Gareth T. Jones
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
Gary J. Macfarlane
Candy McCabe Candy.Mccabe@uwe.ac.uk
Professor of Clinical Research and Practice
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.
Jones, G. T., Macfarlane, G. J., Walker-Bone, K., Burton, K., Heine, P., McCabe, C., …Coggon, D. (2019). Maintained physical activity and physiotherapy in the management of distal arm pain: A randomised controlled trial. RMD Open, 5(1), https://doi.org/10.1136/rmdopen-2018-000810
|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||Jan 15, 2019|
|Publisher||BMJ Publishing Group|
|Peer Reviewed||Peer Reviewed|
|Keywords||distal arm pain, physiotherapy, advice, randomised trial|