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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 [2830]
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, 3638]
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, 4446]
Surgery 12. IF a patient was symptomatic after a minimum of 6–12 months of conservative therapies, THEN surgery should be recommended. A / Strong [4749]
  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.