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NCT Number: NCT07582510

Telerehabilitation vs Supervised Physiotherapy for Medial Epicondylitis

This randomized controlled trial aims to compare the effectiveness of telerehabilitation and supervised physiotherapy in patients with medial epicondylitis. The primary outcome is improvement in pain and function using the Patient-Rated Elbow Evaluation (PREE). Secondary outcomes include pain intensity, grip strength, musculoskeletal ultrasound findings, adherence, and upper limb disability measured by Quick DASH.

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Key information

Conditions

Medial Epicondylitis Arm Injuries Elbow Injuries Elbow Tendinopathy Muscular Diseases Musculoskeletal Diseases Physiotherapy Telerehabilitation Tendinopathy Tendon Injuries Wounds and Injuries

Age range

18 year–60 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Outpatient clinic, faculty of Physical Therapy, Benha university

Banhā, Benha, 11503, Egypt

Location status: Recruiting

Location contact

Mahmoud Hamada Mohamed Associate Professor, Ph.D

CONTACT

[email protected]

01096968910

About this study

Medial epicondylitis is a tendinopathy affecting the common flexor origin of the elbow, resulting in pain and functional limitation. Supervised physiotherapy is commonly used; however, telerehabilitation provides an accessible and scalable alternative. Evidence comparing these two delivery models is limited.

This randomized controlled trial will compare telerehabilitation and supervised physiotherapy over an 8-week intervention period. Clinical outcomes will be assessed using PREE, pain intensity, grip strength, and QuickDASH. Musculoskeletal ultrasound will be used to evaluate tendon structural characteristics. The study will also explore the relationship between imaging findings and clinical outcomes.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age 18 to 60 years
  • Clinical diagnosis of medial epicondylitis
  • Symptoms duration ≥6 weeks
  • Pain with resisted wrist flexion
  • Local tenderness at medial epicondyle

Exclusion criteria

  • Previous elbow surgery
  • Corticosteroid injection within the past 3 months
  • Cervical radiculopathy
  • Systemic inflammatory disease
  • Bilateral symptoms

Treatment and study plan

Telerehabilitation exercise program

Other

Participants will perform a home-based progressive loading program targeting the wrist flexor-pronator muscles three times per week for 8 weeks. The protocol will progress from isometric exercises in weeks 1-2 (4-5 × 30-45 s holds), to eccentric loading in weeks 3-4 (3 × 15 repetitions), followed by combined concentric-eccentric training in weeks 5-6 (3-4 × 10-12 repetitions), and heavy slow resistance in weeks 7-8 (3-4 × 6-8 repetitions at ~70-85% 1RM). Exercise intensity will be guided by a pain-monitoring model (≤5/10), with progression based on tolerance. Participants will receive weekly video consultations, instructional materials, and adherence will be tracked via digital logs.

Supervised Physiotherapy Program

Other

Participants will undergo an identical progressive loading program targeting the wrist flexor-pronator muscles, administered three times per week for 8 weeks under direct physiotherapist supervision. The intervention will follow the same staged progression: will progress from isometric exercises in weeks 1-2 (4-5 × 30-45 s holds), to eccentric loading in weeks 3-4 (3 × 15 repetitions), followed by combined concentric-eccentric training in weeks 5-6 (3-4 × 10-12 repetitions), and heavy slow resistance in weeks 7-8 (3-4 × 6-8 repetitions at ~70-85% 1RM). Exercise intensity will be guided by a pain-monitoring model (≤5/10), with progression based on tolerance. This supervised approach ensures correct technique, optimal load progression and adherence to the protocol

Primary outcomes

  1. Change in Patient-Rated Elbow Evaluation (PREE) Score

    Time frame: Baseline and 8 Weeks

    The PREE is a 15-item questionnaire assessing pain and functional disability. Scores range from 0 to 100, with higher scores indicating worse pain and function.

Secondary outcomes

  1. Colour Ultrasonography

    Time frame: Baseline and 8 Weeks

    Change in tendon hypervascularity and hypoechogenicity will be assessed using color Doppler ultrasonography and graded on a four-point scale (Grade 1-Grade 4). Ultrasonographic evaluation will include assessment of hypoechoic changes within the common flexor tendon, tendon sheath thickening, partial or full-thickness tendon ruptures, neovascularization detected by Doppler imaging, and cortical irregularities or damage at the medial epicondyle.

  2. Grip Strength (hand dynamometer)

    Time frame: Baseline and 8 Weeks

    Measured using a hand dynamometer. Hand grip strength will be assessed using a calibrated hydraulic hand dynamometer with participants seated comfortably, shoulder adducted and neutrally rotated, elbow flexed to 90°, forearm in neutral position, and wrist positioned between 0-30° extension according to standardized testing procedures. Participants will be instructed to perform maximal voluntary grip contraction for approximately 3-5 seconds. Three trials will be recorded for the affected upper limb with a 30-60 second rest interval between attempts, and the mean value in kilograms (kg) will be used for statistical analysis.

  3. Pain Intensity (Visual Analog Scale)

    Time frame: Baseline and 8 Weeks

    Pain intensity will be assessed using a 10-cm Visual Analog Scale (VAS) ranging from 0 ("no pain") to 10 ("worst imaginable pain") at rest and during resisted wrist flexion.

Study contacts

Contact information is provided by the study sponsor or research team.

Mahmoud Hamada Mohamed Associate Professor, Ph.D

CONTACT

[email protected]

01096968910

Sponsors and collaborators

Lead sponsor

Benha University

Other

Registry information

Official study title

Effectiveness of Telerehabilitation Versus Supervised Physiotherapy on Pain, Function, Strength, and Musculoskeletal Ultrasound Parameters in Patients With Medial Epicondylitis: A Randomized Controlled Trial

Acronym: TELE-ME

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
May 13, 2026
Registry last updated
May 18, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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