Predictors of poor functional outcome of an episode of distal upper limb pain: the Arm Pain Trial

Daniel Whibley, Kathryn Martin, Karina Lovell, Gary J MacFarlane, Keith T Palmer, David Coggon, Karen Walker-Bone, Kim Burton, Peter J Heine, Candy McCabe, Paul McNamee, Alex McConnachie, Gareth T Jones

Research output: Contribution to journalAbstractpeer-review


Background Every year an estimated 15% of the UK population consult their GP for arm pain, with almost half reporting pain in the distal upper limb. Work incapacity resulting from disabling distal upper limb pain presents a substantial economic burden to society. Previous studies focusing on the whole arm have enrolled low numbers of participants with distal upper limb pain, preventing meaningful analysis for this region. There has also been a focus on pain outcome, with less attention given to functional status. Psychosocial factors have been identified as important in determining disability associated with other musculoskeletal pain syndromes. Identification of specific, modifiable psychosocial factors that predict functional impairment associated with an episode of distal upper limb pain may inform management strategies, as well as public and occupational health initiatives. Methods This analysis used data from a randomised controlled trial investigating management of distal upper limb pain (ISRCTN79085082). Participants were recruited after referral to physiotherapy and randomised to one of three groups: advice to rest the distal upper limb during the usual waiting period for physiotherapy (six to seven weeks), advice to remain active, and fast-track (immediate) physiotherapy. The primary outcome was persistent disability at six months, measured using the modified Disabilities of the Arm, Shoulder and Hand questionnaire (DASH: range 0–11). Outcome was dichotomised, with poor outcome defined as any disability (1–11). Information on a range of putative prognostic factors was collected using a self-completed questionnaire, including demographic, painrelated, psychosocial, occupational, functional and general health factors. Forward stepwise multivariable logistic regression (inclusion set at p<0.1 and exclusion at p>0.15) was used to identify factors at recruitment that independently predicted poor functional outcome six months later. Results Of 431 participants (55% female), 63% experienced functional limitation six months after recruitment. After adjustment for sex and baseline pain and disability, 21 factors (pain-related, psychosocial, occupational and general health) predicted outcome at significance level p<0.2 and were offered to the stepwise regression model. Independent predictors of functional limitation at six months included being female (OR 2.16, 95%CI 1.03–4.52), presenting with moderate pain (3.48, 1.01–11.92) or severe pain (5.78, 1.63– 20.48) compared to mild pain, holding the belief that physical activity might be harmful for arm pain (1.81, 0.72–4.55), scoring in the middle or upper third on the Modified Somatic Perception Questionnaire (2.54, 1.11–5.83 and 5.34, 1.88–15.16 respectively) compared to the lower third, and undertaking non-computer based tasks at work that involve repetitive wrist or finger movement for >4 hours per day (2.47, 1.20–5.09). Conclusion This study found that continued functional limitation was common, with nearly two-thirds of participants reporting some disability six months after presenting with pain in the distal upper limb. Two psychological factors predicted poor outcome: negative beliefs about activity and presenting with features of somatisation. Patients presenting to primary care or physiotherapy services with distal upper limb pain and such predictors of poor outcome may benefit from psychological interventions. These results may help to inform a stratified model of care where those at higher risk of persistent disability are identified early and treated accordingly
Original languageEnglish
Article number34
Pages (from-to)22-23
Number of pages2
JournalBritish Journal of Pain
Issue number2 Suppl. 1
Publication statusPublished - Apr 2015
EventBritish Pain Society Annual Scientific Meeting 2015 - Glasgow, United Kingdom
Duration: 21 Apr 201523 Apr 2015


  • Arm pain
  • Arm Pain trial


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