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Maintained physical activity and physiotherapy in the management of distal arm pain - a randomised controlled trial.

Maintained physical activity and physiotherapy in the management of distal arm pain - a randomised controlled trial.
Maintained physical activity and physiotherapy in the management of distal arm pain - a randomised controlled trial.
Objectives: the epidemiology of distal arm pain and back pain are similar. However, management differs considerably: for back pain, rest is discouraged, whereas patients with distal arm pain are commonly advised to rest and referred to physiotherapy. We hypothesised that remaining active would reduce long-term disability; and that fast-track physiotherapy would be superior to physiotherapy after time on a waiting-list.

Methods: adults referred to community-based physiotherapy with distal arm pain were randomised to: advice to remain active while awaiting physiotherapy (typically delivered after 6-8wks); advice to rest while awaiting physiotherapy; or immediate treatment. Intention-to-treat analysis determined whether the probability of recovery at 26wks was greater among the active advice group, compared with those advised to rest; and/or among those receiving immediate versus usually-timed physiotherapy.

Results: 538 of 1663 patients invited between Feb-2012 and Feb-2014 were randomised (active = 178; rest = 182; immediate physiotherapy = 178). 81% provided primary outcome data; and complete recovery was reported by 60 (44%), 46 (32%) and 53 (35%), respectively. Those advised to rest experienced a lower probability of recovery (odds ratio: 0.54; 95%CI: 0.32-0.90), versus advice to remain active. However, there was no benefit of immediate physiotherapy (0.64; 0.39-1.07).

Conclusions: among patients awaiting physiotherapy for distal arm pain, advice to remain active results in better 26wk functional outcome, compared with advice to rest. Also, immediate physiotherapy confers no additional benefit in terms of disability, compared to physiotherapy delivered after 6-8wks waiting time. These findings question current guidance for the management of distal arm pain.
2056-5933
Jones, Gareth.T.
4a081913-b60d-4916-996f-298cfd47cd88
Macfarlane, Gary J.
e17bbdb7-9d82-42ac-8a0a-09bf10885e3c
Walker-Bone, Karen
ad7d1336-ed2c-4f39-ade5-da84eb412109
Burton, Kimberly
097e1dc3-2fa8-46cd-8fb2-98c339b51986
Heine, Peter J.
1b839f52-c8d7-44c8-8f4d-a0939deb511e
McCabe, Candy
9f918646-3e83-4e67-b54d-c6a01e307ce5
McNamee, Paul
ebb7a998-46dd-42e1-9579-53e48cf3350b
McConnachie, Alex
c930d8cf-ab00-47e9-a22d-dbcf7a26f039
Zhang, Ruiqi
bfe735e7-89e9-4465-92e1-9ab6be463472
Whibley, Daniel
24a207f0-9e24-4e2a-8a15-6846d2da0fb2
Palmer, Keith T
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Coggon, David
2b43ce0a-cc61-4d86-b15d-794208ffa5d3
Jones, Gareth.T.
4a081913-b60d-4916-996f-298cfd47cd88
Macfarlane, Gary J.
e17bbdb7-9d82-42ac-8a0a-09bf10885e3c
Walker-Bone, Karen
ad7d1336-ed2c-4f39-ade5-da84eb412109
Burton, Kimberly
097e1dc3-2fa8-46cd-8fb2-98c339b51986
Heine, Peter J.
1b839f52-c8d7-44c8-8f4d-a0939deb511e
McCabe, Candy
9f918646-3e83-4e67-b54d-c6a01e307ce5
McNamee, Paul
ebb7a998-46dd-42e1-9579-53e48cf3350b
McConnachie, Alex
c930d8cf-ab00-47e9-a22d-dbcf7a26f039
Zhang, Ruiqi
bfe735e7-89e9-4465-92e1-9ab6be463472
Whibley, Daniel
24a207f0-9e24-4e2a-8a15-6846d2da0fb2
Palmer, Keith T
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Coggon, David
2b43ce0a-cc61-4d86-b15d-794208ffa5d3

Jones, Gareth.T., Macfarlane, Gary J., Walker-Bone, Karen, Burton, Kimberly, Heine, Peter J., McCabe, Candy, McNamee, Paul, McConnachie, Alex, Zhang, Ruiqi, Whibley, Daniel, Palmer, Keith T and Coggon, David (2019) Maintained physical activity and physiotherapy in the management of distal arm pain - a randomised controlled trial. RMD Open, 5. (doi:10.1136/rmdopen-2018-000810).

Record type: Article

Abstract

Objectives: the epidemiology of distal arm pain and back pain are similar. However, management differs considerably: for back pain, rest is discouraged, whereas patients with distal arm pain are commonly advised to rest and referred to physiotherapy. We hypothesised that remaining active would reduce long-term disability; and that fast-track physiotherapy would be superior to physiotherapy after time on a waiting-list.

Methods: adults referred to community-based physiotherapy with distal arm pain were randomised to: advice to remain active while awaiting physiotherapy (typically delivered after 6-8wks); advice to rest while awaiting physiotherapy; or immediate treatment. Intention-to-treat analysis determined whether the probability of recovery at 26wks was greater among the active advice group, compared with those advised to rest; and/or among those receiving immediate versus usually-timed physiotherapy.

Results: 538 of 1663 patients invited between Feb-2012 and Feb-2014 were randomised (active = 178; rest = 182; immediate physiotherapy = 178). 81% provided primary outcome data; and complete recovery was reported by 60 (44%), 46 (32%) and 53 (35%), respectively. Those advised to rest experienced a lower probability of recovery (odds ratio: 0.54; 95%CI: 0.32-0.90), versus advice to remain active. However, there was no benefit of immediate physiotherapy (0.64; 0.39-1.07).

Conclusions: among patients awaiting physiotherapy for distal arm pain, advice to remain active results in better 26wk functional outcome, compared with advice to rest. Also, immediate physiotherapy confers no additional benefit in terms of disability, compared to physiotherapy delivered after 6-8wks waiting time. These findings question current guidance for the management of distal arm pain.

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More information

Accepted/In Press date: 9 January 2019
e-pub ahead of print date: 4 March 2019

Identifiers

Local EPrints ID: 427442
URI: https://eprints.soton.ac.uk/id/eprint/427442
ISSN: 2056-5933
PURE UUID: b25f022f-8dcf-4f9d-9513-0cf33e90af9e
ORCID for Karen Walker-Bone: ORCID iD orcid.org/0000-0002-5992-1459
ORCID for David Coggon: ORCID iD orcid.org/0000-0003-1930-3987

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Date deposited: 16 Jan 2019 17:30
Last modified: 20 Jul 2019 04:03

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