{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T11:55:41Z","timestamp":1793879741618,"version":"4.7.0"},"reference-count":44,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T00:00:00Z","timestamp":1674000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Physical activity (PA) can generate physical stress on the musculoskeletal system. Thus, the aim of the current study was to assess the influence of the level of physical activity on clinical tests used in the diagnosis of lateral epicondylitis in adults, intertest reliability and accuracy based on ultrasound imaging, and relationship with energy expenditure. Methods: 102 adults with lateral epicondylitis were assessed via an International Physical Activity Questionnaire and divided according to PA level: low (n = 19) moderate (n = 42) or high (n = 41). Pain (visual analog scale), Cozen\u2019s and Mill\u2019s clinical tests and ultrasound exams were performed. Results: The Cozen\u2019s and Mill\u2019s tests differed among PA levels. Excellent reliability was found for Mill\u2019s test for PA levels and the ultrasound exam (low ICC = 1.0, moderate ICC = 0.82 and high ICC = 0.99). Good reliability was found for Cozen\u2019s test (low ICC = 0.80, moderate ICC = 0.74 and high ICC = 0.73), but with significant differences between the ultrasound exams. The Cozen\u2019s and Mill\u2019s clinical tests had no relationship to the level of energy expenditure for PA levels. Conclusion: Mill\u2019s test was reliable and accurate for the PA levels. Intertest reliability was poor for the PA levels. Mill\u2019s test proved to be accurate based on the ultrasound exam. The pain caused by the tests was not related to the level of energy expenditure.<\/jats:p>","DOI":"10.3390\/ijerph20031794","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T02:04:35Z","timestamp":1674093875000},"page":"1794","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Differences in Clinical Tests for Assessing Lateral Epicondylitis Elbow in Adults Concerning Their Physical Activity Level: Test Reliability, Accuracy of Ultrasound Imaging, and Relationship with Energy Expenditure"],"prefix":"10.3390","volume":"20","author":[{"given":"Marcos Martins","family":"Soares","sequence":"first","affiliation":[{"name":"Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, S\u00e3o Paulo 04829-300, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patr\u00edcia Colombo","family":"Souza","sequence":"additional","affiliation":[{"name":"Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, S\u00e3o Paulo 04829-300, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1061-3789","authenticated-orcid":false,"given":"Ana Paula","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, S\u00e3o Paulo 04829-300, Brazil"},{"name":"Medicine and Physical Therapy Department, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo 05360-160, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.jhsa.2017.03.016","article-title":"Radiographic and clinical analysis of lateral epicondylitis","volume":"42","author":"Shillito","year":"2017","journal-title":"J. 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