Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)

Gareth T. Jones, Kathrin Mertens, Gary J. Macfarlane, Keith T Palmer, David Coggon, Karen Walker-bone, Kim Burton, Peter J Heine, Candy Mccabe, Paul McNamee, Alex Mcconnachie

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.

Methods/Design: Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.
We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.

Discussion: Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms.

Trial registration: Registered on www.controlled-trials.com (reference number: ISRCTN79085082).
Original languageEnglish
Article number71
Pages (from-to)1-9
Number of pages9
JournalBMC Musculoskeletal Disorders
Volume15
DOIs
Publication statusPublished - 10 Mar 2014

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Upper Extremity
Arm
Randomized Controlled Trials
Exercise
Pain
Waiting Lists
Hand
Intention to Treat Analysis
Random Allocation
Elbow
Wrist
Forearm
Outpatients
Referral and Consultation
Therapeutics
Surveys and Questionnaires

Cite this

Jones, Gareth T. ; Mertens, Kathrin ; Macfarlane, Gary J. ; Palmer, Keith T ; Coggon, David ; Walker-bone, Karen ; Burton, Kim ; Heine, Peter J ; Mccabe, Candy ; McNamee, Paul ; Mcconnachie, Alex. / Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial). In: BMC Musculoskeletal Disorders. 2014 ; Vol. 15. pp. 1-9.
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title = "Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)",
abstract = "Background: Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.Methods/Design: Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.Discussion: Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms.Trial registration: Registered on www.controlled-trials.com (reference number: ISRCTN79085082).",
keywords = "Randomised controlled trial, Arm pain, Physiotherapy, Advice, Rest, Active, Pain management",
author = "Jones, {Gareth T.} and Kathrin Mertens and Macfarlane, {Gary J.} and Palmer, {Keith T} and David Coggon and Karen Walker-bone and Kim Burton and Heine, {Peter J} and Candy Mccabe and Paul McNamee and Alex Mcconnachie",
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Jones, GT, Mertens, K, Macfarlane, GJ, Palmer, KT, Coggon, D, Walker-bone, K, Burton, K, Heine, PJ, Mccabe, C, McNamee, P & Mcconnachie, A 2014, 'Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)', BMC Musculoskeletal Disorders, vol. 15, 71, pp. 1-9. https://doi.org/10.1186/1471-2474-15-71

Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial). / Jones, Gareth T.; Mertens, Kathrin; Macfarlane, Gary J.; Palmer, Keith T; Coggon, David; Walker-bone, Karen; Burton, Kim; Heine, Peter J; Mccabe, Candy; McNamee, Paul; Mcconnachie, Alex.

In: BMC Musculoskeletal Disorders, Vol. 15, 71, 10.03.2014, p. 1-9.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)

AU - Jones, Gareth T.

AU - Mertens, Kathrin

AU - Macfarlane, Gary J.

AU - Palmer, Keith T

AU - Coggon, David

AU - Walker-bone, Karen

AU - Burton, Kim

AU - Heine, Peter J

AU - Mccabe, Candy

AU - McNamee, Paul

AU - Mcconnachie, Alex

PY - 2014/3/10

Y1 - 2014/3/10

N2 - Background: Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.Methods/Design: Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.Discussion: Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms.Trial registration: Registered on www.controlled-trials.com (reference number: ISRCTN79085082).

AB - Background: Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.Methods/Design: Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.Discussion: Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms.Trial registration: Registered on www.controlled-trials.com (reference number: ISRCTN79085082).

KW - Randomised controlled trial

KW - Arm pain

KW - Physiotherapy

KW - Advice

KW - Rest

KW - Active

KW - Pain management

U2 - 10.1186/1471-2474-15-71

DO - 10.1186/1471-2474-15-71

M3 - Article

VL - 15

SP - 1

EP - 9

JO - BMC Musculoskeletal Disorders

JF - BMC Musculoskeletal Disorders

SN - 1471-2474

M1 - 71

ER -