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

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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.

LanguageEnglish
Article numbere000810
JournalRMD Open
Volume5
Issue number1
DOIs
Publication statusPublished - 1 Mar 2019

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

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Jones, G. T., Macfarlane, G. J., Walker-bone, K., Burton, A., Heine, P. J., 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), [e000810]. https://doi.org/10.1136/rmdopen-2018-000810
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 ; Vol. 5, No. 1.
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title = "Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial",
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.",
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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, vol. 5, no. 1, e000810. https://doi.org/10.1136/rmdopen-2018-000810

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, Vol. 5, No. 1, e000810, 01.03.2019.

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 - 2019/3/1

Y1 - 2019/3/1

N2 - 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.

AB - 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.

KW - distal arm pain

KW - Physiotherapy

KW - Advice

KW - Randomised trial

KW - ULD

KW - Activity

KW - disability

KW - Fibromyalgis/pain syndromes

KW - Physcial therapy

KW - Health services research

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U2 - 10.1136/rmdopen-2018-000810

DO - 10.1136/rmdopen-2018-000810

M3 - Article

VL - 5

JO - RMD Open

JF - RMD Open

SN - 2056-5933

IS - 1

M1 - e000810

ER -