P178 Advising workers with distal arm pain to remain active: a secondary analysis of the ARM trial, a multicentre randomised controlled trial
Authors: Jones Gareth T , Macfarlane Gary J , Burton Kim , Walker-Bone Karen 
Published: April 2022

Abstract

Background/Aims
Pain in the distal arm (elbow/forearm/wrist/hand) is common amongst working-aged adults and causes substantial work disability. The best strategy for managing arm pain is uncertain and patients are often referred to physiotherapy. We have recently shown in a randomised controlled trial (the ARM trial) that long-term disability was reduced among patients advised to remain active while awaiting physiotherapy, compared to advice to rest. The aim of the current study was to determine whether this approach is effective among workers, who may have to continue activities that are causing or exacerbating their pain; and whether there was any differential effect between workers doing manual versus non-manual work, and exposed versus not exposed to a range of physically demanding activities involving the upper limb.

Methods
The ARM trial (ISRCTN79085082) recruited patients with distal arm pain from 14 outpatient physiotherapy departments across the UK. Eligible consenting patients were randomised equally to: Advice to remain active, while awaiting physiotherapy; Advice to rest, while awaiting physiotherapy; or Immediate physiotherapy. This was done using a mixed randomisation/minimisation algorithm, maintaining treatment balance regarding treatment centre, gender, laterality, a broad categorisation of diagnosis, and baseline arm function. The primary outcome was freedom from disability at 26wks, as determined using the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. In the current study, an intention-to-treat analysis was undertaken for the sub-group of trial participants in paid employment &gt; =20hrs/wk at the start of the study. Results are presented as odds ratios, with 95% confidence intervals, for the probability of recovery.

Results
We have previously shown, among persons awaiting physiotherapy for distal arm pain, that advice to remain active is associated with improved long-term outcomes. Although not powered as a trial for workers, our findings suggest that these results also hold true for people in paid work - and there is certainly no evidence that this advice is detrimental. We have also shown that fast-track physiotherapy seems to confer no benefit, over and above therapy delivered after a period on a waiting list which calls into question the benefit of rapid access rehabilitation programmes.

Conclusion
We have previously shown, among persons awaiting physiotherapy for distal arm pain, that advice to remain active is associated with improved long-term outcomes. Although not powered as a trial for workers, our findings suggest that these results also hold true for people in paid work who may have to continue activities that are causing or exacerbating their pain. Certainly, there is no evidence that this advice is detrimental. We have also shown that fast-track physiotherapy seems to confer no benefit, over and above therapy delivered after a period on a waiting list which calls into question the benefit of rapid access rehabilitation programmes.

Disclosure
G.T. Jones: None. G.J. Macfarlane: None. K. Burton: Royalties; Was involved in the development of The Arm Book (ISBN: 978-0117069145) to which the experimental leaflet in this trial is related, and may receive future royalties on the booklet. K. Walker-Bone: None.