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

Gareth T Jones (Corresponding Author), Gary J Macfarlane, Karen Walker-Bone, Kim Burton, Peter Heine, Candida McCabe, Paul McNamee, Alex McConnachie, Rachel Zhang, Daniel Whibley, Keith T Palmer, David Coggon

Research output: Contribution to journalArticle

1 Citation (Scopus)
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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.
Original languageEnglish
Article number000810
JournalRMD Open
Volume5
Issue number1
DOIs
Publication statusPublished - Feb 2019

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

Keywords

  • Fibromyalgis/pain syndromes
  • Health services research
  • Physcial therapy

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Maintained physical activity and physiotherapy in the management of distal arm pain : a randomised controlled trial . / Jones, Gareth T (Corresponding Author); Macfarlane, Gary J; Walker-Bone, Karen; Burton, Kim; Heine, Peter; McCabe, Candida; McNamee, Paul; McConnachie, Alex; Zhang, Rachel ; Whibley, Daniel; Palmer, Keith T; Coggon, David.

In: RMD Open, Vol. 5, No. 1, 000810, 02.2019.

Research output: Contribution to journalArticle

Jones, Gareth T ; Macfarlane, Gary J ; Walker-Bone, Karen ; Burton, Kim ; Heine, Peter ; McCabe, Candida ; McNamee, Paul ; McConnachie, Alex ; Zhang, Rachel ; Whibley, Daniel ; Palmer, Keith T ; 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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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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note = "The study was funded by Arthritis Research UK (reference: 19231). As part of the grant-awarding procedure, the funder and external parties working for the funder, reviewed and commented on the study design and regular update reports on study progress were submitted to the funder’s Progress Review Committee. However, they had no role in the collection, analysis and interpretation of data; nor in the writing of the report; nor the decision to submit the paper for publication. Data sharing statement Relevant anonymised patient level data are available on reasonable request, from the corresponding author.",
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T1 - Maintained physical activity and physiotherapy in the management of distal arm pain

T2 - a randomised controlled trial

AU - Jones, Gareth T

AU - Macfarlane, Gary J

AU - Walker-Bone, Karen

AU - Burton, Kim

AU - Heine, Peter

AU - McCabe, Candida

AU - McNamee, Paul

AU - McConnachie, Alex

AU - Zhang, Rachel

AU - Whibley, Daniel

AU - Palmer, Keith T

AU - Coggon, David

N1 - The study was funded by Arthritis Research UK (reference: 19231). As part of the grant-awarding procedure, the funder and external parties working for the funder, reviewed and commented on the study design and regular update reports on study progress were submitted to the funder’s Progress Review Committee. However, they had no role in the collection, analysis and interpretation of data; nor in the writing of the report; nor the decision to submit the paper for publication. Data sharing statement Relevant anonymised patient level data are available on reasonable request, from the corresponding author.

PY - 2019/2

Y1 - 2019/2

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.

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KW - Physcial therapy

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