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...
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BMJ Publishing Group
2019-06-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/5/1/e000810.full |
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| author | Karen Walker-Bone David Coggon Gary J Macfarlane Paul McNamee Gareth T Jones Kim Burton Peter Heine Candida McCabe Alex McConnachie Rachel Zhang Daniel Whibley Keith Palmer |
| author_facet | Karen Walker-Bone David Coggon Gary J Macfarlane Paul McNamee Gareth T Jones Kim Burton Peter Heine Candida McCabe Alex McConnachie Rachel Zhang Daniel Whibley Keith Palmer |
| author_sort | Karen Walker-Bone |
| collection | DOAJ |
| description | 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 6–8 weeks); advice to rest while awaiting physiotherapy, or immediate treatment. Intention-to-treat analysis determined whether the probability of recovery at 26 weeks 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 February 2012 and February 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%). Those advised to rest experienced a lower probability of recovery (OR: 0.54; 95% CI 0.32 to 0.90) versus advice to remain active. However, there was no benefit of immediate physiotherapy (0.64; 95% CI 0.39 to 1.07).Conclusions Among patients awaiting physiotherapy for distal arm pain, advice to remain active results in better 26-week functional outcome, compared with advice to rest. Also, immediate physiotherapy confers no additional benefit in terms of disability, compared with physiotherapy delivered after 6–8 weeks waiting time. These findings question current guidance for the management of distal arm pain. |
| format | Article |
| id | doaj-art-dab054d3e8494ee7a2116918692f9738 |
| institution | Kabale University |
| issn | 2056-5933 |
| language | English |
| publishDate | 2019-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj-art-dab054d3e8494ee7a2116918692f97382025-08-20T03:25:27ZengBMJ Publishing GroupRMD Open2056-59332019-06-015110.1136/rmdopen-2018-000810Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trialKaren Walker-Bone0David Coggon1Gary J Macfarlane2Paul McNamee3Gareth T Jones4Kim Burton5Peter Heine6Candida McCabe7Alex McConnachie8Rachel Zhang9Daniel Whibley10Keith Palmer111 Monash Centre for Occupational & Environmental Health (MonCOEH), Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia3 MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK1 Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK9 Health Economics Research Unit, University of Aberdeen, Aberdeen, UK2 Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK5 Centre for Applied Research in Health, University of Huddersfield, Huddersfield, UK6 Warwick Clinical Trials Unit, University of Warwick, Coventry, UK7 Royal United Hospitals Bath NHS Foundation Trust, Bath, UKRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK10 Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK1 Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK3 MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UKObjectives 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 6–8 weeks); advice to rest while awaiting physiotherapy, or immediate treatment. Intention-to-treat analysis determined whether the probability of recovery at 26 weeks 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 February 2012 and February 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%). Those advised to rest experienced a lower probability of recovery (OR: 0.54; 95% CI 0.32 to 0.90) versus advice to remain active. However, there was no benefit of immediate physiotherapy (0.64; 95% CI 0.39 to 1.07).Conclusions Among patients awaiting physiotherapy for distal arm pain, advice to remain active results in better 26-week functional outcome, compared with advice to rest. Also, immediate physiotherapy confers no additional benefit in terms of disability, compared with physiotherapy delivered after 6–8 weeks waiting time. These findings question current guidance for the management of distal arm pain.https://rmdopen.bmj.com/content/5/1/e000810.full |
| spellingShingle | Karen Walker-Bone David Coggon Gary J Macfarlane Paul McNamee Gareth T Jones Kim Burton Peter Heine Candida McCabe Alex McConnachie Rachel Zhang Daniel Whibley Keith Palmer Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial RMD Open |
| title | Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial |
| title_full | Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial |
| title_fullStr | Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial |
| title_full_unstemmed | Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial |
| title_short | Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial |
| title_sort | maintained physical activity and physiotherapy in the management of distal arm pain a randomised controlled trial |
| url | https://rmdopen.bmj.com/content/5/1/e000810.full |
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