Telerehabilitation vs Supervised Physiotherapy for Medial Epicondylitis (TELE-ME)

Effectiveness of Telerehabilitation Versus Supervised Physiotherapy on Pain, Function, Strength, and Musculoskeletal Ultrasound Parameters in Patients With Medial Epicondylitis: A Randomized Controlled Trial

This randomized controlled trial aims to compare the effectiveness of telerehabilitation and supervised physiotherapy in patients with medial epicondylitis. The primary outcome is improvement in pain and function using the Patient-Rated Elbow Evaluation (PREE). Secondary outcomes include pain intensity, grip strength, musculoskeletal ultrasound findings, adherence, and upper limb disability measured by Quick DASH.

Study Overview

• Status: Recruiting
• Conditions: Telerehabilitation; Physiotherapy; Medial Epicondylitis
• Intervention / Treatment: Other: Telerehabilitation Exercise Program; Other: Supervised Physiotherapy Program

Detailed Description

Medial epicondylitis is a tendinopathy affecting the common flexor origin of the elbow, resulting in pain and functional limitation. Supervised physiotherapy is commonly used; however, telerehabilitation provides an accessible and scalable alternative. Evidence comparing these two delivery models is limited.

This randomized controlled trial will compare telerehabilitation and supervised physiotherapy over an 8-week intervention period. Clinical outcomes will be assessed using PREE, pain intensity, grip strength, and QuickDASH. Musculoskeletal ultrasound will be used to evaluate tendon structural characteristics. The study will also explore the relationship between imaging findings and clinical outcomes.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mahmoud Hamada Mohamed Associate Professor, Ph.D; Phone Number: 01096968910; Email: mahmoud.mohamed@fpt.bu.edu.eg

Study Locations

• Egypt
  • Benha
    • Banhā, Benha, Egypt, 11503
      • Recruiting
      • Outpatient clinic, faculty of Physical Therapy, Benha university
      • Contact: Mahmoud Hamada Mohamed Associate Professor, Ph.D; Phone Number: 01096968910; Email: mahmoud.mohamed@fpt.bu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18 to 60 years
• Clinical diagnosis of medial epicondylitis
• Symptoms duration ≥6 weeks
• Pain with resisted wrist flexion
• Local tenderness at medial epicondyle

Exclusion Criteria:

• Previous elbow surgery
• Corticosteroid injection within the past 3 months
• Cervical radiculopathy
• Systemic inflammatory disease
• Bilateral symptoms

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Telerehabilitation; Participants will receive a structured home-based rehabilitation program delivered through digital platforms with weekly remote supervision.	Other: Telerehabilitation Exercise Program; Participants will perform a home-based progressive loading program targeting the wrist flexor-pronator muscles three times per week for 8 weeks. The protocol will progress from isometric exercises in weeks 1-2 (4-5 × 30-45 s holds), to eccentric loading in weeks 3-4 (3 × 15 repetitions), followed by combined concentric-eccentric training in weeks 5-6 (3-4 × 10-12 repetitions), and heavy slow resistance in weeks 7-8 (3-4 × 6-8 repetitions at ~70-85% 1RM). Exercise intensity will be guided by a pain-monitoring model (≤5/10), with progression based on tolerance. Participants will receive weekly video consultations, instructional materials, and adherence will be tracked via digital logs.
Active Comparator: Supervised Physiotherapy; Participants will receive clinic-based physiotherapy sessions including supervised exercises.	Other: Supervised Physiotherapy Program; Participants will undergo an identical progressive loading program targeting the wrist flexor-pronator muscles, administered three times per week for 8 weeks under direct physiotherapist supervision. The intervention will follow the same staged progression: will progress from isometric exercises in weeks 1-2 (4-5 × 30-45 s holds), to eccentric loading in weeks 3-4 (3 × 15 repetitions), followed by combined concentric-eccentric training in weeks 5-6 (3-4 × 10-12 repetitions), and heavy slow resistance in weeks 7-8 (3-4 × 6-8 repetitions at ~70-85% 1RM). Exercise intensity will be guided by a pain-monitoring model (≤5/10), with progression based on tolerance. This supervised approach ensures correct technique, optimal load progression and adherence to the protocol

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Patient-Rated Elbow Evaluation (PREE) Score	The PREE is a 15-item questionnaire assessing pain and functional disability. Scores range from 0 to 100, with higher scores indicating worse pain and function.	Baseline and 8 Weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Colour Ultrasonography	Change in tendon hypervascularity and hypoechogenicity will be assessed using color Doppler ultrasonography and graded on a four-point scale (Grade 1-Grade 4). Ultrasonographic evaluation will include assessment of hypoechoic changes within the common flexor tendon, tendon sheath thickening, partial or full-thickness tendon ruptures, neovascularization detected by Doppler imaging, and cortical irregularities or damage at the medial epicondyle.	Baseline and 8 Weeks
Grip Strength (hand dynamometer)	Measured using a hand dynamometer. Hand grip strength will be assessed using a calibrated hydraulic hand dynamometer with participants seated comfortably, shoulder adducted and neutrally rotated, elbow flexed to 90°, forearm in neutral position, and wrist positioned between 0-30° extension according to standardized testing procedures. Participants will be instructed to perform maximal voluntary grip contraction for approximately 3-5 seconds. Three trials will be recorded for the affected upper limb with a 30-60 second rest interval between attempts, and the mean value in kilograms (kg) will be used for statistical analysis.	Baseline and 8 Weeks
Pain Intensity (Visual Analog Scale)	Pain intensity will be assessed using a 10-cm Visual Analog Scale (VAS) ranging from 0 ("no pain") to 10 ("worst imaginable pain") at rest and during resisted wrist flexion.	Baseline and 8 Weeks

Collaborators and Investigators

• Sponsor: Benha University

Study record dates

Study Major Dates

• Study Start (Actual): May 14, 2026
• Primary Completion (Estimated): November 15, 2026
• Study Completion (Estimated): December 15, 2026

Study Registration Dates

• First Submitted: May 3, 2026
• First Submitted That Met QC Criteria: May 8, 2026
• First Posted (Actual): May 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 18, 2026
• Last Update Submitted That Met QC Criteria: May 14, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: telerehabilitation; grip strength; Quick DASH; medial epicondylitis; Patient-Rated Elbow Evaluation
• Additional Relevant MeSH Terms: Elbow Injuries; Musculoskeletal Diseases; Muscular Diseases; Wounds and Injuries; Tendon Injuries; Arm Injuries; Tendinopathy; Elbow Tendinopathy
• Other Study ID Numbers: Telerehabilitation of ME 2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No