Open Access Highly Accessed Research article

Quality measures for the care of patients with lateral epicondylalgia

Francisco Minaya-Muñoz123*, Francesc Medina-Mirapeix4 and Fermin Valera-Garrido123

Author Affiliations

1 MVClinic. Juan Antonio Samaranch Torelló St., 6B. Fitness Sports Center Valle de Las Cañas, 28223, Pozuelo de Alarcón, Madrid, Spain

2 Faculty of Medicine, San Pablo CEU University, Madrid, Spain

3 Fremap Hospital, Majadahonda, Madrid, Spain

4 Department of Physiotherapy, University of Murcia, Campus Mare Nostrum, Universidad de Murcia, 30100, Campus de Espinardo Murcia, Spain

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BMC Musculoskeletal Disorders 2013, 14:310  doi:10.1186/1471-2474-14-310

Published: 30 October 2013



Lateral epicondylalgia (LE) defines a condition of varying degrees of pain near the lateral epicondyle. Studies on the management of LE indicated unexplained variations in the use of pharmacologic, non-pharmacological and surgical treatments.

The main aim of this paper was to develop and evaluate clinical quality measures (QMs) or quality indicators, which may be used to assess the quality of the processes of examination, education and treatment of patients with LE.


Different QMs were developed by a multidisciplinary group of experts in Quality Management of Health Services during a period of one year. The process was based following a 3-step model: i) review and proportion of existing evidence-based recommendations; ii) review and development of quality measures; iii) pilot testing of feasibility and reliability of the indicators leading to a final consensus by the whole panel.


Overall, a set of 12 potential indicators related to medical and physical therapy assessment and treatment were developed to measure the performance of LE care. Different systematic reviews and randomized control trials supported each of the indicators judged to be valid during the expert panel process. Application of the new indicator set was found to be feasible; only the measurement of two quality measures had light barriers. Reliability was mostly excellent (Kappa > 0.8).


A set of good practice indicators has been built and pilot tested as feasible and reliable. The chosen 3-step standardized evidence-based process ensures maximum clarity, acceptance and sustainability of the developed indicators.

Lateral epicondylalgia; Quality of care; Recommendations; Quality measures; Clinical quality indicators