Quality measures for the care of patients with lateral epicondylalgia

Francisco Minaya-Muñoz, Francesc Medina-Mirapeix, Fermin Valera-Garrido, Francisco Minaya-Muñoz, Francesc Medina-Mirapeix, Fermin Valera-Garrido

Abstract

Background: Lateral epicondylalgia (LE) defines a condition of varying degrees of pain near the lateral epicondyle. Studies on the management of LE indicated unexplained variations in the use of pharmacologic, non-pharmacological and surgical treatments. The main aim of this paper was to develop and evaluate clinical quality measures (QMs) or quality indicators, which may be used to assess the quality of the processes of examination, education and treatment of patients with LE.

Methods: Different QMs were developed by a multidisciplinary group of experts in Quality Management of Health Services during a period of one year. The process was based following a 3-step model: i) review and proportion of existing evidence-based recommendations; ii) review and development of quality measures; iii) pilot testing of feasibility and reliability of the indicators leading to a final consensus by the whole panel.

Results: Overall, a set of 12 potential indicators related to medical and physical therapy assessment and treatment were developed to measure the performance of LE care. Different systematic reviews and randomized control trials supported each of the indicators judged to be valid during the expert panel process. Application of the new indicator set was found to be feasible; only the measurement of two quality measures had light barriers. Reliability was mostly excellent (Kappa > 0.8).

Conclusions: A set of good practice indicators has been built and pilot tested as feasible and reliable. The chosen 3-step standardized evidence-based process ensures maximum clarity, acceptance and sustainability of the developed indicators.

Figures

Figure 1
Figure 1
Diagram of the 3-step process developed to define the quality measures.
Figure 2
Figure 2
Exemplary presentation of standardized report for an evidence-based quality measure.

References

    1. Scher DL, Wolf JM. Lateral epicondylitis. Orthopedics. 2009;32(4):276–282. doi: 10.3928/01477447-20090401-06.
    1. Fedorczyk JM. Tennis elbow: blending basic science with clinical practice. J Hand Ther. 2006;19(2):146–53.6. doi: 10.1197/j.jht.2006.02.016.
    1. Bales CP, Placzek JD, Malone KJ. et al.Microvascular supply of the lateral epicondyle and common extensor origin. J Shoulder Elbow Surg. 2007;16:497–501. 3. doi: 10.1016/j.jse.2006.08.006.
    1. Faro F, Wolf JM. Lateral epicondylitis: review and current concepts. J Hand Surg [Am] 2007;32:1271–1279. doi: 10.1016/j.jhsa.2007.07.019.
    1. Fedorczyk JM. Tendinopathies of the elbow, wrist, and hand: histopathology and clinical considerations. J Hand Ther. 2012;25(2):191–200. doi: 10.1016/j.jht.2011.12.001.
    1. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Occupation and epicondylitis: a population-based study. Rheumatology (Oxford) 2012;51(2):305–310. doi: 10.1093/rheumatology/ker228.
    1. Coombes BK, Bisset L, Vicenzino B. A new integrative model of lateral epicondylalgia. Br J Sports Med. 2009;43:252–258. doi: 10.1136/bjsm.2008.052738.
    1. Lo MY, Safran MR. Surgical treatment of lateral epicondylitis: a systematic review. Clin Orthop Relat Res. 2007;463:98–106.
    1. Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012;4(5):384–393. doi: 10.1177/1941738112454651.
    1. Lohr K. In: Medicare: a strategy for quality assurance. Vol. 1. Medicare, editor. Washington, DC: National Academy Press; 1990. Committee to design a strategy for quality review and assurance.
    1. Department of Health and Human Services. National Quality Measures Clearinghouse™ (NQMC) [Internet]. U.S. 2011.
    1. Jamtvedt G, Young JM, Kristoffersen DT, Thomson O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006. p. CD000259.
    1. Mainz J. Defining and classifying clinical indicators for quality improvement. Int J Qual Health Care. 2003;15(6):523–530. doi: 10.1093/intqhc/mzg081.
    1. Mainz J. Developing evidence-based clinical indicators: a state of the art methods primer. Int J Qual Health Care. 2003;15(Suppl 1):i5–i11.
    1. Scottish Intercollegiate Guidelines Network (SIGN) [Internet] Healthcare Improvement Scotland [cited 2011 Jul 24] Available from:
    1. Ministry of Health NZ. New Zealand Guidelines Group (NZGG) [Internet] 2011. .
    1. NICE. National Institute for Health and Clinical Excellence. 2011.
    1. Ministerio de Sanidad, Servicios Sociales e Igualdad. Biblioteca de Guías de Práctica Clínica de Sistema Nacional de Salud. 2011. .
    1. Andrews J, Guyatt G, Oxman AD, Alderson P, Dahm P, Falck-Ytter Y. et al.GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol. 2013;66(7):719–725. doi: 10.1016/j.jclinepi.2012.03.013.
    1. Lemeshow S, Hosmer DW, Klar J, Lwanga SK. Adequacy of sampling size in health studies. Willshire: WHO/John Wiley & Sons; 1992. Lot quality assurance sampling.
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174. doi: 10.2307/2529310.
    1. Kotnis NA, Chiavaras MM, Harish S. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol. 2012;41(4):369–386. doi: 10.1007/s00256-011-1343-8.
    1. Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med. 2011;39(10):2130–2134. doi: 10.1177/0363546511417113.
    1. Waseem M, Nuhmani S, Ram CS, Sachin Y. Lateral epicondylitis: a review of the literature. J Back Musculoskelet Rehabil. 2012;25(2):131–142.
    1. Söderberg J, Grooten WJ, Ang BO. Effects of eccentric training on hand strength in subjects with lateral epicondylalgia: a randomized-controlled trial. Scand J Med Sci Sports. 2012;22(6):797–803. doi: 10.1111/j.1600-0838.2011.01317.x.
    1. Aguilera Eguia RA. Terapia manual en epicondialgia lateral (revisión sistemática) Rev Soc Esp Dolor. 2009;16(2):112–115. doi: 10.1016/S1134-8046(09)70918-8.
    1. Herquelot E, Bodin J, Roquelaure Y, Ha C, Leclerc A, Goldberg M, Zins M, Descatha A. Work-related risk factors for lateral epicondylitis and other cause of elbow pain in the working population. Am J Ind Med. 2013;56(4):400–409. doi: 10.1002/ajim.22140.
    1. Van Rijn RM, Huisstede BM, Koes BW, Burdorf A. Associations between work-related factors and specific disorders at the elbow: a systematic literature review. Rheumatology (Oxford) 2009;48(5):528–36.
    1. Haahr J, Andersen J. Prognostic factors in lateral epicondylitis: a randomized trial with one-year follow-up in 266 new cases treated with minimal occupation intervention or the usual approach in general practice. Rheumatology. 2003;42:1216–1225. doi: 10.1093/rheumatology/keg360.
    1. Nilsson P, Baigi A, Swärd L, Möller M, Månsson J. Lateral epicondylalgia: a structured programme better than corticosteroids and NSAID. Scand J Occup Ther. 2012;19(5):404–410. doi: 10.3109/11038128.2011.620983.
    1. Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2002;2 CD003686.
    1. Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466(7):1539–1554. doi: 10.1007/s11999-008-0260-1.
    1. Ofman JJ, MacLean CH, Straus WL. et al.A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs. J Rheumatol. 2002;29:804–812.
    1. Richy F, Bruyere O, Ethgen O. et al.Time dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use: a consensus statement using a meta-analytic approach. Ann Rheum Dis. 2004;63:759–766. doi: 10.1136/ard.2003.015925.
    1. Hooper L, Brown TJ, Elliott R. et al.The effectiveness of five strategies for the prevention of gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs: systematic review. BMJ. 2004;329(7472):948. doi: 10.1136/bmj.38232.680567.EB.
    1. Raman J, MacDermid J, Grewal R. Effectiveness of different methods of resistance exercises in lateral epicondylosis. a systematic review. J Hand Ther. 2012;25(1):5–25. doi: 10.1016/j.jht.2011.09.001.
    1. Rees JD, Wolman RL, Wilson A. Eccentric exercises; why do they work, what are the problems and how can we improve them? Br J Sports Med. 2009;43(4):242–246. doi: 10.1136/bjsm.2008.052910.
    1. Bisset L, Coombes B, Vicenzino B. Tennis elbow. Clin Evid (online) 2011. 2011;27:1117.
    1. Vicenzino B, Paungmali A, Buratowski S, Wright A. Specific manipulative therapy treatment for chronic lateral epicondilalgia producer uniquely characteristic hypoalgesia. Man Ther. 2001;6:203–212.
    1. Tumilty S, Munn J, McDonough S, Hurley D, Basford J, Baxter D. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomed Laser Surg. 2010;28(1):3–16. doi: 10.1089/pho.2008.2470.
    1. Gaujoux-Viala C, Dougados M, Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomized controlled trials. Ann Rheum Dis. 2009;68:1843–1849. doi: 10.1136/ard.2008.099572.
    1. Hart L. Corticosteroid and other injections in the management of tendinopathies: a review. Clin J Sport Med. 2011;21(6):540–541. doi: 10.1097/01.jsm.0000407929.35973.b9.
    1. Coombes BK, Bisset L, Connelly LB, Brooks P, Vicenzino B. Optimising corticosteroid injection for lateral epicondylalgia with the addition of physiotherapy: a protocol for a randomised control trial with placebo comparison. BMC Musculoskelet Disord. 2009;10:76. doi: 10.1186/1471-2474-10-76.
    1. Rabago D, Best TM, Zgierska AE, Zeisig E, Ryan M, Crane D. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. Br J Sports Med. 2009;43(7):471–481. doi: 10.1136/bjsm.2008.052761.
    1. Prieto-Lucena J, González-Carmona O, Pons-Sarazibar Y, Vázquez-Sousa C, Bravo-Paniagua M, Pastor-Mañosa C. Infiltraciones de sangre autóloga y plasma enriquecido en plaquetas en el tratamiento de la epicondilitis. Una revisión sistemática. Rehabilitación. 2012;46(2):157–163.
    1. Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, Bliddal H, Christensen R. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2012;41(6):1435–1446.
    1. Buchbinder R, Johnston RV, Barnsley L, Assendelft WJ, Bell SN, Smidt N. Surgery for lateral elbow pain. Cochrane Database Syst Rev. 2011;3 CD003525.
    1. Orchard J, Kountouris A. The management of tennis elbow. BMJ. 2011;10:342.
    1. Behrens SB, Deren ME, Matson AP, Bruce B, Green A. A review of modern management of lateral epicondylitis. Phys Sportsmed. 2012;40(2):34–40. doi: 10.3810/psm.2012.05.1963.
    1. Pencharz JN, MacLean CH. Measuring quality in arthritis care: the arthritis foundation’s quality indicator set for osteoarthritis. Arthritis Rheum. 2004;51:538–548. doi: 10.1002/art.20521.
    1. Heuschmann PU, Biegler MK, Busse O, Elsner S, Grau A, Hasenbein U. et al.Development and implementation of evidence-based indicators for measuring quality of acute stroke care: the Quality Indicator Board of the German Stroke Registers Study Group (ADSR) Stroke. 2006;37(10):2573–2578. doi: 10.1161/01.STR.0000241086.92084.c0.
    1. Fung CS, Chin WY, Dai DS, Kwok RL, Tsui EL, Wan YF. et al.Evaluation of the quality of care of a multi-disciplinary risk factor assessment and management programme (RAMP) for diabetic patients. BMC Fam Pract. 2012;13(1):116. doi: 10.1186/1471-2296-13-116.
    1. Sorensen LP, Krog BR, Kongsted A, Bronfort G, Hartvigsen J. Development of disease-specific quality indicators for Danish chiropractic patients with low back pain. J Manipulative Physiol Ther. 2011;34(4):204–210. doi: 10.1016/j.jmpt.2011.04.005.
    1. Rosenfeld RM, Shiffman RN, Robertson P. Clinical practice guideline development manual, third edition: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg. 2013;148(1 Suppl):S1–S55. doi: 10.1177/0194599812467004.
    1. Kötter T, Blozik E, Scherer M. Methods for the guideline-based development of quality indicators–a systematic review. Implement Sci. 2012;7:21. doi: 10.1186/1748-5908-7-21.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir