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Transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the TATE trial (ISRCTN 87141084)

BACKGROUND: Tennis elbow is a common and often extremely painful musculoskeletal condition, which has considerable impact on individuals as well as economic implications for healthcare utilization and absence from work. Many management strategies have been studied in clinical trials. Whilst corticos...

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Autores principales: Chesterton, Linda S, van der Windt, Daniëlle A, Sim, Julius, Lewis, Martyn, Mallen, Christian D, Mason, Elizabeth E, Warlow, Catherine, Vohora, Kanchan, Hay, Elaine M
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797760/
https://www.ncbi.nlm.nih.gov/pubmed/20003341
http://dx.doi.org/10.1186/1471-2474-10-156
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author Chesterton, Linda S
van der Windt, Daniëlle A
Sim, Julius
Lewis, Martyn
Mallen, Christian D
Mason, Elizabeth E
Warlow, Catherine
Vohora, Kanchan
Hay, Elaine M
author_facet Chesterton, Linda S
van der Windt, Daniëlle A
Sim, Julius
Lewis, Martyn
Mallen, Christian D
Mason, Elizabeth E
Warlow, Catherine
Vohora, Kanchan
Hay, Elaine M
author_sort Chesterton, Linda S
collection PubMed
description BACKGROUND: Tennis elbow is a common and often extremely painful musculoskeletal condition, which has considerable impact on individuals as well as economic implications for healthcare utilization and absence from work. Many management strategies have been studied in clinical trials. Whilst corticosteroid injections offer short term pain relief, this treatment is unpleasant and is used with caution due to an associated high risk of pain recurrence in the long term. Systematic reviews conclude that there is no clear and effective treatment for symptoms of pain in the first 6 weeks of the condition. There is a clear need for an intervention that is acceptable to patients and provides them with effective short-term pain relief without increasing the risk of recurrence. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, non-invasive, non-pharmacological form of analgesia that is commonly used in the treatment of pain. TENS has very few contraindications and is simple to apply. It also benefits from being patient controlled, thereby promoting self-management. This study aims to assess the effectiveness, in terms of pain relief, and cost-effectiveness of a self-management package of treatment that includes TENS. METHODS/DESIGN: The design of the study will be a two-group pragmatic randomized clinical trial. 240 participants aged 18 years and over with tennis elbow will be recruited from 20-30 GP practices in Staffordshire, UK. Participants are to be randomized on a 1:1 basis to receive either primary care management (standard GP consultation, medication, advice and education) or primary care management with the addition of TENS, over 6 weeks. Our primary outcome measure is average intensity of elbow pain in the past 24 hours (0-10 point numerical rating scale) at 6 weeks. Secondary outcomes include pain and limitation of function, global assessment of change, days of sick leave, illness perceptions, and overall health status. A cost-effectiveness analysis will also be performed. Patient adherence and satisfaction data will be collected at 6 weeks, 6 months and 12 months by postal questionnaire. A diary will also be completed for the first 2 weeks of treatment. Clinical effectiveness and cost-effectiveness analyses will be carried out using an intention-to-treat approach as the primary analysis. DISCUSSION: This paper presents detail on the rationale, design, methods and operational aspects of the trial. TRIAL REGISTRATION: Current Controlled Trials. ISRCTN87141084
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spelling pubmed-27977602009-12-25 Transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the TATE trial (ISRCTN 87141084) Chesterton, Linda S van der Windt, Daniëlle A Sim, Julius Lewis, Martyn Mallen, Christian D Mason, Elizabeth E Warlow, Catherine Vohora, Kanchan Hay, Elaine M BMC Musculoskelet Disord Study protocol BACKGROUND: Tennis elbow is a common and often extremely painful musculoskeletal condition, which has considerable impact on individuals as well as economic implications for healthcare utilization and absence from work. Many management strategies have been studied in clinical trials. Whilst corticosteroid injections offer short term pain relief, this treatment is unpleasant and is used with caution due to an associated high risk of pain recurrence in the long term. Systematic reviews conclude that there is no clear and effective treatment for symptoms of pain in the first 6 weeks of the condition. There is a clear need for an intervention that is acceptable to patients and provides them with effective short-term pain relief without increasing the risk of recurrence. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, non-invasive, non-pharmacological form of analgesia that is commonly used in the treatment of pain. TENS has very few contraindications and is simple to apply. It also benefits from being patient controlled, thereby promoting self-management. This study aims to assess the effectiveness, in terms of pain relief, and cost-effectiveness of a self-management package of treatment that includes TENS. METHODS/DESIGN: The design of the study will be a two-group pragmatic randomized clinical trial. 240 participants aged 18 years and over with tennis elbow will be recruited from 20-30 GP practices in Staffordshire, UK. Participants are to be randomized on a 1:1 basis to receive either primary care management (standard GP consultation, medication, advice and education) or primary care management with the addition of TENS, over 6 weeks. Our primary outcome measure is average intensity of elbow pain in the past 24 hours (0-10 point numerical rating scale) at 6 weeks. Secondary outcomes include pain and limitation of function, global assessment of change, days of sick leave, illness perceptions, and overall health status. A cost-effectiveness analysis will also be performed. Patient adherence and satisfaction data will be collected at 6 weeks, 6 months and 12 months by postal questionnaire. A diary will also be completed for the first 2 weeks of treatment. Clinical effectiveness and cost-effectiveness analyses will be carried out using an intention-to-treat approach as the primary analysis. DISCUSSION: This paper presents detail on the rationale, design, methods and operational aspects of the trial. TRIAL REGISTRATION: Current Controlled Trials. ISRCTN87141084 BioMed Central 2009-12-11 /pmc/articles/PMC2797760/ /pubmed/20003341 http://dx.doi.org/10.1186/1471-2474-10-156 Text en Copyright ©2009 Chesterton et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Study protocol
Chesterton, Linda S
van der Windt, Daniëlle A
Sim, Julius
Lewis, Martyn
Mallen, Christian D
Mason, Elizabeth E
Warlow, Catherine
Vohora, Kanchan
Hay, Elaine M
Transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the TATE trial (ISRCTN 87141084)
title Transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the TATE trial (ISRCTN 87141084)
title_full Transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the TATE trial (ISRCTN 87141084)
title_fullStr Transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the TATE trial (ISRCTN 87141084)
title_full_unstemmed Transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the TATE trial (ISRCTN 87141084)
title_short Transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the TATE trial (ISRCTN 87141084)
title_sort transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the tate trial (isrctn 87141084)
topic Study protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797760/
https://www.ncbi.nlm.nih.gov/pubmed/20003341
http://dx.doi.org/10.1186/1471-2474-10-156
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