A service evaluation and improvement project: a three year systematic audit cycle of the physiotherapy treatment for Lateral Epicondylalgia

Objective To improve outcomes of physiotherapy treatment for patients with Lateral Epicondylalgia. Design A systematic audit and quality improvement project over three phases, each of one year duration. Setting Salford Royal NHS Foundation Trust Teaching Hospital Musculoskeletal Physiotherapy out-patients department. Participants n = 182. Interventions Phase one - individual discretion; Phase two - strengthening as a core treatment however individual discretion regarding prescription and implementation; Phase three - standardised protocol using high load isometric exercise, progressing on to slow combined concentric & eccentric strengthening. Main outcome measures Global Rating of Change Scale, Pain-free grip strength, Patient Rated Tennis Elbow Evaluation, Tampa Scale of Kinesophobia-11. Results Phase three demonstrated a reduction in the average number of treatments by 42% whilst improving the number of responders to treatment by 8% compared to phase one. Complete cessation of non-evidence based treatments was also observed by phase three. Conclusions Strengthening should be a core treatment for LE. Load setting needs to be sufficient. In phase three of the audit a standardised tendon loading programme using patient specific high load isometric exercises into discomfort/pain demonstrated a higher percentage of responders compared to previous phases. (c) 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.