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

Gareth T. Jones, Gary J. Macfarlane, Karen Walker-bone, Anthony Burton, Peter J Heine, Candy Mccabe, Paul McNamee, Alex Mcconnachie, Ruiqi Zhang, Daniel Whibley, Keith Palmer, David Coggon

Research output: Contribution to journalArticle

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 6-8wks); advice to rest while awaiting physiotherapy; or immediate treatment. Intention-to-treat analysis determined whether the probability of recovery at 26wks 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 Feb-2012 and Feb-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%), respectively. Those advised to rest experienced a lower probability of recovery (odds ratio: 0.54; 95%CI: 0.32-0.90), versus advice to remain active. However, there was no benefit of immediate physiotherapy (0.64; 0.39-1.07).
Conclusions
Among patients awaiting physiotherapy for distal arm pain, advice to remain active results in better 26wk functional outcome, compared with advice to rest. Also, immediate physiotherapy confers no additional benefit in terms of disability, compared to physiotherapy delivered after 6-8wks waiting time. These findings question current guidance for the management of distal arm pain.
LanguageEnglish
JournalRMD Open
Publication statusAccepted/In press - 9 Jan 2019

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Randomized Controlled Trials
Exercise
Pain
Back Pain
Intention to Treat Analysis
Waiting Lists
Epidemiology
Odds Ratio
Therapeutics

Cite this

Jones, G. T., Macfarlane, G. J., Walker-bone, K., Burton, A., Heine, P. J., Mccabe, C., ... Coggon, D. (Accepted/In press). Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial. RMD Open.
Jones, Gareth T. ; Macfarlane, Gary J. ; Walker-bone, Karen ; Burton, Anthony ; Heine, Peter J ; Mccabe, Candy ; McNamee, Paul ; Mcconnachie, Alex ; Zhang, Ruiqi ; Whibley, Daniel ; Palmer, Keith ; Coggon, David. / Maintained physical activity and physiotherapy in the management of distal arm pain : a randomised controlled trial. In: RMD Open. 2019.
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title = "Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial",
abstract = "ObjectivesThe 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.MethodsAdults referred to community-based physiotherapy with distal arm pain were randomised to: advice to remain active while awaiting physiotherapy (typically delivered after 6-8wks); advice to rest while awaiting physiotherapy; or immediate treatment. Intention-to-treat analysis determined whether the probability of recovery at 26wks was greater among the active advice group, compared with those advised to rest; and/or among those receiving immediate versus usually-timed physiotherapy.Results538 of 1663 patients invited between Feb-2012 and Feb-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{\%}), respectively. Those advised to rest experienced a lower probability of recovery (odds ratio: 0.54; 95{\%}CI: 0.32-0.90), versus advice to remain active. However, there was no benefit of immediate physiotherapy (0.64; 0.39-1.07).ConclusionsAmong patients awaiting physiotherapy for distal arm pain, advice to remain active results in better 26wk functional outcome, compared with advice to rest. Also, immediate physiotherapy confers no additional benefit in terms of disability, compared to physiotherapy delivered after 6-8wks waiting time. These findings question current guidance for the management of distal arm pain.",
keywords = "distal arm pain, Physiotherapy, Advice, Randomised trial, ULD, Activity, disability",
author = "Jones, {Gareth T.} and Macfarlane, {Gary J.} and Karen Walker-bone and Anthony Burton and Heine, {Peter J} and Candy Mccabe and Paul McNamee and Alex Mcconnachie and Ruiqi Zhang and Daniel Whibley and Keith Palmer and David Coggon",
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Jones, GT, Macfarlane, GJ, Walker-bone, K, Burton, A, Heine, PJ, Mccabe, C, McNamee, P, Mcconnachie, A, Zhang, R, Whibley, D, Palmer, K & Coggon, D 2019, 'Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial', RMD Open.

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, Anthony; Heine, Peter J; Mccabe, Candy; McNamee, Paul; Mcconnachie, Alex; Zhang, Ruiqi; Whibley, Daniel; Palmer, Keith; Coggon, David.

In: RMD Open, 09.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Maintained physical activity and physiotherapy in the management of distal arm pain

T2 - RMD Open

AU - Jones, Gareth T.

AU - Macfarlane, Gary J.

AU - Walker-bone, Karen

AU - Burton, Anthony

AU - Heine, Peter J

AU - Mccabe, Candy

AU - McNamee, Paul

AU - Mcconnachie, Alex

AU - Zhang, Ruiqi

AU - Whibley, Daniel

AU - Palmer, Keith

AU - Coggon, David

PY - 2019/1/9

Y1 - 2019/1/9

N2 - ObjectivesThe 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.MethodsAdults referred to community-based physiotherapy with distal arm pain were randomised to: advice to remain active while awaiting physiotherapy (typically delivered after 6-8wks); advice to rest while awaiting physiotherapy; or immediate treatment. Intention-to-treat analysis determined whether the probability of recovery at 26wks was greater among the active advice group, compared with those advised to rest; and/or among those receiving immediate versus usually-timed physiotherapy.Results538 of 1663 patients invited between Feb-2012 and Feb-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%), respectively. Those advised to rest experienced a lower probability of recovery (odds ratio: 0.54; 95%CI: 0.32-0.90), versus advice to remain active. However, there was no benefit of immediate physiotherapy (0.64; 0.39-1.07).ConclusionsAmong patients awaiting physiotherapy for distal arm pain, advice to remain active results in better 26wk functional outcome, compared with advice to rest. Also, immediate physiotherapy confers no additional benefit in terms of disability, compared to physiotherapy delivered after 6-8wks waiting time. These findings question current guidance for the management of distal arm pain.

AB - ObjectivesThe 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.MethodsAdults referred to community-based physiotherapy with distal arm pain were randomised to: advice to remain active while awaiting physiotherapy (typically delivered after 6-8wks); advice to rest while awaiting physiotherapy; or immediate treatment. Intention-to-treat analysis determined whether the probability of recovery at 26wks was greater among the active advice group, compared with those advised to rest; and/or among those receiving immediate versus usually-timed physiotherapy.Results538 of 1663 patients invited between Feb-2012 and Feb-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%), respectively. Those advised to rest experienced a lower probability of recovery (odds ratio: 0.54; 95%CI: 0.32-0.90), versus advice to remain active. However, there was no benefit of immediate physiotherapy (0.64; 0.39-1.07).ConclusionsAmong patients awaiting physiotherapy for distal arm pain, advice to remain active results in better 26wk functional outcome, compared with advice to rest. Also, immediate physiotherapy confers no additional benefit in terms of disability, compared to physiotherapy delivered after 6-8wks waiting time. These findings question current guidance for the management of distal arm pain.

KW - distal arm pain

KW - Physiotherapy

KW - Advice

KW - Randomised trial

KW - ULD

KW - Activity

KW - disability

M3 - Article

JO - RMD Open

JF - RMD Open

SN - 2056-5933

ER -