Cross-cultural adaptation of the patient-rated tennis elbow evaluation to Canadian French

Lateral Elbow Pain and Muscle Function Impairments

Although often described as a self-limiting condition and likely to resolve on its own, high recurrence rates and extended sick leave frame a need for effective non-surgical treatment for people with lateral elbow tendinopathy. The interrelationship of histological and structural changes to the tendon, the associated impairments in motor control, and potential changes in pain processing may all drive symptoms. This clinical practice guideline covers the epidemiology, functional anatomy and pathophysiology, risk factors, clinical course, prognosis, differential diagnosis, tests and measures, and interventions for managing lateral elbow tendinopathy in the physical therapy clinic. J Orthop Sports Phys Ther 2022;52(12):CPG1-CPG111. doi:10.2519/jospt.2022.0302.

Psychometric properties and cross-cultural adaptation of the Patient-Rated Tennis Elbow Evaluation (PRTEE); a systematic review and meta-analysis

PURPOSE

To synthesize and appraise the evidence on the translation, cross-cultural adaptation, and psychometric properties of the Patient-Rated Tennis Elbow Evaluation (PRTEE).

METHOD

Five electronic databases were searched from 1999 to 2021. Two independent reviewers assessed the risk of bias and quality of the included studies using the COSMIN recommended guidelines. The overall quality of the evidence on each psychometric property was provided using the GRADE approach.

RESULTS

Twenty-one studies met the criteria for inclusion in this review. The PRTEE was translated and cross-culturally adapted to 13 languages and cultures. High quality of evidence supports sufficient pooled results for test-retest reliability (0.96(CI: 0.94-0.97)), construct validity (against Disabilities of the Arm, Shoulder, and Hand (DASH): 0.81(CI: 0.76-0.85), against Visual Analogue Scale (VAS): 0.70 (0.62-0.74)), and responsiveness of the PRTEE. The overall rating of the structural validity and internal consistency (0.96(CI: 0.94-0.97)) was indeterminate, and the quality of evidence was low and moderate, respectively. Regarding measurement error, the overall rating of the summarized results (Standard error of measurement (SEM): 3.1 (1.8 to 4.4) and Minimal Detectable Change (MDC₉₅): 8.9 (5.3-12.5)) was sufficient, and the quality of evidence was moderate.

CONCLUSION

Moderate to high quality evidence supports adequate psychometric properties of the PRTEE in terms of internal consistency, test-retest reliability, measurement error, hypothesis testing for construct validity, and responsiveness.Implications for RehabilitationThe PRTEE can measure the construct of pain and disability at a single time-point and detect changes over time precisely.The PRTEE can be used in clinical setting for patients with acute, subacute, and chronic Lateral Elbow Tendinopathy (LET), athletes who suffer from elbow pain and tennis players.

Adaptation and transcultural translation into Spanish of the Patient-Rated Tennis Elbow Evaluation Questionnaire

The purpose of this study was to perform the translation and cross-cultural adaptation of the Patient-Rated Tennis Elbow Evaluation Questionnaire to Spanish language and evaluate its reliability and validity. The translation and cultural adaptation into Spanish was done in accordance with the published guidelines. One-hundred fifty Spanish-speaking patients with unilateral chronic lateral epicondylalgia competed the questionnaire. Test-retest reliability was established by the intraclass correlation coefficient. Internal consistency was established with Cronbach's α. To establish convergent validity, we used the Disabilities of the Arm, Shoulder, and Hand Questionnaire using the Spearman's correlation coefficient. Error estimation in the measurements was calculated with the standard error of measurement. Our results showed a high internal consistency (Cronbach's α = .96) and high test-retest reliability (intraclass coefficient = .9; .89-.94; P < .001). The Spearman's correlation coefficient (r = .765; P < .001) showed a good relationship between the Spanish version of the Patient-Rated Tennis Elbow Evaluation Questionnaire and the Disabilities of the Arm, Shoulder, and Hand Questionnaire. The standard error of measurement (11.9%) showed little variability of measurements. In conclusion, the Spanish version of the Patient-Rated Tennis Elbow Evaluation Questionnaire is a valid and reliable tool that can be used to assess lateral epicondylalgia in Spanish-speaking individuals in order to implement the best treatment and reduce time with pain and disability.

Patient-Rated Tennis Elbow Evaluation (PRTEE)

BACKGROUND

The Patient-Rated Tennis Elbow Evaluation questionnaire (PRTEE) is a specific questionnaire available for assessing the health status of patients with lateral epicondylitis. An official German translation does not yet exist.

OBJECTIVES

The aim of this study was to translate and cross-culturally adapt the English version of the PRTEE into German.

MATERIAL AND METHODS

The translation and cross-cultural adaptation was completed by an expert committee comprising people of varying professional and linguistic backgrounds. According to international guidelines, the English original was first translated into German, then back-translated and the final version was pre-tested on patients.

RESULTS

No major difficulties were encountered during the translation process and smaller linguistic discrepancies could be resolved in the expert committee. For the pre-validation testing, 11 patients with extensor repair due to persistent lateral epicondylitis were included. They rated the questionnaire as easy to understand and complete. The final version was approved by the developers of the original questionnaire as the official German translation.

CONCLUSIONS

Although the measurement properties of the German version were not evaluated in this study, the original shows good reliability, validity and responsiveness. In summary, the PRTEE is a questionnaire quick and easy to complete for patients with lateral epicondylitis. Therefore, it is suitable for the clinical routine assessment of subjective health status or the outcome after an intervention.

Cross-cultural adaptation and measurement properties of the Patient-Rated Tennis Elbow Evaluation for the Persian language

Introduction

The Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire is a tool designed for self-assessment of forearm pain and disability in patients with tennis elbow. The aims of this study were to translate and cross-culturally adapt the PRTEE questionnaire into Persian and evaluate its reliability and construct validity.

Methods

The PRTEE questionnaire was translated into and cross-culturally adapted to Persian in 90 consecutive patients with tennis elbow, according to well-established guidelines. Reliability was tested by means of test–retest and internal consistency. The measurement error was measured by calculating the standard error of measurement. Based on the standard error of measurement, the minimum detectable change was calculated. To evaluate construct and convergent validity, correlation with the PRTEE with the Disabilities of the Arm, Shoulder and Hand questionnaire and Visual analogue scale was used.

Results

In the process of cross-cultural adaptation, two items (6 and 8) were modified. In item 6, the term “door knob” was changed to “turn a key”, and in the item 8, “cup of coffee” was changed to “cup of milk”. Item-total correlations were greater than 0.55 (ranged from 0.55 to 0.76), internal consistency was high (Cronbach’s alpha, 0.94) and a high intraclass correlation coefficient (0.98) indicated excellent reliability of the P-PRTEE. The standard error of measurement and minimum detectable change were 5.40 and 14.24, respectively. The Persian version of the PRTEE questionnaire (P-PRTEE) shows strong construct and convergent validity ( r values = 0.85, p < 0.05).

Conclusions

The P-PRTEE is valid and reliable in assessing disability and pain in Persian patients with tennis elbow. The excellent psychometric properties of the P-PRTEE endorse the use of this questionnaire in clinical settings.

Reliability and validity of Chinese version of a tool to assess the quality of life in idiopathic pulmonary fibrosis in patients with interstitial lung disease

OBJECTIVE

This paper aims to determine the reliability and validity of the Chinese version of a tool that assesses the quality of life in idiopathic pulmonary fibrosis (cATAQ-IPF) in patients with interstitial lung disease (ILD).

METHODS

We used the process of scale introduction to establish cATAQ-IPF. The content validity of the scale was evaluated by six experts. A total of 92 patients with ILD completed the cATAQ-IPF, St. George's respiratory questionnaire (SGRQ), and The Medical Research Council dyspnoea scale at the baseline, and 15 patients completed cATAQ-IPF at the follow-up period 2 weeks later. Thus, yielding data were used to assess various psychometric properties of cATAQ-IPF. Intraclass correlation coefficient (ICC), Cronbach's α coefficient, content validity index (CVI), item-level CVI (I-CVI), Pearson's coefficients, criterion-relation validity, and known-group validity were used for data analysis.

RESULTS

The cATAQ-IPF showed excellent test-retest reliability (ICC = 0.95), except for the therapy domain (Cronbach's α = 0.60) and acceptable internal consistency (Cronbach's α = 0.96 for the total). The scale-level CVI was 0.80, and the I-CVI was in the range of 0.78-1.00. The total cATAQ-IPF score was strongly correlated with the SGRQ total score (r = 0.71, P < 0.01). The cATAQ-IPF score of patients with ILD was 250.74 ± 47.39, and that of patients with IPF was 287.90 ± 22.56. Patients with IPF possessed considerable impairments in health-related quality of life according to the cATAQ-IPF score (t = 4.94, P < 0.01).

CONCLUSIONS

The cATAQ-IPF is a reliable and valid instrument for the evaluation of quality of life of Chinese patients with various forms of ILD.

Reliability and validity of the Chinese CECA10 questionnaire for Chinese patients with condyloma acuminata

Condyloma acuminata (CA) is a sexually transmitted disease that affects quality of life (QOL). CECA10 is an English-language questionnaire for assessing QOL in patients with CA, but there is no equivalent in China. This study aimed to develop a validated and reliable Chinese version of CECA10.The Chinese CECA10 was developed from the English version by forward translation, back translation, comparison with the original, cultural adjustments, and a pre-test (5 patients). The Chinese CECA10 and EuroQol Five Dimensions Three Level Questionnaire (EQ-5D-3L) was administered to patients with CA. Content validity (item/scale content validity indexes, I-CVI/S-CVI), test-retest reliability (intraclass coefficient, ICC), internal consistency (Cronbach α), criterion validity (comparison with the Dermatology Life Quality Index, DLQL, using Spearman correlation analysis), construct validity (exploratory factor analysis), and discriminant validity (between subgroups based on number of warts, number of recurrences, or number of sites involved) were assessed.The Chinese CECA10 had good test-retest reliability (ICC = 0.98, P < .001), internal consistency (Cronbach α values of 0.88, 0.84, and 0.83 for the total questionnaire, psychological dimension, and sexual dimension, respectively), content validity (I-CVI = 1 for all items), and criterion validity (r = -0.50, P < .001). Exploratory factor analysis extracted 2 factors with a cumulative contribution of 61.75%; the factor loading with each item was >0.4. Discriminant validity was not high. The mean CECA10 and EQ-VAS scores of 211 patients with CA (28.19 ± 7.16 years; 139 males) were 34.56 ± 19.01 and 64.64 ± 19.28, respectively.The Chinese CECA10 has good reliability and validity for evaluating the QOL of Chinese patients with CA.

Cross-cultural adaptation and validation of the Patient-Rated Tennis Elbow Evaluation Questionnaire on lateral elbow tendinopathy for French-speaking patients

STUDY DESIGN

Translation and validation of algo-functional questionnaire.

INTRODUCTION

The lateral elbow tendinopathy is a common injury in tennis players and physical workers. The Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire was specifically designed to measure pain and functional limitations in patients with lateral epicondylitis (tennis elbow). First developed in English, this questionnaire has since been translated into several languages.

PURPOSE OF THE STUDY

The aims of the study were to translate and cross-culturally adapt the PRTEE questionnaire into French and to evaluate the reliability and validity of this translated version of the questionnaire (PRTEE-F).

METHODS

The PRTEE was translated and cross-culturally adapted into French according to international guidelines. To assess the reliability and validity of the PRTEE-F, 115 participants were asked twice to fill in the PRTEE-F, and once the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and the Short Form Health Survey (SF-36). Internal consistency (using Cronbach's alpha), test-retest reliability (using intraclass correlation coefficient (ICC), standard error of measurement and minimal detectable change), and convergent and divergent validity (using the Spearman's correlation coefficients respectively with the DASH and with some subscales of the SF-36) were assessed.

RESULTS

The PRTEE was translated into French without any problems. PRTEE-F showed a good test-retest reliability for the overall score (ICC 0.86) and for each item (ICC 0.8-0.96) and a high internal consistency (Cronbach's alpha = 0.98). The correlation analyses revealed high correlation coefficients between PRTEE-F and DASH (convergent validity) and, as expected, a low or moderate correlation with the divergent subscales of the SF-36 (discriminant validity). There was no floor or ceiling effect.

DISCUSSION AND CONCLUSIONS

The PRTEE questionnaire was successfully cross-culturally adapted into French. The PRTEE-F is reliable and valid for evaluating French-speaking patients with lateral elbow tendinopathy.

Management of Chronic Lateral Epicondylitis With Manual Therapy and Local Cryostimulation: A Pilot Study

Objective

The purpose of this pilot study was to evaluate the feasibility and efficacy of adding cryostimulation to manual therapy in patients with chronic lateral epicondylitis.

Methods

The control group (n = 19) was treated with manual therapy consisting of soft-tissue therapy and radial head mobilizations. The experimental group (n = 18) received cryostimulation in addition to manual therapy care similar to that for the control group. Both protocols consisted of 8 treatments over a 4-week period. Outcome measures included pain intensity (visual analog scale), pain-free grip strength (handheld dynamometer), and functional index (Patient-Rated Tennis Elbow Evaluation questionnaire). Assessments were performed at baseline, postintervention, and 3-month follow-up. Adherence and dropout rates were also considered.

Results

Both groups exhibited significant improvements in pain intensity and functional index at postintervention assessments, which were maintained at follow-up. All participants attended the prescribed number of treatments, but 27% were lost at follow-up. Minor adverse events were reported after cryostimulation in 4 cases.

Conclusions

This study indicated that it is feasible to complete a clinical trial evaluating the efficacy of adding cryostimulation to manual therapy in patients with chronic lateral epicondylitis. On the basis of these preliminary data, the combination of cryostimulation and manual therapy care did not provide any additional benefits in both the short term and the long term. Manual myofascial point treatment and mobilization techniques yielded positive outcomes in chronic lateral epicondylitis. Further studies should focus on the sole therapeutic effect of cryostimulation in both patients with acute and those with chronic conditions.

Evaluation of the reliability and validity of the Persian version of Patient-Rated Elbow Evaluation questionnaire

Elbow joint pathologies are highly prevalent in Persian-speaking countries. A reliable low-cost method like an appropriate questionnaire is mandatory for the early diagnosis of elbow joint disorders. Among designed questionnaires, Patient-Rated Elbow Evaluation (PREE) is an accepted commonly used scale evaluating pain and dysfunction of the patients. The aims of the study were to cross-culturally adapt and also to identify the psychometric properties of the Persian PREE. The original version of the PREE was translated and cross-culturally adapted to Persian according to the guidelines by Beaton et al. Seventy-three patients and thirty-nine healthy people were enrolled in the study. Test-retest reliability and internal consistency were evaluated using ICC, Cronbach's alpha, and item-total correlation, respectively. Construct validity was investigated using Disability of Arm, Shoulder, and Hand (DASH) questionnaire and physical component scale of SF-36 (PCS). To determine a cutoff point for discriminating patients from non-patients, receiver operating characteristic curve was plotted. The Persian PREE displayed high internal consistency (Cronbach's alpha = 0.91) and had acceptable ICC values in the subscales and total score (ICC > 0.90). A positive moderate correlation with DASH (r = 0.66, P < 0.001) and a negative moderate correlation with PCS of SF-36 (r = -0.44, P < 0.001) were observed. The cutoff point equal to 13.16 was determined for Persian PREE. The Persian PREE exhibited promising validity and reliability. The findings supported its applicability in clinical situations that were consistent with the original version.

Outcome Evaluation in Tendinopathy: Foundations of Assessment and a Summary of Selected Measures

Synopsis Clinical measurement studies that address outcome evaluation for patients with tendinopathy should consider conceptual, clinical, practical, and measurement issues to guide the selection of valid measures. Clinical outcomes reported in research studies can provide benchmarks that assist with interpretation of scores during clinical decision making. Given the pathophysiology and functional impacts of tendinopathy, there is a need for outcome measures that assess physical impairments, activity performance, and patient-reported symptoms and function. Tendinopathy-specific patient-reported outcome measures have been shown to be superior to more generic tools for some conditions, such as lateral epicondyle tendinopathy (Patient-Rated Tennis Elbow Evaluation) and Achilles tendinopathy (Victorian Institute of Sport Assessment-Achilles), whereas both generic shoulder outcome measures and disease-specific measures perform similarly in individuals with rotator cuff tendinopathy. A patient-reported outcome measure that captures pain and limitation in function should be fundamental to outcome evaluation in patients with tendinopathy. The current measurement literature does not yet provide comprehensive empirical data to define optimal outcome measures for all types of tendinopathy. This article reviews concepts, instruments, and measurement properties that should provide clinicians with a foundation for assessment of condition severity and treatment outcomes in patients with tendinopathy. J Orthop Sports Phys Ther 2015;45(11):950-964. Epub 15 Oct 2015. doi:10.2519/jospt.2015.6054.

Translation and validation of the PREE (Patient Rated Elbow Evaluation) to a French version

BACKGROUND

Only a few outcome measures specific to elbow pathology and the assessment of their impacts on function are valid and reliable when used in French speaking populations. The English version of the Patient Rated Elbow Evaluation (PREE) was determined to be an optimal candidate for translation.

HYPOTHESIS

A French version of the PREE (PREE-Fr) will be generated and compared to its original version in terms of reliability and responsiveness.

MATERIALS AND METHODS

The PREE was translated following the guidelines of the American Academy of Orthopedic Surgeons. Patients with a variety of elbow pathologies completed the French version of the PREE (PREE-Fr), the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Mayo Elbow Performance Score (MEPS) on three different occasions. The test-retest reliability of the PREE-Fr was calculated using questionnaires that were filled out with a one-week interval between them. The responsiveness was assessed using questionnaires filled out six months after treatment.

RESULTS

A French version of the PREE was generated. Data gathered from 54 patients yielded an intra-class correlation coefficient for reliability of 0.89 (CI95%: 0.79-0.94) for the PREE-Fr. For construct validity, using the Pearson correlation coefficient, we obtained excellent correlation between the PREE-Fr and QuickDASH at day one, one week and six months (0.89-0.96) while that between the PREE and MEPS was good to excellent (0.70-0.95). Responsiveness of the PREE-Fr was assessed and yielded a standardized response mean of 1.03, meaning that a large change was recorded between day one and six months.

DISCUSSION

The PREE-Fr should be considered in French speaking populations for patients with elbow pathology, whether it is for research or evaluation purposes as it is valid, reliable and responsive to change.

Cross-cultural adaptation and reliability and validity of the Dutch Patient-Rated Tennis Elbow Evaluation (PRTEE-D)

Background

Lateral Epicondylalgia (LE) is a common injury for which no reliable and valid measure exists to determine severity in the Dutch language. The Patient-Rated Tennis Elbow Evaluation (PRTEE) is the first questionnaire specifically designed for LE but in English. The aim of this study was to translate into Dutch and cross-culturally adapt the PRTEE and determine reliability and validity of the PRTEE-D (Dutch version).

Methods

The PRTEE was cross-culturally adapted according to international guidelines. Participants (n = 122) were asked to fill out the PRTEE-D twice with a one week interval to assess test-retest reliability. Internal consistency of the PRTEE-D was determined by calculating Crohnbach’s alphas for the questionnaire and subscales. Intraclass Correlation Coefficients (ICC) were calculated for the overall PRTEE-D score, pain and function subscale and individual questions to determine test-retest reliability. Additionally, the Disabilities for the Arm, Shoulder and Hand questionnaire (DASH) and Visual Analogue Scale (VAS) pain scores were obtained from 30 patients to assess construct validity; Spearman’s correlation coefficients were calculated between the PRTEE-D (subscales) and DASH and VAS-pain scores.

Results

The PRTEE was successfully cross-culturally adapted into Dutch (PRTEE-D). Crohnbach’s alpha for the first assessment of the PRTEE-D was 0.98; Crohnbach’s alpha was 0.93 for the pain subscale and 0.97 for the function subscale. ICC for the PRTEE-D was 0.98; subscales also showed excellent ICC values (pain scale 0.97 and function scale 0.97). A significant moderate correlation exists between PRTEE-D and DASH (0.65) and PRTEE-D and VAS pain (0.68).

Conclusion

The PRTEE was successfully cross-culturally adapted and this study showed that the PRTEE-D is reliable and valid to obtain an indication of severity of LE. An easy-to-use instrument for practitioners is now available and this facilitates comparing Dutch and international research data.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-270) contains supplementary material, which is available to authorized users.

Effectiveness of different methods of resistance exercises in lateral epicondylosis--a systematic review

STUDY DESIGN

Systematic Review.

INTRODUCTION

Lateral epicondylosis (LE) is relatively common with an annual incidence in the general population of 1% to 3%. Systematic reviews have identified exercise is effective, but have not established specific exercise parameters.

PURPOSE

The purpose of this systematic review was to synthesize the quality and content of clinical research addressing type and dosage of resistance exercises in lateral epicondylosis.

METHODS

Computerized bibliographic databases (1990-2010) were searched using relevant keywords; bibliographies of included papers were hand searched. Of 594 screened abstracts, 11 articles (12 studies) met inclusion criteria. Articles were randomly allocated to pairs of reviewers who independently verified data extraction and appraised the full text, using a structured critical appraisal tool with 24 items. Data extraction was limited by a lack of consistent reporting of elements of exercise dosage.

RESULTS

The mean quality rating of the studies was 72%, with 2 papers exceeding 75% quality. Of the 12 studies, 9 addressed the effects of isotonic (eccentric/concentric) exercises, 2 studied the effect of isometric and one studied isokinetic exercises. The exercise programs ranged over a period of 4 to 52 weeks. Exercises were prescribed 1 to 6 times per day, with an average duration of 15 minutes per session, and average of 15 repetitions (range: 3 to 50), with 1 to 4 sets per session.

CONCLUSION

All the studies reported that resistance exercise resulted in substantial improvement in pain and grip strength; eccentric exercise was most studied. Strengthening using resistance exercises is effective in reducing pain and improving function for lateral epicondylosis but optimal dosing is not defined.

LEVEL OF EVIDENCE

2a.