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Maintained physical activity and physiotherapy in the management of distal upper limb pain - a protocol for a randomised controlled trial (the arm pain trial)

Maintained physical activity and physiotherapy in the management of distal upper limb pain - a protocol for a randomised controlled trial (the arm pain trial)
Maintained physical activity and physiotherapy in the management of distal upper limb pain - a protocol for a randomised controlled trial (the arm pain trial)
Background
Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.

Methods/Design
Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.

We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.

Discussion
Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms.
randomised controlled trial, arm pain, physiotherapy, advice, rest, active, pain management
71-[9pp]
Jones, G.T.
38fb956f-a1fc-4ae5-a589-75927f458a7d
Mertens, K.
c77c5608-62ea-480e-b340-f536cc9d62de
Macfarlane, G.J.
332acabb-a9cf-4434-b375-c8dd3a659e9f
Palmer, K.T.
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Coggon, D.
2b43ce0a-cc61-4d86-b15d-794208ffa5d3
Walker-Bone, K.
ad7d1336-ed2c-4f39-ade5-da84eb412109
Burton, K.
5a0824db-5013-4746-81ea-76dd6c4383e8
Heine, P.J.
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McCabe, C.
e63e9240-b59c-40da-8707-1cd555451a43
McNamee, P.
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McConnachie, A.
763c8776-b584-441c-a7b4-af068e1f0ef9
Jones, G.T.
38fb956f-a1fc-4ae5-a589-75927f458a7d
Mertens, K.
c77c5608-62ea-480e-b340-f536cc9d62de
Macfarlane, G.J.
332acabb-a9cf-4434-b375-c8dd3a659e9f
Palmer, K.T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Coggon, D.
2b43ce0a-cc61-4d86-b15d-794208ffa5d3
Walker-Bone, K.
ad7d1336-ed2c-4f39-ade5-da84eb412109
Burton, K.
5a0824db-5013-4746-81ea-76dd6c4383e8
Heine, P.J.
d897037e-8ea9-4d2d-ba6f-8a69c9c4dad3
McCabe, C.
e63e9240-b59c-40da-8707-1cd555451a43
McNamee, P.
77afd18f-a2f7-4165-8b26-de11124102ee
McConnachie, A.
763c8776-b584-441c-a7b4-af068e1f0ef9

Jones, G.T., Mertens, K., Macfarlane, G.J., Palmer, K.T., Coggon, D., Walker-Bone, K., Burton, K., Heine, P.J., McCabe, C., McNamee, P. and McConnachie, A. (2014) Maintained physical activity and physiotherapy in the management of distal upper limb pain - a protocol for a randomised controlled trial (the arm pain trial). BMC Musculoskeletal Disorders, 15, 71-[9pp]. (doi:10.1186/1471-2474-15-71). (PMID:24612447 )

Record type: Article

Abstract

Background
Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.

Methods/Design
Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.

We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.

Discussion
Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms.

Full text not available from this repository.

More information

e-pub ahead of print date: 10 March 2014
Published date: 10 March 2014
Keywords: randomised controlled trial, arm pain, physiotherapy, advice, rest, active, pain management
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 365805
URI: http://eprints.soton.ac.uk/id/eprint/365805
PURE UUID: bfa2e583-216b-4975-96dd-691f3f29c0ab
ORCID for D. Coggon: ORCID iD orcid.org/0000-0003-1930-3987
ORCID for K. Walker-Bone: ORCID iD orcid.org/0000-0002-5992-1459

Catalogue record

Date deposited: 17 Jun 2014 12:15
Last modified: 20 Jul 2019 01:16

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Contributors

Author: G.T. Jones
Author: K. Mertens
Author: G.J. Macfarlane
Author: K.T. Palmer
Author: D. Coggon ORCID iD
Author: K. Walker-Bone ORCID iD
Author: K. Burton
Author: P.J. Heine
Author: C. McCabe
Author: P. McNamee
Author: A. McConnachie

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