RT Journal Article
SR Electronic
T1 Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial
JF RMD Open
JO RMD Open
FD EULAR
SP e000810
DO 10.1136/rmdopen-2018-000810
VO 5
IS 1
A1 Gareth T Jones
A1 Gary J Macfarlane
A1 Karen Walker-Bone
A1 Kim Burton
A1 Peter Heine
A1 Candida McCabe
A1 Paul McNamee
A1 Alex McConnachie
A1 Rachel Zhang
A1 Daniel Whibley
A1 Keith Palmer
A1 David Coggon
YR 2019
UL http://rmdopen.bmj.com/content/5/1/e000810.abstract
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.