Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Emilio Puentedura

Date of original Performance / Presentation

January 2025

Publication Date / Copyright Date

1-1-2025

Abstract

There is a lack of clear guidance to identify the optimal loading strategy for those with lateral elbow tendinopathy (LET) which is compounded by the absence of the application of pain experience measurement in the population. The investigator measured the pain experience within biomedical, psychosocial, and psychological domains in the pursuit of identifying subclassifications of the LET population. Through improved pain experience measurement methods and comprehensive measures within the biomedical, psychological, and psychosocial domains, it is the aim of this dissertation study to identify associations that could lead to evidence-based subclassification of those with LET to improve treatment outcomes based on the pain experience. Participants were recruited from outpatient clinics using convenience sampling, employing flyers, electronic records, social media, and emails for recruitment. Participants completed demographic questionnaires and patient-reported outcome measures, including pain intensity, functional ability, central sensitization, locus of control, catastrophizing, fear-avoidance, and anxiety/depression. Physical measures such as two-point discrimination, pressure pain threshold, grip strength, and laterality were also assessed. Results indicated a significant link between fear-avoidance and pain intensity, emphasizing psychological influences. Pain catastrophizing correlated with increased fear-avoidance. Central sensitization significantly impacted pain intensity and anxiety levels, with these factors predicting high central sensitization. However, no measures effectively predicted functional ability. These findings highlighted the necessity of a biopsychosocial approach in LET management, suggesting that targeted interventions addressing psychological and central sensitization factors were crucial for improved patient outcomes. This research sought to refine pain experience measurement and provide evidence-based subclassifications in a shared decision-making model.

Disciplines

Physical Therapy

Keywords

Biopsychosocial; Central Sensitization; Fear-avoidance; Pain; Patient-centered; Tennis Elbow

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