statements)

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“…Measuring grip strength with extended elbow, as we did, may reflect a more sensitive outcome for patients with lateral epicondylitis, 30,31 although it limits comparability with the recommended standardized positioning method for grip strength. Furthermore, ASHT recommended that "the second handle position of the dynamometer should be used when evaluating grip strength" and "the mean of three successive trials should be used as the outcome measure of grip strength."…”

Section: Discussionmentioning

confidence: 82%

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Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis

Smidt

Windt

Assendelft

et al. 2002

Archives of Physical Medicine and Rehabilitation

257

159

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ABSTRACT. Smidt N, van der Windt DA, Assendelft WJ, Mourits AJ, Devillé WL, de Winter AF, Bouter LM. Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis. Arch Phys Med Rehabil 2002;83:1145-50.Objective: To evaluate the interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis in primary care.Design: Two physiotherapists assessed independently, and in randomized order, the severity of complaints scored on an 11-point numeric rating scale, pain-free grip strength, maximum grip strength, and pressure pain threshold.Setting: Primary care center in the Netherlands. Participants: Fifty patients were assessed by both physiotherapists.Interventions: Not applicable. Main Outcome Measures: Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) were calculated to assess interobserver reliability. The Bland and Altman method was used to assess interobserver agreement, which included calculation of the mean difference between the observers (d ), the 95% CI for d, the standard deviation of the differences, and the 95% limits of agreement. Finally, the smallest detectable difference (SDD) was calculated.Results: The ICC for the severity of complaints was .90. The ICCs for the pain-free grip strength and maximum grip strength were .97 and .98, respectively. The pressure pain threshold showed a lower reliability (ICCϭ.77). The interobserver agreement for all outcome measures was good, but systematic differences in assessment between the physiotherapists were found for the maximum grip strength and pressure pain threshold. For pressure pain threshold, the SDD was clearly larger than the predefined acceptable difference of 10% of the total range of measurement.Conclusions: The interobserver reliability of severity of complaints and grip strength was excellent, whereas the pressure pain threshold showed unsatisfactory reliability. Grip strength and overall assessment of the severity of complaints are useful and reliable measures for the assessment of lateral epicondylitis. Pain-free grip strength, in particular, is relatively easy to perform and has been shown to be associated with other measures of functional disability in patients with lateral epicondylitis. We, therefore, recommend the use of pain-free grip strength in both research and clinical practice.

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Section: Discussionmentioning

confidence: 82%

“…In contrast, changes in maximum grip strength were not associated with improvement of symptoms. 30,31 These results and their clinical implications favor the use of pain-free grip strength in lateral epicondylitis.…”

Section: Discussionmentioning

confidence: 99%

Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis

Smidt

Windt

Assendelft

et al. 2002

Archives of Physical Medicine and Rehabilitation

257

159

View full text Add to dashboard Cite

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“…1,10 In most cases there is also a deficit in strength in these muscles. 20 In the laboratory, 2 frequently used outcome measures are pressure pain thresholds 25,26,32,34 and pain-free grip strength. 25,26 These 2 tests mimic the clinic physical examination tests that are positive in the majority of cases of lateral epicondylalgia.…”

mentioning

confidence: 99%

“…20 In the laboratory, 2 frequently used outcome measures are pressure pain thresholds 25,26,32,34 and pain-free grip strength. 25,26 These 2 tests mimic the clinic physical examination tests that are positive in the majority of cases of lateral epicondylalgia. The strong correlation between level of disability and deficits in pain-free grip strength testing, 20 along with its responsiveness to change and high reliability, has facilitated its use as an indicator of physical impairment and dysfunction not only in the laboratory but also in the clinical setting.…”

mentioning

confidence: 99%

“…The strong correlation between level of disability and deficits in pain-free grip strength testing, 20 along with its responsiveness to change and high reliability, has facilitated its use as an indicator of physical impairment and dysfunction not only in the laboratory but also in the clinical setting. 4,26,25 Stratford and Levy 25 have shown the pain-free grip strength test to be a more sensitive instrument of change than the maximum grip strength test.…”

mentioning

confidence: 99%

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Initial Effects of Elbow Taping on Pain-Free Grip Strength and Pressure Pain Threshold

Vicenzino

Brooksbank²,

Minto³

et al. 2003

J Orthop Sports Phys Ther

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Study design: Single-blind, placebo control, randomized, crossover, experimental study with repeated measures. Objective: To determine the initial effects of a taping technique on grip strength and pain in individuals with lateral epicondylalgia. Background: Taping techniques are advocated for chronic musculoskeletal conditions such as lateral epicondylalgia, a prevalent disorder with significant impact on the individual and community. Little evidence exists supporting the effects of taping techniques on musculoskeletal pain. Methods and Measures: Sixteen participants (mean age ± SD, 45.8 ± 10.2 years) with chronic lateral epicondylalgia (mean duration ± SD, 13.1 ± 9.9 months) participated in a placebo control study of an elbow taping technique. Outcome measures were pain-free grip strength and pressure pain threshold taken before, immediately after, and 30 minutes after application of tape. Results: The taping technique significantly improved pain-free grip strength by 24% from baseline (P = .028). The treatment effect was greater than that for placebo and control conditions. Changes in pressure pain threshold (19%), although positive, were not statistically significant. Conclusion:This preliminary study demonstrated an initial ameliorative effect of a taping technique for lateral epicondylalgia and suggests that it should be considered as an adjunct in the management of this condition. J Orthop Sports Phys Ther 2003;33:400-407

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Upper limb position affects pain‐free grip strength in individuals with lateral elbow tendinopathy

Cooke

Obst

Vicenzino

et al. 2021

Physiotherapy Res Intl

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Background and Purpose Pain‐free grip (PFG) force is commonly used to monitor treatment outcomes in lateral elbow tendinopathy (LET); however, it is unclear whether changes in forearm and elbow position affect PFG force values. This study aims to examine the effect of elbow/shoulder and forearm position on non‐normalised and normalised PFG force in individuals with unilateral LET. Methods A cohort study including 21 subjects with clinically diagnosed unilateral LET (13 females, mean [SD] age 50 [8] years) performed PFG force (symptomatic arm) and maximal grip (asymptomatic arm) tasks using four upper limb positions: (1) shoulder neutral, elbow flexed (90°), forearm pronated; (2) shoulder neutral, elbow flexed (90°), forearm neutral; (3) shoulder flexed (90°), elbow extended, forearm pronated; and (4) shoulder flexed (90°), elbow extended, forearm neutral. PFG force was normalised to the maximal grip of the asymptomatic side. Repeated‐measures analyses of variance were used to compare non‐normalised and PFG force normalised to maximal grip between positions. Results Both non‐normalised and normalised PFG forces were greater in position 2 than position 1, position 3 and position 4 (elbow‐by‐forearm interaction non‐normalised p = 0.002, normalised p = 0.004). There were no differences between positions 1, 3 and 4 for either non‐normalised or normalised PFG strength. Discussion This study shows that PFG force was higher when performed with forearm neutral supination/pronation, elbow flexion and shoulder neutral than other tested positions, and irrespective of whether PFG force was normalised to the maximal grip force of the contralateral limb. This indicates that arm position should be standardised for comparison.

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Assessing Valid Change over Time in Patients with Lateral Epicondylitis at the Elbow

Cited by 68 publications

References 0 publications

Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis

Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis

Initial Effects of Elbow Taping on Pain-Free Grip Strength and Pressure Pain Threshold

Upper limb position affects pain‐free grip strength in individuals with lateral elbow tendinopathy

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