Abstract
Background: Arm pain is common amongst working-aged adults and causes substantial work disability. The results of a population-based randomised controlled trial (the ARM trial) suggested that advice to remain active reduced disability after 6 months.
Aims: To verify ARM trial results amongst people in paid employment.
Methods: The ARM trial recruited adults with distal arm pain referred for physiotherapy and randomised equally to three groups: wait-listed for physiotherapy (advised to rest); wait-listed for physiotherapy (advised to remain active); or early physiotherapy. The primary outcome was absence of disability at 26 weeks. Secondary analyses were undertaken amongst participants in paid employment.
Results: Amongst 538 trial participants, 347 (64%) were in paid employment, mean age 46.1 years, 47% in manual work. Employed participants were randomised equally to the three arms. Amongst the 271 (78% workers with 26-week data), 43% of those advised to remain active were free from disability, as compared with 37% of those advised to rest. 40% of those who waited for physiotherapy were disability-free as compared with 35% of those treated rapidly. Advice to rest was associated with lower chances of recovery amongst workers who lift/carry weights and those who believed work had caused their symptoms (p=0.023). Conclusions: Although not powered as a trial for workers only, our findings suggest that advising activity was as beneficial for people currently in paid work and may be superior to advice to rest in reducing disability. Addressing harmful beliefs about causation of symptoms has potential to reduce disability.
Aims: To verify ARM trial results amongst people in paid employment.
Methods: The ARM trial recruited adults with distal arm pain referred for physiotherapy and randomised equally to three groups: wait-listed for physiotherapy (advised to rest); wait-listed for physiotherapy (advised to remain active); or early physiotherapy. The primary outcome was absence of disability at 26 weeks. Secondary analyses were undertaken amongst participants in paid employment.
Results: Amongst 538 trial participants, 347 (64%) were in paid employment, mean age 46.1 years, 47% in manual work. Employed participants were randomised equally to the three arms. Amongst the 271 (78% workers with 26-week data), 43% of those advised to remain active were free from disability, as compared with 37% of those advised to rest. 40% of those who waited for physiotherapy were disability-free as compared with 35% of those treated rapidly. Advice to rest was associated with lower chances of recovery amongst workers who lift/carry weights and those who believed work had caused their symptoms (p=0.023). Conclusions: Although not powered as a trial for workers only, our findings suggest that advising activity was as beneficial for people currently in paid work and may be superior to advice to rest in reducing disability. Addressing harmful beliefs about causation of symptoms has potential to reduce disability.
| Original language | English |
|---|---|
| Pages (from-to) | 268-274 |
| Number of pages | 7 |
| Journal | Occupational Medicine |
| Volume | 73 |
| Issue number | 5 |
| Early online date | 1 Jun 2023 |
| DOIs | |
| Publication status | Published - 1 Jun 2023 |
Bibliographical note
The ARM pain trial was funded by a grant from Arthritis Research UK (now Versus Arthritis): Award reference: 19231.Keywords
- employment
- lifting
- arm
- upper limb pain
- disability