Article Text

Original research
Development of an optimised physiotherapist-led treatment protocol for lateral elbow tendinopathy: a consensus study using an online nominal group technique
  1. Marcus Bateman1,2,
  2. Benjamin Saunders2,
  3. Chris Littlewood3,
  4. Jonathan C Hill2
  1. 1Derby Shoulder Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
  2. 2School of Medicine, Keele University, Stoke-on-Trent, UK
  3. 3Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
  1. Correspondence to Mr Marcus Bateman; marcus.bateman{at}


Objectives There are a wide range of physiotherapy treatment options for people with lateral elbow tendinopathy (LET); however, previous studies have reported inconsistent approaches to treatment and a lack of evidence demonstrating clinical effectiveness. This study aimed to combine the best available research evidence with stakeholder perspectives to develop key components of an optimised physiotherapist-led treatment protocol for testing in a future randomised controlled trial (RCT).

Design Online consensus groups using nominal group technique (NGT), a systematic approach to building consensus using structured multistage meetings.

Setting UK National Health Service (NHS).

Participants 10 physiotherapists with special interest in LET, 2 physiotherapy service managers and 3 patients who had experienced LET.

Interventions Two consensus groups were conducted; the first meeting focused on agreeing the types of interventions to be included in the optimised treatment protocol; the second meeting focused on specific details of intervention delivery. Participants were sent an evidence summary of available treatments for LET prior to the first meeting. All treatment options were discussed before anonymous voting and ranking of priority. Consensus for inclusion of each treatment option was set at ≥70% based on OMERACT guidelines. Options with 30%–69% agreement were discussed again, and a second vote was held, allowing for a change of opinion.

Results The optimised physiotherapist-led treatment package included: advice and education, exercise therapy and orthotics. Specific components for each of these interventions were also agreed such as: condition-specific advice, health-promotion advice, exercise types, exercise into ‘acceptable’ levels of pain, exercise dosage and type of orthoses. Other treatment options including electrotherapy, acupuncture and manual therapy were excluded.

Conclusion An optimised physiotherapist-led treatment protocol for people with LET was successfully developed using an online NGT consensus approach. This intervention is now ready for testing in a future pilot/feasibility RCT to contribute much needed evidence about the treatment of LET.

Trial registration number This is the pre-cursor to the OPTimisE Pilot and Feasibility Randomised Controlled Trial. Registration:

  • elbow & shoulder
  • musculoskeletal disorders
  • primary care
  • sports medicine

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors All authors were involved in the design of the study and writing of this manuscript. MB and BS conducted the nominal group technique meetings. MB is guarantor.

  • Funding MB was funded by a National Institute for Health Research (NIHR) Chartered Society of Physiotherapy Charitable Trust Doctoral Fellowship for this research project (reference NIHR300704). This paper presents independent research funded by the NIHR and Chartered Society of Physiotherapy Charitable Trust. The views expressed are those of the author(s) and not necessarily those of Chartered Society of Physiotherapy Charitable Trust, the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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