Patient-centred assessment of physical and psychological functioning in tennis elbow

Recently, patient-centered assessment tools have received much attention in health care because of the help they offer in understanding the impact of a condition on the patients’ health status and in developing treatment strategies. For the assessment of pain level and functional disability in Tennis Elbow (TE), a number of tools are available ranging from condition-specific measures, for example the Patient-Rated Forearm Evaluation Questionnaire (PRFEQ) (recently modified as the Patient-Rated Tennis Elbow Questionnaire), to generic measures, which are used to assess all types of elbow injuries. In addition, other assessment tools such as the Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation Questionnaire (PRWEQ) have been used to assess pain symptoms and functional disability of elbow injured patients including TE. Kinesiologic theory suggests that the upper limb operates as a single functional unit so that disorders specific to one joint may result in functional disability in other parts of the limb. Support for this comes from old and recent studies reporting associations between injuries of various joints with pathologic manifestations in other upper limb segments. ‘‘Shoulder-hand syndrome,’’ which has been known since 1969, is a clear example. Thus a combination of regional and also joint-specific function and pain assessment tools may provide a better evaluation of whole upper limb performance. Our first aim, therefore, was to assess pain and functional disability in TE patients against a group of healthy controls (C) by using both regional and joint-specific upper limb assessment tools. In addition, despite many recent reports of the role of psychological factors such as anxiety and depression in TE and other upper limb conditions, these factors are not addressed appropriately in upper limb tools. Furthermore, the importance of pain-related fear (pain anxiety), fear avoidance and subsequent pain catastrophizing has been highlighted by behavioral theorists, and so the insight that pain-related fear and anxiety may initiate and maintain functional disability in chronic pain patients is not new. Our second aim was therefore to address the importance of psychological assessment in TE patients. To do this, we used the Hospital Anxiety and Depression Scale (HADS) as a validated measurement of anxiety and depression, which has also been suggested to be useful in musculoskeletal settings.