Even experts cannot agree on the optimal use of platelet-rich plasma in lateral elbow tendinopathy: an international Delphi study

Abstract Background Platelet-rich plasma (PRP) is widely used in the management of lateral elbow tendinopathy (LET) despite conflicting evidence on its effectiveness. With high levels of user experience, this study aimed to assess consensus amongst experts on its clinical use. Methods A three-round international Delphi study was conducted. Participants were invited through national society mailing lists and contact lists derived from a systematic search of the literature on PRP. In round one, a primary working group developed 40 statements on PRP preparation and clinical application. In rounds two and three, an international group of researchers on PRP and clinical users of the device scored their levels of agreement with the statements on a five-point scale. Consensus was defined as an interquartile range of ≤ 1. Results Consensus of agreement was only reached for 17/40 (42.5%) statements. For statements on PRP formulation, consensus of agreement was reached in 2/6 statements (33%). Only limited consensus on the contraindications, delivery strategy and delivery technique was achieved. Conclusion Experts reached very limited consensus on the use of PRP in LET. High levels of user experience have not resulted in a convergence of opinion on the technical components of PRP formulation and delivery, substantiating the need for further studies and improved trial reporting.

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Protocol for the development of a core outcome set for lateral elbow tendinopathy (COS-LET)

Trials ◽

10.1186/s13063-021-05291-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Marcus Bateman ◽

Jonathan P. Evans ◽

Viana Vuvan ◽

Val Jones ◽

Adam C. Watts ◽

...

Keyword(s):

Outcome Measures ◽

Health Care Professionals ◽

Delphi Study ◽

Evidence Synthesis ◽

Core Outcome Set ◽

Outcome Evaluation ◽

Core Outcome ◽

Outcome Set ◽

Lateral Elbow ◽

Lateral Elbow Tendinopathy

Abstract Background Lateral elbow tendinopathy (LET) is a common condition that can cause significant disability and associated socioeconomic cost. Although it has been widely researched, outcome measures are highly variable which restricts evidence synthesis across studies. In 2019, a working group of international experts, health care professionals and patients, in the field of tendinopathy (International Scientific Tendinopathy Symposium Consensus (ICON) Group), published the results of a consensus exercise defining the nine core domains that should be measured in tendinopathy research. The aim of this study is to develop a core outcome set (COS) for LET mapping to these core domains. The primary output will provide a template for future outcome evaluation of LET. In this protocol, we detail the methodological approach to the COS-LET development. Methods This study will employ a three-phase approach. (1) A systematic review of studies investigating LET will produce a comprehensive list of all instruments currently employed to quantify the treatment effect or outcome. (2) Instruments will be matched to the list of nine core tendinopathy outcome domains by a Steering Committee of clinicians and researchers with a specialist interest in LET resulting in a set of candidate instruments. (3) An international three-stage Delphi study will be conducted involving experienced clinicians, researchers and patients. Within this Delphi study, candidate instruments will be selected based upon screening using the Outcome Measures in Rheumatology (OMERACT) truth, feasibility and discrimination filters with a threshold of 70% agreement set for consensus. Conclusions There is currently no COS for the measurement or monitoring of LET in trials or clinical practice. The output from this project will be a minimum COS recommended for use in all future English language studies related to LET. The findings will be published in a high-quality journal and disseminated widely using professional networks, social media and via presentation at international conferences. Trial registration Registered with the Core Outcome Measures in Effectiveness Trials (COMET) database, November 2019. https://www.comet-initiative.org/Studies/Details/1497.

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Protocol for the Development of a Core Outcome Set for Lateral Elbow Tendinopathy (COS-LET)

10.21203/rs.3.rs-340653/v1 ◽

2021 ◽

Author(s):

Marcus Bateman ◽

Jonathan P Evans ◽

Viana Vuvan ◽

Valerie Jones ◽

Adam C Watts ◽

...

Keyword(s):

Outcome Measures ◽

Health Care Professionals ◽

Delphi Study ◽

Evidence Synthesis ◽

Core Outcome Set ◽

Outcome Evaluation ◽

Core Outcome ◽

Outcome Set ◽

Lateral Elbow ◽

Lateral Elbow Tendinopathy

Abstract Background Lateral elbow tendinopathy (LET) is a common condition that can cause significant disability and associated socioeconomic cost. Although it has been widely researched, outcome measures are highly variable which restricts evidence synthesis across studies. In 2019 a working group of international experts, health care professionals and patients, in the field of tendinopathy (International Scientific Tendinopathy Symposium Consensus (ICON) Group) published the results of a consensus exercise defining the nine core domains that should be measured in tendinopathy research. The aim of this study is to develop a Core Outcome Set (COS) for LET mapping to these core domains. The primary output will provide a template for future outcome evaluation of LET. In this protocol we detail the methodological approach to the COS-LET development. Methods This study will employ a three-phase approach. (1) A systematic review of studies investigating LET will produce a comprehensive list of all instruments currently employed to quantify treatment effect or outcome. (2) Instruments will be matched to the list of nine core tendinopathy outcome domains by a Steering Committee of clinicians and researchers with a specialist interest in LET resulting in a set of candidate instruments. (3) An International three-stage Delphi Study will be conducted involving experienced clinicians, researchers and patients. Within this Delphi Study candidate instruments will be selected based upon screening using the Outcome Measures in Rheumatology (OMERACT) truth, feasibility and discrimination filters with a threshold of 70% agreement set for consensus. Conclusions There is currently no COS for the measurement or monitoring of LET in trials or clinical practice. The output from this project will be a minimum COS recommended for use in all future English-language studies related to LET. The findings will be published in a high-quality journal and disseminated widely using professional networks, social media and via presentation at international conferences.

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Platelet-Rich Plasma Versus an Eccentric Exercise Program for Recalcitrant Lateral Elbow Tendinopathy

PM&R ◽

10.1016/j.pmrj.2015.05.001 ◽

2015 ◽

Vol 7 (6) ◽

pp. 654-661

Author(s):

Joseph Ihm ◽

Kenneth Mautner ◽

Joseph Blazuk ◽

Jaspal Ricky Singh

Keyword(s):

Eccentric Exercise ◽

Platelet Rich Plasma ◽

Exercise Program ◽

Lateral Elbow ◽

Lateral Elbow Tendinopathy

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Effectiveness of the "Tecaretherapy" in Patients With Lateral Elbow Tendinopathy

Case Medical Research ◽

10.31525/ct1-nct03939247 ◽

2019 ◽

Author(s):

Keyword(s):

Lateral Elbow ◽

Lateral Elbow Tendinopathy

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Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-102525 ◽

2020 ◽

pp. bjsports-2020-102525

Author(s):

Stefanos Karanasios ◽

Vasileios Korakakis ◽

Rod Whiteley ◽

Ioannis Vasilogeorgis ◽

Sarah Woodbridge ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Risk Of Bias ◽

Short Term ◽

Lateral Elbow ◽

Long Term Follow Up ◽

Wait And See ◽

Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

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Soda Machine and User Experience: A Study of Icon Display

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181320641493 ◽

2020 ◽

Vol 64 (1) ◽

pp. 2035-2045

Author(s):

Vera Puglisi ◽

Jasmine Ghorbani ◽

Yan Chen ◽

Manuel Nyagisere ◽

Grace Babalola ◽

...

Keyword(s):

User Experience ◽

User Satisfaction ◽

Touch Screen ◽

T Test ◽

Consumer Electronics ◽

Point Scale ◽

Test User

Touch-screen GUIs have become a key feature of modern consumer electronics. The purpose of this study is to investigate the effect that reducing the number of icons on the GUI of a popular soda machine has on drink selection time and user satisfaction. Twenty subjects participated in the study, with 10 assigned to the control and experimental groups respectively. Time to make a drink selection was recorded and compared between groups using unpaired t-test. User satisfaction was measured using a five-point scale questionnaire. The results suggested that user satisfaction, except for the display dependability category, is not affected by the reduction of the number of icons on the soda machine GUI and no change was observed in drink selection time.

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Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Clinical and Sonographic Results at 90 Months

The American Journal of Sports Medicine ◽

10.1177/03635465211010158 ◽

2021 ◽

pp. 036354652110101

Author(s):

Benjamin F.H. Ang ◽

P. Chandra Mohan ◽

Meng Ai Png ◽

John Carson Allen ◽

Tet Sen Howe ◽

...

Keyword(s):

Pain Relief ◽

Extensor Tendon ◽

Tissue Healing ◽

Lateral Elbow ◽

Percutaneous Tenotomy ◽

Vas Scores ◽

The Common ◽

Lateral Elbow Tendinopathy

Background: In a study from our institution, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon for recalcitrant lateral elbow tendinopathy showed excellent safety profiles, high tolerability, efficiency, sustained pain relief, functional improvement, and sonographic evidence of tissue healing in 20 patients at 3 years’ follow-up. Purpose: To explore the long-term clinical and sonographic results of ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon. Study Design: Case series; Level of evidence, 4. Methods: The same cohort of 20 patients was recalled after 7 years, and visual analog scale (VAS) for pain and Disabilities of the Arm, Shoulder and Hand (DASH) scores, need for secondary intervention, and overall satisfaction were assessed. They were also reassessed using ultrasound imaging of the brevis and the common extensor tendon to evaluate tendon hypervascularity, tendon thickness, and the progress or the recurrence of the hypoechoic scar tissue. Results: We successfully scored 19 patients and performed ultrasound on 16 patients with a median follow-up of 90 months (range, 86-102 months). There were no adverse outcomes and satisfaction remained at 100% (6 patients, satisfied; 13 patients, very satisfied). No patient developed a recurrence of symptoms and signs of lateral elbow tendinopathy, and therefore no secondary intervention was required. The improvement from baseline and early term scores was sustained ( P < .001 for all). At 90 months, there was a significant improvement in VAS scores and DASH–Compulsory scores compared with preprocedure scores and all follow-up times until 3 months. There was no difference in VAS scores and DASH–Compulsory scores at 90 months compared with 6 and 36 months. For DASH–Work scores, there was a significant improvement at 90 months compared with preprocedure scores, but there was no difference between DASH–Work scores at 90 months and scores at all other points of follow-up. At 90 months, hypervascularity remained resolved in 79% of patients, while all patients had reduced tendon swelling and sustained resolution or reduction of the hypoechoic lesion. Conclusion: At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon, previously shown to enhance recovery of lateral elbow tendinopathy, demonstrated good durability of pain relief and functional recovery that was previously achieved. This was accompanied by sustained sonographic tissue healing with no significant deterioration.

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