A systematic review of prognostic factors for distal upper limb pain

Daniel Whibley, Kathryn R Martin, Karina Lovell, Gareth T Jones

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10 Citations (Scopus)
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Background: 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.
Aim: To identify factors that predict outcome of distal upper limb pain.
Study design: Systematic review
Method: 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.
Results: 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.
Conclusions: 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.
Original languageEnglish
Pages (from-to)241-255
Number of pages15
JournalBritish Journal of Pain
Issue number4
Early online date30 Jun 2015
Publication statusPublished - 1 Nov 2015

Bibliographical note

Mel Bickerton, Information Consultant at the University of Aberdeen, provided assistance with the development of the search strategy.

Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: D.W. was funded by a University of Aberdeen Institute of Applied Health Sciences PhD studentship.


  • distal upper limb
  • prognosis
  • systematic review
  • musculoskeletal pain
  • prognostic factors


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