Caitlin E Hill

Objective
To examine the frequency of use and establish routine clinical practice of patient-reported outcome measures (PROMs), performance-based OMs and clinician-reported OMs in the assessment of a suspected case of lateral elbow tendinopathy (LET).
Methods
Physiotherapists from eight countries completed an anonymous online survey, rating their frequency of use (never, rarely, sometimes, often and always) for unidimensional PROMs, multidimensional PROMs, performance-based OMs and clinician-reported OMs. To establish clinical practices, responses were dichotomised into routine (≥70% often/always) and not-routine (≥70% sometimes/rarely/never); items below both thresholds were classified as neither.
Results
Two hundred ninety-nine respondents completed the survey. No outcome measure met the criteria for routine practice. Eight of 17 multidimensional PROMs, and six of eight clinician-reported OMs met the criteria for not-routine practice. All unidimensional PROMs and performance-based OMs, and a select number of multidimensional PROMs and clinician-reported OMs did not meet the threshold for routine or not-routine practice.
Conclusions
Our results suggest no single outcome measure is routinely used by physiotherapists assessing a suspected case of LET. It is plausible that physiotherapists select OMs based on patient presentation, rather than the clinical diagnosis, or that outcome measures are perhaps seen more as a research tool than common place in clinical practice.

Background
Pain-free grip strength is an important outcome measure in lateral elbow tendinopathy (LET); yet, the reliability and minimum detectable change (MDC) in functional positions are unknown.

Purpose
The purpose of this study is to examine the between- and within-session pain-free grip strength reliability and MDC in LET.

Methods
Twenty-three individuals with LET completed three pain-free grip strength trials with the elbow flexed and extended. The first trial and the mean of three trials were analyzed. Between-session data were collected 2–28 days apart. Within-session data were collected 20–30 min apart.

Results
Between-session intraclass correlation coefficients (ICCs) were good (ICC2,1 = 0.75) for single trials (flexed), excellent (ICC2,1 = 0.89–0.94) for single trials (extended), and excellent for the mean of three trials (both positions). Within-session ICCs were excellent for single (ICC2,1 = 0.89–0.91) and the mean of three trials (ICC2,3 = 0.96–0.98) in both positions. Between-session flexed MDCs were 133 N (single) versus 90 N (mean) and extended MDCs were 118 N (single) versus 92 N (mean). Within-session flexed MDCs were 79 N (single) versus 52 N (mean) and extended MDCs were 125 N (single) versus 46 N (mean).

Conclusions
Using the mean of three trials is recommended, and clinicians can be confident of true change if between-session differences are >92 N and within-session differences are >52 N.

To investigate the effects of multidirectional elastic tape on pain and function in individuals with lateral elbow tendinopathy.
Randomised crossover trial.
Biomechanics laboratory.
27 participants (11 females, mean (SD) age: 48.6 (11.9) years) with clinically diagnosed lateral elbow tendinopathy of at least six weeks' duration.
Tensioned multidirectional elastic tape applied over the wrist, compared to control tape (untensioned), and no tape conditions.
Pain-free grip strength and pressure pain threshold were recorded at three timepoints for each condition: baseline, post-application, and following an exercise circuit. Change scores were calculated as the post-application or post-exercise value minus baseline. Repeated-measure analyses of variance were used to examine differences between conditions.
There were no statistically significant differences in pain-free grip strength between conditions (flexed position: F
 = 0.02,
 = 0.98; extended position: F
 = 2.26,
 = 0.12) or across timepoints (post-application vs post-exercise) (flexed position: F
 = 0.94,
 = 0.34; extended position: F
 = 0.79,
 = 0.38). Seven participants (26%) increased pain-free grip strength above the minimal detectable change following application of multidirectional elastic tape. There were no statistically significant differences in pressure pain threshold between conditions (affected lateral epicondyle: F
 = 0.54,
 = 0.54) or across timepoints (affected lateral epicondyle: F
 = 0.94,
 = 0.34).
Tensioned multidirectional elastic tape may not immediately improve pain-free grip strength or pressure pain threshold in our lateral elbow tendinopathy population; however, individual variation may exist.

Background
Lateral elbow tendinopathy is associated with changes to forearm muscle activity and wrist posture during gripping. Multidirectional elastic tape is thought to exert a deloading effect on underlying musculotendinous structures, which could potentially alter muscle activity or wrist posture.

Methods
This single-blinded randomised crossover trial compared the immediate effects of tensioned multidirectional elastic tape, untensioned control tape, and no tape, in individuals with lateral elbow tendinopathy. Muscle activity of extensor carpi radialis longus and brevis, extensor carpi ulnaris, and extensor digitorum and wrist extension angle were recorded during a submaximal gripping task. Muscle activity was normalised to the maximum amplitude recorded during maximal grip. Change scores were calculated (post-condition minus baseline). Repeated-measure analyses of variance were used to examine between-condition differences.

Findings
27 participants (16 males, mean age (SD): 48.6 (11.9) years) underwent all conditions. Extensor digitorum muscle activity was reduced during the multidirectional elastic tape, compared to control tape and no tape (MD −5.6% [95%CI: −9.9 to −1.3], MD −5.8% [95%CI: −10.2 to −1.4], respectively). Extensor carpi ulnaris muscle activity was reduced during the multidirectional elastic tape, compared to the control tape (mean difference [MD] −3.2% [95%CI: −5.3 to −1.1]), but increased during the control tape, compared to the no tape (MD 2.9% [95%CI: 0.8 to 5.0]). No differences were observed in extensor carpi radialis brevis or longus muscle activity, or extension wrist angle between conditions.

Interpretation
A decreased in extensor carpi ulnaris and extensor digitorum muscle activity during multidirectional elastic tape may be evidence of a deloading effect during submaximal gripping.

Background
Lateral elbow tendinopathy (LET) is a common musculoskeletal condition that can be treated with therapeutic tape. However, little is known of taping practices for LET in a clinical setting.

Objectives
To examine Australian healthcare practitioners’ taping techniques, clinical reasoning, and information sources regarding therapeutic tape use for LET.

Design
Cross-sectional survey.

Methods
An anonymous online survey was distributed between September 2018 and February 2019. Respondents answered questions about demographics, frequency of tape use, techniques, reasons for application, factors influencing clinical decision-making, and information sources, related to tape for LET.

Results/findings
188 Australian healthcare practitioners completed the survey. The majority of respondents were physiotherapists (n = 132, 70%) with the remainder of respondents being chiropractors (21%), myotherapists (3%), exercise physiologists (3%), or osteopaths (3%). 51% of respondents use tape as part of their management for LET at least half the time. The most popular taping technique used is a transverse band of rigid tape across the forearm (n = 78, 55% of respondents who use tape). The most common reasons for tape application are to reduce pain during occupational tasks (n = 123, 65%), and during sport/hobbies (n = 101, 54%). Respondents predominately rely on experience and patient preference to guide tape use. 63% of all respondents (n = 118) sought information about tape from professional development courses.

Conclusion
A wide range of tape techniques are used to treat LET, despite limited evidence for efficacy. Justification for tape is largely based on experience and patient preference; with information mostly gained from professional development courses. More research is required to understand the relationship between the evidence and clinical use of tape to treat LET.

Background
Lateral elbow tendinopathy is associated with pain during gripping, with forearm/wrist orthoses prescribed for treatment.

Objectives
To investigate the immediate effects of forearm and/or wrist orthoses on outcome measures of pain and function in individuals with lateral elbow tendinopathy.

Design
Systematic review

Methods
Four electronic databases were searched to identify randomised controlled trials reporting the immediate effects of forearm and/or wrist orthoses on pain and function in individuals with lateral elbow tendinopathy. The quality of evidence was rated from high to very low, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) for the primary outcomes. Where possible, standardised mean difference (SMD) and 95% confidence intervals were calculated to compare post measures between forearm and/or wrist orthoses and control/placebo conditions.

Results
The search revealed 1965 studies, of which, seven randomised crossover trials were included. Using the GRADE approach there was low quality evidence revealing a significant decrease in pain during contraction (SMD range −0.65 to −0.83) with forearm orthoses compared to a control/placebo condition. Low quality evidence revealed improvements in pain-free grip strength with the use of a forearm orthosis (SMD range 0.24–0.38), but not maximal grip strength (SMD range 0.14–0.15). Low quality evidence revealed a static wrist orthosis did not improve pain-free grip strength (SMD -0.08) or maximal grip strength (SMD -0.22).

Conclusion
There is low quality evidence that forearm orthoses can immediately reduce pain during contraction and improve pain-free grip strength but not maximal grip strength in individuals with lateral elbow tendinopathy.

Objective
To systematically identify, appraise, and examine evidence regarding the effects of therapeutic tape on pain and function in individuals with lateral epicondylalgia (LE).

Methods
Five electronic databases were systematically searched up to March 2018. Full-text, peer-reviewed, English-language studies were included if they had an LE population, a standalone tape condition, and an outcome related to pain or function.

Results
Eight out of 2022 screened studies were included. Three studies demonstrated immediate (i.e. within 1 h) improvements in pain and pain-free grip strength following diamond deloading rigid tape. One study reported immediate improvements in proprioception following transverse rigid tape. The immediate effects of longitudinal kinesiotape were inconsistent. One study reported improvements in pain and pain-free grip strength, while another study reported no effect on pain, strength, or muscle activity. Two studies examined short-term (i.e. within six weeks) kinesiotape application. One study reported two weeks of longitudinal kinesiotape improved pain and maximum grip strength. The other study reported one week of diamond kinesiotape improved patient-reported pain and function, but not maximum grip strength.

Conclusions
In individuals with LE, diamond deloading rigid tape may immediately improve pain and strength. There is conflicting evidence regarding kinesiotape effects in both immediate and short-term timeframes.