Optimising physiotherapy for people with lateral elbow tendinopathy - Results of a mixed-methods pilot and feasibility randomised controlled trial (OPTimisE).

The study was not powered for between-group comparison, so the descriptive outcome data cannot be used to conclude that either treatment is better. Neither participants nor physiotherapists were blinded, and data analysis was not masked to allocation. Usual care was not standardised; physiotherapists had no restrictions on what they could offer, so the control group is a moving target. Questionnaire returns were low at 6 weeks (59%) and 12 weeks (65%), and the 6-month rate of 81% was only achieved after a protocol amendment allowing telephone data collection. Five participants in the OPTimisE group never attended their first session and received no intervention, yet were included in the analysis. The authors note that usual care at research-active sites may be of higher quality than in general practice, which could inflate the control group's results. No translation services were provided, potentially excluding under-served communities. Only 6 of 18 OPTimisE participants returned exercise diaries, limiting adherence data.

Funded by the NIHR and the Chartered Society of Physiotherapy Charitable Trust. The lead author holds a doctoral fellowship from the same two bodies. The authors declare no conflicts of interest.

Do not read the descriptive outcome data as evidence that the OPTimisE protocol outperforms usual physiotherapy. The study was not powered for between-group comparison, and in some measures the trend actually favoured the usual care group. The authors themselves question whether a future head-to-head trial is warranted.