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Measurement properties of core outcomes in patients with tennis elbow

Håkon Sveinall^1,2, Jens Ivar Brox^1,2, Kaia B Engebretsen¹

¹Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.

Shoulder & Elbow

|June 2, 2025

Abstract

Background:

The Patient-Rated Tennis Elbow Evaluation (PRTEE), pain on gripping, pain-free, and maximum grip strength are widely used outcomes for tennis elbow. This study tested the measurement properties with a prospective test-retest study design.

Methods:

100 participants with tennis elbow were included. The reliability, internal consistency, validity, responsiveness, and the Minimal Important Change (MIC) were evaluated.

Results:

The reliability of all measures was acceptable. 8/15 PRTEE items were below the criteria for content validity. For PRTEE total score (0-100), the smallest detectable change 95% (SDC_95%) was 17 points, and for the pain and function subscales (0-50) 8 and 12. For pain on gripping (0-10), the SDC_95% was 4, and 6.4 kg for pain-free grip strength and 8.4 kg for maximum grip strength. The MIC for PRTEE total score was 9 points, 11 for pain and 4 for function. The MIC was 3.5 for pain on gripping, and 6.5 kg and 1 kg for pain-free and maximum grip strength. Construct validity was confirmed for PRTEE, pain-free grip strength, and pain on gripping. PRTEE pain and pain-free grip strength were responsive.

Conclusion:

All measurements were reliable. PRTEE had questionable content validity. The interpretation of MIC is challenging due to large measurement errors.

Keywords:

Tennis elbow elbow tendinopathy hand strength minimal clinically important difference muscle strength dynamometer pain measurement patient reported outcome measures psychometrics reproducibility of results validation study

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