Advice to remain active with arm pain reduces disability

Arm pain is a common problem in the workplace. In contrast with the standard biomedical management of distal arm pain, these secondary analyses suggest that advising workers to keep using their arms as much as possible leads to less disability at 6 months, particularly amongst workers who lift heavy weights or believe work caused their symptoms. Early physiotherapy, however, made no difference to disability outcomes. Similar results were seen amongst workers diagnosed with lateral epicondylitis. Background Arm pain is common amongst working-aged adults and causes substantial work disability. The results of a population-based randomized controlled trial (the ARM trial) suggested that advice to remain active reduced disability after 6 months. Aims To verify ARM trial results amongst people in paid employment. Methods The ARM trial recruited adults with distal arm pain referred for physiotherapy and randomized equally to three groups: wait-listed for physiotherapy (advised to rest); wait-listed for physiotherapy (advised to remain active) or early physiotherapy. The primary outcome was absence of disability at 26 weeks. Secondary analyses were undertaken amongst participants in paid employment. Results Amongst 538 trial participants, 347 (64%) were in paid employment, mean age 46.1 years and 47% in manual work. Employed participants were randomized equally to the three arms. Amongst the 271 (78% workers with 26-week data), 43% of those advised to remain active were free from disability, as compared with 37% of those advised to rest. Forty per cent of those who waited for physiotherapy were disability-free as compared with 35% of those treated rapidly. Advice to rest was associated with lower chances of recovery amongst workers who lift/carry weights and those who believed work had caused their symptoms (P = 0.023). Conclusions Although not powered as a trial for workers only, our findings suggest that advising activity was as beneficial for people currently in paid work and may be superior to advice to rest in reducing disability. Addressing harmful beliefs about causation of symptoms has the potential to reduce disability.

Automated summary

Arm pain is a common problem in the workplace. Advicing workers to keep using their arms as much as possible leads to less disability at 6 months, especially for those who lift heavy weights or believe work caused their symptoms. Early physiotherapy, however, made no difference to disability outcomes. Similar results were seen amongst workers diagnosed with lateral epicondylitis.