Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK.
Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK.
RMD Open. 2019 Mar 4;5(1):e000810. doi: 10.1136/rmdopen-2018-000810. eCollection 2019.
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.
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.
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).
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.
远端手臂疼痛和背痛的流行病学相似。然而，管理方法却大不相同：对于背痛，不鼓励休息，而对于远端手臂疼痛，通常建议患者休息并转介物理治疗。我们假设保持活跃会减少长期残疾，并且快速通道物理治疗将优于在等待名单上等待一段时间后的物理治疗。
将被转诊至社区基础物理治疗的患有远端手臂疼痛的成年人随机分为三组：在等待物理治疗期间建议保持活跃（通常在 6-8 周后进行）；在等待物理治疗期间建议休息；或立即治疗。意向治疗分析确定在 26 周时，积极建议组与建议休息和/或立即接受治疗的组相比，恢复的可能性是否更大。
在 2012 年 2 月至 2014 年 2 月之间邀请的 1663 名患者中有 538 名（积极组=178；休息组=182；立即物理治疗组=178）。81%的患者提供了主要结局数据，60 名（44%）、46 名（32%）和 53 名（35%）报告完全恢复。与保持活跃的建议相比，建议休息的患者恢复的可能性较低（OR：0.54；95%CI 0.32 至 0.90）。然而，立即物理治疗没有带来任何好处（0.64；95%CI 0.39 至 1.07）。
在等待物理治疗的远端手臂疼痛患者中，与建议休息相比，保持活跃的建议可在 26 周时获得更好的功能结局。此外，与等待 6-8 周后进行物理治疗相比，立即进行物理治疗在残疾方面没有额外的益处。这些发现质疑了目前对远端手臂疼痛管理的指导。
