Whibley Daniel, Martin Kathryn R, Lovell Karina, Jones Gareth T
Musculoskeletal Research Collaboration, Epidemiology Group, University of Aberdeen, Aberdeen, UK ; Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK.
School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
Br J Pain. 2015 Nov;9(4):241-55. doi: 10.1177/2049463715590885.
Musculoskeletal pain in the distal upper limb is relatively common, can be a cause of disability, presents a high cost to society and is clinically important. Previous reviews of prognostic factors have focused on pain in the proximal upper limb, whole upper extremity or isolated regions of the distal upper limb.
To identify factors that predict outcome of distal upper limb pain.
Systematic review.
Eight bibliographic databases were searched from inception to March 2014. Eligible articles included adults with pain anywhere in the distal upper limb at baseline from randomised controlled trials with a waiting list, expectant policy or usual care group, or observational studies where no treatment or usual care was provided. Data describing the association between a putative prognostic factor and pain or functional outcome at follow-up were required. Quality was assessed using the Quality in Prognostic Studies tool.
Seven articles reporting on six studies were identified. Heterogeneity of study populations and outcome measures prevented a meta-analysis so a narrative synthesis of results was undertaken. Three factors (being female, a longer duration of the complaint at initial presentation and having musculoskeletal pain in multiple locations) were significantly associated with poor pain outcome in more than one study. Being female was the only factor significantly associated with poor functional outcome in more than one study.
A range of sociodemographic, pain-related, occupational and psychosocial prognostic factors for distal upper limb pain outcomes were investigated in studies included in the review. However, due to the lack of commonality of factors investigated and lack of consistency of results across studies, there is limited evidence for predictors of distal upper limb pain outcomes. Further research is required to identify prognostic factors of distal upper limb pain, particularly modifiable factors that may influence management.
上肢远端的肌肉骨骼疼痛相对常见，可能导致残疾，给社会带来高昂成本，且在临床上具有重要意义。以往对预后因素的综述主要关注上肢近端、整个上肢或上肢远端孤立区域的疼痛。
确定预测上肢远端疼痛预后的因素。
系统评价。
检索了8个文献数据库，检索时间从建库至2014年3月。符合条件的文章包括来自随机对照试验的成年人，这些试验设有等待名单、观察性策略或常规护理组，基线时上肢远端任何部位有疼痛，或者是未提供治疗或常规护理的观察性研究。需要有描述假定预后因素与随访时疼痛或功能结局之间关联的数据。使用“预后研究质量”工具评估质量。
共识别出7篇报道6项研究的文章。研究人群和结局指标的异质性使得无法进行荟萃分析，因此对结果进行了叙述性综合分析。在不止一项研究中，有三个因素（女性、初始就诊时症状持续时间较长、多处有肌肉骨骼疼痛）与疼痛预后不良显著相关。女性是在不止一项研究中与功能预后不良显著相关的唯一因素。
本综述纳入的研究调查了一系列与上肢远端疼痛结局相关的社会人口学、疼痛相关、职业和心理社会预后因素。然而，由于所研究因素缺乏共性，且各研究结果缺乏一致性，关于上肢远端疼痛结局预测因素的证据有限。需要进一步研究以确定上肢远端疼痛的预后因素，特别是可能影响治疗的可改变因素。
