Advice to remain active with arm pain reduces disability
Advice to remain active with arm pain reduces disability
Background: arm pain is common amongst working-aged adults and causes substantial work disability. The results of a population-based randomized controlled trial (the ARM trial) suggested that advice to remain active reduced disability after 6 months.
Aims: to verify ARM trial results amongst people in paid employment.
Methods: the ARM trial recruited adults with distal arm pain referred for physiotherapy and randomized equally to three groups: wait-listed for physiotherapy (advised to rest); wait-listed for physiotherapy (advised to remain active) or early physiotherapy. The primary outcome was absence of disability at 26 weeks. Secondary analyses were undertaken amongst participants in paid employment.
Results: amongst 538 trial participants, 347 (64%) were in paid employment, mean age 46.1 years and 47% in manual work. Employed participants were randomized equally to the three arms. Amongst the 271 (78% workers with 26-week data), 43% of those advised to remain active were free from disability, as compared with 37% of those advised to rest. Forty per cent of those who waited for physiotherapy were disability-free as compared with 35% of those treated rapidly. Advice to rest was associated with lower chances of recovery amongst workers who lift/carry weights and those who believed work had caused their symptoms (P = 0.023).
Conclusions: although not powered as a trial for workers only, our findings suggest that advising activity was as beneficial for people currently in paid work and may be superior to advice to rest in reducing disability. Addressing harmful beliefs about causation of symptoms has the potential to reduce disability.
268–274
Walker-Bone, K.
ad7d1336-ed2c-4f39-ade5-da84eb412109
Macfarlane, G.J.
e17bbdb7-9d82-42ac-8a0a-09bf10885e3c
Burton, K.
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McConnachie, A.M.
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Zhang, R.
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Jones, G.T.
4a081913-b60d-4916-996f-298cfd47cd88
1 June 2023
Walker-Bone, K.
ad7d1336-ed2c-4f39-ade5-da84eb412109
Macfarlane, G.J.
e17bbdb7-9d82-42ac-8a0a-09bf10885e3c
Burton, K.
b5f69408-9340-4599-8649-41b2ae0b6d38
McConnachie, A.M.
26348495-e07b-4b09-b011-9f05ed870741
Zhang, R.
d29b16a3-bb7b-44f0-9688-97186c2252bd
Jones, G.T.
4a081913-b60d-4916-996f-298cfd47cd88
Walker-Bone, K., Macfarlane, G.J., Burton, K., McConnachie, A.M., Zhang, R. and Jones, G.T.
(2023)
Advice to remain active with arm pain reduces disability.
Occupational Medicine, 73 (5), .
(doi:10.1093/occmed/kqad065).
Abstract
Background: arm pain is common amongst working-aged adults and causes substantial work disability. The results of a population-based randomized controlled trial (the ARM trial) suggested that advice to remain active reduced disability after 6 months.
Aims: to verify ARM trial results amongst people in paid employment.
Methods: the ARM trial recruited adults with distal arm pain referred for physiotherapy and randomized equally to three groups: wait-listed for physiotherapy (advised to rest); wait-listed for physiotherapy (advised to remain active) or early physiotherapy. The primary outcome was absence of disability at 26 weeks. Secondary analyses were undertaken amongst participants in paid employment.
Results: amongst 538 trial participants, 347 (64%) were in paid employment, mean age 46.1 years and 47% in manual work. Employed participants were randomized equally to the three arms. Amongst the 271 (78% workers with 26-week data), 43% of those advised to remain active were free from disability, as compared with 37% of those advised to rest. Forty per cent of those who waited for physiotherapy were disability-free as compared with 35% of those treated rapidly. Advice to rest was associated with lower chances of recovery amongst workers who lift/carry weights and those who believed work had caused their symptoms (P = 0.023).
Conclusions: although not powered as a trial for workers only, our findings suggest that advising activity was as beneficial for people currently in paid work and may be superior to advice to rest in reducing disability. Addressing harmful beliefs about causation of symptoms has the potential to reduce disability.
Text
FINAL CLEAN accepted 10.5.23
- Accepted Manuscript
More information
Accepted/In Press date: 10 May 2023
e-pub ahead of print date: 1 June 2023
Published date: 1 June 2023
Additional Information:
Funding Information:
The ARM pain trial was funded by a grant from Arthritis Research UK (now Versus Arthritis): Award reference: 19231.
Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved.
© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Identifiers
Local EPrints ID: 480594
URI: http://eprints.soton.ac.uk/id/eprint/480594
ISSN: 0962-7480
PURE UUID: aa73870e-81aa-42d7-9032-13efa870e8f6
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Date deposited: 07 Aug 2023 16:40
Last modified: 06 Jun 2024 04:06
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Contributors
Author:
G.J. Macfarlane
Author:
K. Burton
Author:
A.M. McConnachie
Author:
R. Zhang
Author:
G.T. Jones
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