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Lateral Epicondylitis in General Practice:
Course and Prognostic Indicators of Outcome
NYNKE SMIDT, MARTYN LEWIS, DANIËLLE A.W.M. VAN DER WINDT, ELAINE M. HAY, LEX M. BOUTER, and PETER CROFT ABSTRACT. Objective. To investigate the course of lateral epicondylitis and identify prognostic indicators associated with short- and longterm outcome of pain intensity. Methods. We prospectively followed patients (n = 349) from 2 randomized controlled trials investigating conservative interventions for lateral epicondylitis in primary care. Uni- and multivariate linear regression analyses were used to investigate the association between potential prognostic indicators and pain intensity (0-100 point scale) measured at 1, 6, and 12 months after randomization. Potential prognostic factors were duration of elbow complaints, concomitant neck pain, concomitant shoulder pain, previous elbow complaints, baseline pain scores, age, gender, involvement of dominant side, social class, and work status. The variables "study" and "treatment" were included as covariates in all models. Results. Pain scores at 1 month followup were higher in patients with severe pain, a long duration of elbow complaints, and concomitant shoulder pain. At 12 month followup, the only different prognostic indicator for poor outcome was concomitant neck pain, in place of shoulder pain. Patients from higher social classes reported lower pain scores at 12 month followup than patients from lower social classes. Conclusions. Lateral epicondylitis seems to be a self-limiting condition in most patients. Long duration of elbow complaints, concomitant neck pain, and severe pain at presentation are associated with poor outcome at 12 months. Our results will help care providers give patients accurate information regarding their prognosis and assist in medical decision-making. (First Release Aug 1 2006; J Rheumatol 2006;33:2053-9) Key Indexing Terms:
TENNIS ELBOW From the Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands and the Primary Care Science Research Centre, Keele University, Keele, Staffordshire, United Kingdom. Supported by The Netherlands Organization for Scientific Research (NWO) and the North Staffordshire Primary Care Research Consortium. N. Smidt, PhD, Lecturer in Clinical Epidemiology, VU University Medical Center; M. Lewis, PhD, Senior Lecturer in Biostatistics, Keele University; D.A.W.M. van der Windt, PhD, Reader in General Practice Epidemiology, VU University Medical Center; E.M. Hay, PhD, Professor of Community Rheumatology, Keele University; L.M. Bouter, PhD, Professor in Clinical Epidemiology, VU University Medical Center; P. Croft, PhD, Professor in Primary Care Epidemiology, Keele University. Address reprint requests to Dr. N. Smidt, Department of Clinical Epidemiology & Biostatistics, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands. E-mail: n.smidt@amc.uva.nl Accepted for publication May 2, 2006.
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