Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Kristian Thorborg, University of Copenhagen
- Second opponent: Consultant Physiotherapist PhD Marcus Bateman, University Hospitals of Derby
- Third member and chair of the evaluation committee: Professor II Nina Østerås, University of Oslo
Chair of the Defence
Professor Hilde Stendal Robinson, University of Oslo
Principal Supervisor
Marianne Bakke Johnsen, Oslo University Hospital
Summary
Tennis elbow, or lateral elbow tendinopathy, is a common musculoskeletal disorder causing pain and functional disability. Physiotherapy is considered first-line treatment and commonly includes interventions such as exercise and extracorporeal shock wave therapy, but both the optimal treatment strategy and the most appropriate outcome measures remain uncertain.
This thesis aimed (1) to cross culturally adapt the Norwegian version of the Patient Rated Tennis Elbow Evaluation (PRTEE) and evaluate measurement properties of the PRTEE and grip strength–related outcomes; (2) to assess the feasibility of a three armed randomised controlled trial comparing heavy slow resistance training, shock wave therapy and advice; and (3) to examine the role of patients’ expectations in predicting pain. A prospective test–retest study with 100 patients (follow up at one week and three months) and a single centre, three armed feasibility trial with 60 patients (follow up at three and six months) were conducted.
PRTEE showed limited content validity and substantial measurement error. Construct validity and responsiveness were acceptable for PRTEE, pain free grip strength and pain on gripping, but not for maximum grip strength. Pain free grip strength emerged as the most robust outcome. The feasibility trial demonstrated good eligibility, randomisation and three month retention, but recruitment was below target, six month retention was suboptimal, and adherence to heavy slow resistance training was low, whereas shock wave therapy was well accepted. Expectations after the first treatment session, but not baseline expectations, predicted three month pain.
Overall, the findings challenge current core outcome recommendations, support pain free grip strength as a key outcome in future trials, and highlight the need for sham controlled, blinded designs that account for patient expectations when evaluating treatments for lateral elbow tendinopathy.
Additional information
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