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A prospective cohort study of arm pain in primary care and physiotherapy--prognostic determinants

A prospective cohort study of arm pain in primary care and physiotherapy--prognostic determinants
A prospective cohort study of arm pain in primary care and physiotherapy--prognostic determinants
OBJECTIVE: To investigate outcome and prognostic determinants for arm pain presenting to primary care and physiotherapy services. METHODS: Patients with arm pain were recruited as they presented to primary care and physiotherapy services, and were followed for 12 months. At baseline, they were classified by diagnosis using a validated examination schedule. Depression, somatizing tendency, health anxiety, fear-avoidance beliefs and chronic pain outside the arm were ascertained using standard definitions. Three outcomes were considered: same-site pain during the final month of follow-up (continuing pain); pain present on most days of that month; and pain present without a break of 7 days over follow-up ('unremitting' pain). Associations were explored in multi-level logistic regression models and summarized as odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: Altogether, 313 (83%) of 375 subjects completed follow-up, including 53% with 'continuing' and 24% with 'unremitting' pain. 'Continuing' pain was predicted most strongly by male sex (OR 1.9, 95% CI 1.2-3.2) (this association was restricted largely to the elbow), higher frequency of pain in the past month at baseline (OR 2.5, 95% CI 1.1-5.6), chronic pain at sites outside the arm (ORs 1.6-2.4 for different sites) and current smoking (OR 3.3, 95% CI 1.6-6.6). There were also indications that mental health and fear-avoidance beliefs influenced prognosis. Predictors for the other two adverse outcomes were similar. CONCLUSION: Arm pain often persists in patients who consult medical services. Predictors of persistence include male sex (elbow only), frequency of pain at baseline, chronic pain at other sites and smoking
health, arm, shoulder pain, methods, adult, england, epidemiology, adverse effects, depression, chronic disease, diagnosis, smoking, middle aged, etiology, male, patients, prognosis, epidemiologic methods, adolescent, pain, primary health care, multicenter studies, female, cohort, sex factors, rehabilitation, research, humans, pain measurement, research support, sex, physical therapy modalities, confidence intervals, odds ratio, anxiety, cohort studies
1462-0324
508-515
Ryall, C.
1d050e52-3791-4fe2-bdbf-e2040b42617f
Coggon, D.
2b43ce0a-cc61-4d86-b15d-794208ffa5d3
Peveler, R.
93198224-78d9-4c1f-9c07-fdecfa69cf96
Poole, J.
d6c5377d-ac31-4552-8108-e5bd16f9fd00
Palmer, K.T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Ryall, C.
1d050e52-3791-4fe2-bdbf-e2040b42617f
Coggon, D.
2b43ce0a-cc61-4d86-b15d-794208ffa5d3
Peveler, R.
93198224-78d9-4c1f-9c07-fdecfa69cf96
Poole, J.
d6c5377d-ac31-4552-8108-e5bd16f9fd00
Palmer, K.T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850

Ryall, C., Coggon, D., Peveler, R., Poole, J. and Palmer, K.T. (2007) A prospective cohort study of arm pain in primary care and physiotherapy--prognostic determinants. Rheumatology, 46 (3), 508-515. (doi:10.1093/rheumatology/kel320).

Record type: Article

Abstract

OBJECTIVE: To investigate outcome and prognostic determinants for arm pain presenting to primary care and physiotherapy services. METHODS: Patients with arm pain were recruited as they presented to primary care and physiotherapy services, and were followed for 12 months. At baseline, they were classified by diagnosis using a validated examination schedule. Depression, somatizing tendency, health anxiety, fear-avoidance beliefs and chronic pain outside the arm were ascertained using standard definitions. Three outcomes were considered: same-site pain during the final month of follow-up (continuing pain); pain present on most days of that month; and pain present without a break of 7 days over follow-up ('unremitting' pain). Associations were explored in multi-level logistic regression models and summarized as odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: Altogether, 313 (83%) of 375 subjects completed follow-up, including 53% with 'continuing' and 24% with 'unremitting' pain. 'Continuing' pain was predicted most strongly by male sex (OR 1.9, 95% CI 1.2-3.2) (this association was restricted largely to the elbow), higher frequency of pain in the past month at baseline (OR 2.5, 95% CI 1.1-5.6), chronic pain at sites outside the arm (ORs 1.6-2.4 for different sites) and current smoking (OR 3.3, 95% CI 1.6-6.6). There were also indications that mental health and fear-avoidance beliefs influenced prognosis. Predictors for the other two adverse outcomes were similar. CONCLUSION: Arm pain often persists in patients who consult medical services. Predictors of persistence include male sex (elbow only), frequency of pain at baseline, chronic pain at other sites and smoking

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More information

Published date: 2007
Keywords: health, arm, shoulder pain, methods, adult, england, epidemiology, adverse effects, depression, chronic disease, diagnosis, smoking, middle aged, etiology, male, patients, prognosis, epidemiologic methods, adolescent, pain, primary health care, multicenter studies, female, cohort, sex factors, rehabilitation, research, humans, pain measurement, research support, sex, physical therapy modalities, confidence intervals, odds ratio, anxiety, cohort studies

Identifiers

Local EPrints ID: 62106
URI: http://eprints.soton.ac.uk/id/eprint/62106
ISSN: 1462-0324
PURE UUID: 03aedc99-71ca-498f-8746-915c459621aa
ORCID for D. Coggon: ORCID iD orcid.org/0000-0003-1930-3987
ORCID for R. Peveler: ORCID iD orcid.org/0000-0001-5596-9394

Catalogue record

Date deposited: 10 Sep 2008
Last modified: 09 Jan 2022 02:51

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Contributors

Author: C. Ryall
Author: D. Coggon ORCID iD
Author: R. Peveler ORCID iD
Author: J. Poole
Author: K.T. Palmer

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