Distal arm pain – pain in the elbow, forearm, wrist or hand – comprises a number of specific and non-specific conditions. It is common in people of working age and results in considerable lost work time, demand for healthcare and disability.
The best approach to management is unclear and, in addition to physiotherapy, patients are often advised to avoid presumed harmful activities. While this may be sensible where there is clear disease of local tissues, an analogy can be drawn with non-specific low back pain which for many years was managed by bed rest, until trials demonstrated an improved prognosis if patients were advised to remain mobile. It seems plausible that distal arm pain might also benefit from such a plan of care.
The ARM trial is testing the hypothesis that patients with distal arm pain who are advised to maintain usual activities while waiting to receive physiotherapy will experience improvements in function compared to those advised to rest the arm. It is also able to address whether “fast-track” physiotherapy results in better outcomes in comparison to physiotherapy delivered at the usual time. The study protocol is available online.
Currently recruitment and follow-up is complete and the trial will report by 2016.
Jones G, Macfarlane GJ, Walker-Bone K, Burton K, Heine PJ, McCabe CS, McNamee P, McConnachie A, Zhang R, Whibley D, Palmer KT, Coggon D. Maintained physical activity and physiotherapy in the management of distal arm pain – a randomised controlled trial.
Jones GT, Mertens K, Macfarlane GJ, Palmer KT, Coggon D, Walker-Bone K, Burton K, Heine P, McCabe C, McNamee P and McConnachie A Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the Arm Pain Trial). BMC Musculoskeletal Disorders. 2014, 15:71 DOI: 10.1186/1471-2474-15-71.
Neilson A, Jones G, Macfarlane G, Walker-Bone K, Burton K, Heine P, McCabe C, McConnachie A, Palmer K, Coggon D, McNamee P. Cost-utility of maintained physical activity and physiotherapy in the management of distal arm pain: an economic evaluation of data from a randomised controlled trial. Family Practice 2019;36(2):179-186.
Whibley D, Martin KR, Lovell K, Jones GT. A systematic review of prognostic factors for distal upper limb pain. British Journal of Pain. 2015;9(4):241-255.
Whibley D, MacDonald R, Macfarlane GJ, Jones GT. Constructs of health belief and disabling distal upper limb pain. Scandinavian Journal of Pain. 2016;13:91-97.
Jones GT, Macfarlane GJ, Palmer KT, Coggon D, Walker-Bone K, et al. Advice to remain active while awaiting physiotherapy is associated with superior long-term outcome among patients with distal arm pain – results from a randomised controlled trial. 2015 ACR/ARHP Annual Meeting, San Francisco [link].
Whibley D, Martin KR, Lovell K, Macfarlane GJ, Palmer K, Coggon D, Walker-Bone K, Burton K, Heine P, McCabe C, McNamee P, McConnachie A, Jones GT. Do Some Patients with Distal Upper Limb Pain Benefit More Than Others from Advice to Remain Active? [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). [link].