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Trial of Blood Flow Restriction Plus Physical Therapy vs. Physical Therapy Alone for Lateral Epicondylitis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT03978897
Recruitment Status : Recruiting
First Posted : June 7, 2019
Last Update Posted : January 15, 2021
Information provided by (Responsible Party):
Aaron Lear, Akron General Medical Center

Brief Summary:
Open label randomized controlled trial comparing evidenced based physical/occupational therapy vs. physical/occupational therapy including blood flow restriction tourniquet in the treatment of lateral epicondylitis (tennis elbow).

Condition or disease Intervention/treatment Phase
Lateral Epicondylitis Device: Blood flow restriction tourniquet Other: Evidence based physical/occupational therapy Not Applicable

Detailed Description:

Patients will be randomized to one of two groups, and treatment will be open label and unblinded. A target of 44 patients for enrollment has been set for 80% power. Treatment will last for 6 visits with physical therapy with recommended visit intervals of 1 week :

Intervention Group: Evidence based physical/occupational therapy, with the addition of therapeutic exercises using a blood flow restriction tourniquet.

Control Group: Patients will receive standard evidence based physical therapy

The primary outcome (Patient-Rated Tennis Elbow Evaluation [PRTEE]) will be collected at enrollment, 3, 6, and 12 months.

Secondary outcomes will be collected at the beginning and end of physical therapy interventions (change in: numeric pain rating scale, maximum pain free grip strength, pain free grip strength). We will collect treatments received after the end of physical therapy and before final follow up.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 44 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Masking Description: Treating therapists and patient will be aware of treatment. The outcome assessor will have access to outcome data only, without knowledge of which treatment patient received.
Primary Purpose: Treatment
Official Title: A Randomized Controlled Trial of Blood Flow Restriction Plus Conventional Physical Therapy vs. Conventional Physical Therapy Alone in the Treatment of Lateral Epicondylitis
Actual Study Start Date : July 1, 2019
Estimated Primary Completion Date : July 1, 2022
Estimated Study Completion Date : July 1, 2023

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Blood flow restriction with physical/occupational therapy
physical/occupational therapy including use of blood flow restriction tourniquet over 6 visits (within a twelve week period).
Device: Blood flow restriction tourniquet
A blood flow restriction tourniquet, which impedes arterial flow to extremity at 50% of usual flow.
Other Name: Delfi personalized tourniquet system

Active Comparator: Evidence based physical/occupational therapy
evidence based physical/occupational therapy program over 6 visits (within a twelve week period) without use of blood flow restriction tourniquet
Other: Evidence based physical/occupational therapy
Up to date physical/occupational therapy for lateral epicondylitis

Primary Outcome Measures :
  1. Patient rated tennis elbow evaluation (PRTEE) [ Time Frame: 12 months ]

    Change in score on 'Patient rated tennis elbow evaluation' total score. Lower numbers suggest less pain, higher scores suggest more pain. Total score 0-100.

    Includes pain subscale (0-50)

    Specific activities subscale (0-60)

    Usual activities subscale (0-40)

    Function Subscale= (specific activities score + usual activities score)/2 (0-50)

    Total Score= Pain subscale + Function Subscale (0-100)

Secondary Outcome Measures :
  1. Numeric pain rating scale [ Time Frame: 12 months ]
    change in score on 0-10 pain rating scale with 0 being no pain, and 10 being worst pain.

  2. Pain free grip strength [ Time Frame: at final therapy visit up to 12 weeks after enrollment ]
    Change in pain free grip strength on dynamometer

  3. Maximum grip strength [ Time Frame: at final therapy visit up to 12 weeks after enrollment ]
    Change in maximum grip strength on dynamometer

  4. Other treatments received [ Time Frame: 12 months ]
    We will collect data on whether the patient sought or received treatments beyond physical/occupational therapy over the 12 months of enrollment in the study

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • The diagnoses included are lateral elbow pain, lateral epicondylitis, or lateral epicondylalgia, more general diagnoses elbow tendinitis or elbow pain will be included if their clinical picture at physical therapy meets criteria for lateral epicondylitis.
  • If the inclusion diagnosis is other than lateral epicondylitis or tennis elbow (such as elbow pain), we will confirm the diagnosis at the first therapy visit with tenderness at the lateral epicondyle and/or pain with resisted wrist/long finger extension at the lateral epicondyle.
  • Pain for 4 weeks or more.
  • All participants must be between the age of 18 and 70 years old and have had pain for 4 weeks or more.

Exclusion Criteria:

  • Ligamentous elbow sprain, osteoarthritis of elbow and cervical radiculopathy in the affected limb will be excluded from the study.
  • Any history of ligamentous, bony or other soft tissue reconstruction surgery at the affected elbow,
  • Vascular disorders to include: history of DVT, history of endothelial dysfunction, peripheral vascular disease
  • Injection therapy (corticosteroid, platelet rich plasma, or other injection therapy) in the prior 3 months to the affected site
  • Current fracture in affected arm
  • History of crush injury to affected arm
  • Any surgery on affected arm in last 1 year
  • Surgical procedure on their contralateral extremity (Changed 9/2019 to surgery within last year on contralateral upper extremity).
  • History of lymphectomy (such as axillary exploration with breast surgery, lymph node biopsy in the affected axilla/arm)
  • Pregnancy
  • Active infection
  • Current cancer diagnosis/treatment
  • Sickle cell anemia or trait
  • Kidney dialysis
  • History of syncope/passing out with pressure to body (such as massage, or blood pressure cuff).
  • inability to consent

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT03978897

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Contact: Chanda Mullen, PhD 3303446236
Contact: Aaron Lear, MD, CAQ 3303446047

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United States, Ohio
Cleveland Clinic Akron General Recruiting
Akron, Ohio, United States, 44307
Contact: Philip Toal, DPT    330-344-6000   
Sponsors and Collaborators
Akron General Medical Center
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Principal Investigator: Aaron Lear, MD, CAQ Cleveland Clinic Akron General
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Responsible Party: Aaron Lear, Director of Primary Care Sports Medicine, Akron General Medical Center Identifier: NCT03978897    
Other Study ID Numbers: 19001
First Posted: June 7, 2019    Key Record Dates
Last Update Posted: January 15, 2021
Last Verified: January 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Product Manufactured in and Exported from the U.S.: Yes
Keywords provided by Aaron Lear, Akron General Medical Center:
lateral epicondylitis
tennis elbow
blood flow restriction
physical therapy
Additional relevant MeSH terms:
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Tennis Elbow
Elbow Tendinopathy
Muscular Diseases
Musculoskeletal Diseases
Arm Injuries
Wounds and Injuries
Tendon Injuries