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.
Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland St Lucia, Queensland 4072, Australia. b.vicenzino@uq.edu.au
Bill
B
Vicenzino
Dugal
D
Smith
Joshua
J
Cleland
Leanne
L
Bisset
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