A service evaluation and improvement project: A three year systematic audit cycle of the physiotherapy treatment for Lateral Epicondylalgia

Barratt, PA and Selfe, James (2018) A service evaluation and improvement project: A three year systematic audit cycle of the physiotherapy treatment for Lateral Epicondylalgia. Physiotherapy, 104 (2). pp. 209-216. ISSN 0031-9406

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Abstract

© 2017 Chartered Society of Physiotherapy. 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.