Maintained physical activity and physiotherapy in the management of distal arm pain: A randomised controlled trial

Jones, Gareth T.; Macfarlane, Gary J.; Walker-Bone, Karen; Burton, Kim; Heine, Peter; McCabe, Candy; McNamee, Paul; McConnachie, Alex; Zhang, Rachel; Whibley, Daniel; Palmer, Keith; Coggon, David

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 6-8 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.

• Journal Article Type: Article
• Acceptance Date: Jan 9, 2019
• Online Publication Date: Mar 4, 2019
• Publication Date: Jan 1, 2019
• Deposit Date: Jan 15, 2019
• Publicly Available Date: Mar 15, 2019
• Journal: RMD Open
• Electronic ISSN: 2056-5933
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 5
• Issue: 1
• Article Number: e000810
• DOI: https://doi.org/10.1136/rmdopen-2018-000810
• Keywords: distal arm pain, physiotherapy, advice, randomised trial
• Public URL: https://uwe-repository.worktribe.com/output/851027
• Publisher URL: http://dx.doi.org/10.1136/rmdopen-2018-000810
• Contract Date: Jan 15, 2019