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Table 1 Evidence-based recommendations for lateral epicondylalgia care

From: Quality measures for the care of patients with lateral epicondylalgia

Components of care

Evidence-based recommendations

Evidence level / strength recommendation

I. Patient exam

 

Physical Examination

1. IF a patient begins a treatment for lateral epicondylalgia, THEN evidence that the affected tendon was examined should be documented (at least orthopaedic tests).

B / Strong [22]

Pain and functional assessment

2. IF a patient has symptomatic lateral epicondylalgia, THEN pain should be assessed (at least the intensity level) upon initiation of a new treatment at least once.

B / Strong [23, 39, 43]

3. IF a patient has symptomatic lateral epicondylalgia, THEN functional status should be assessed upon initiation of a new treatment at least once.

B / Strong [23, 39, 43]

II. Educational interventions

 

Education

4. IF a patient has symptomatic lateral epicondylalgia, THEN education about self-management of risk factors (repetitive movements, etc.) should be given or recommended at least once.

A / Strong [28–30]

III. Therapeutic interventions

 

1. Pharmacological therapy

 

First line

5. IF a patient is started on pharmacological therapy to treat lateral epicondylalgia, THEN NSAIDs should be tried first.

B / Weak [31, 32]

Prophylaxis

6. IF a patient with a risk factor for GI bleeding (age ≥75, peptic ulcer disease, history of GI bleeding) is treated with a NSAID, THEN he or she should be treated concomitantly with inhibitors (e.g. proton pump inhibitor, misoprostol, etc.).

A / Strong [35]

2. Physical therapy

 

First line

7. IF a patient is started on physical therapy to treat lateral epicondylalgia, THEN a program of exercise therapy (training epicondyle muscles excentrically and concentrically) should be tried first.

A / Strong [24, 25, 36–38]

8. IF a patient is started on physical therapy to treat lateral epicondylalgia, THEN manual therapy by mobilization with movement should be tried first.

A / Strong [26, 39]

9. IF a patient is started on physical therapy to treat lateral epicondylalgia, THEN laser therapy should be tried first.

A / Strong [40]

Time to referral

10. IF a patient is treated with corticosteroid injection for lateral epicondylalgia, THEN a multimodal program of physical therapy should be initiated early before 14 days.

A / Strong [43]

3. Other therapeutic interventions

 

First line

11. IF a patient is treated with platelet-rich plasma for lateral epicondylalgia, THEN infiltration into the extensor digitorum communis tendon by peppering technique should be recommended.

B / Strong [42, 44–46]

Surgery

12. IF a patient was symptomatic after a minimum of 6–12 months of conservative therapies, THEN surgery should be recommended.

A / Strong [47–49]

  1. Evidence level A (one or more randomized controlled trials, with or without systematic review) and B (significant observational studies).
  2. Strength of recommendations strong and weak according to specific classifications.