Development of a clinical prediction rule to identify initial responders to mobilisation with movement and exercise for lateral epicondylalgia.
The aim of this post hoc analysis was to develop a preliminary clinical prediction rule (CPR) for identifying patients with lateral epicondylalgia (LE) likely to respond to mobilisation with movement and exercise (PT). Currently practitioners do not have an evidence-based means to identify such patients a priori. Potential predictive factors were recorded at baseline and reference measures at 3 weeks after treatment was initiated. Participants (n=64) received standardised PT. After 3 weeks, participants were categorised as having experienced 'improvement' or 'no improvement' with treatment. Factors with univariate relationship (p<0.15) to 'improvement' were entered into a step-wise logistic regression model. Receiver operator characteristic curves were used to calculate cut-off points for continuous variables. Analyses resulted in a CPR that included: age (<49 years, +LR=2.6) as well as pain free grip strength on the affected (>112N, +LR=2.3) and unaffected side (<336N, +LR=2.1). Probability of improvement rose from 79 to 100% if all three were positive. The CPR did not predict outcome for wait and see (n=57), indicating it was more accurate for PT. This post hoc analysis has created a Level IV CPR that with further validation will help practitioners identify responders. Future studies are required to validate the rule.
Vicenzino
Bill
B
Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland St Lucia, Queensland 4072, Australia. b.vicenzino@uq.edu.au
Smith
Dugal
D
Cleland
Joshua
J
Bisset
Leanne
L
D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D018737:Hand Strength; D006801:Humans; D018953:Kinesiology, Applied / Q000379:methods; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D008875:Middle Aged; D009068:Movement; D013716:Tennis Elbow / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult