title: A systematic review of prognostic factors for distal upper limb pain.
abstract: 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.
  
  
  OBJECTIVE
  To identify factors that predict outcome of distal upper limb pain.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  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.
authors.affiliation: 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.
authors.forename: Daniel
authors.initials: D
authors.lastname: Whibley
authors.affiliation: 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.
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Martin
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
authors.affiliation: 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.
authors.forename: Gareth T
authors.initials: GT
authors.lastname: Jones
keywords: Distal upper limb; musculoskeletal pain; prognosis; prognostic factors; systematic review