Role of mechanical and psychosocial factors in the onset of forearm pain: prospective population based studyBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7262.676 (Published 16 September 2000) Cite this as: BMJ 2000;321:676
All rapid responses
Macfarlane et al. conducted a two-year population-based cohort study
to determine the aetiology of forearm pain. They assessed the relative
contribution of pyschological factors and work-related mechanical and
pyschosocial factors in the onset of new forearm pain. They concluded that
forearm pain has a multifactorial aetiology combining the above factors.
The age range used was 18-65 years, which has potential implications for a
large proportion of the general population. However, several flaws in the
design of this study limit the value of its results.
The quality of data is highly dependent on questionnaire design,
patient understanding of questions and recall. Furthermore, forearm pain
itself was not clearly defined, and was only considered if it occurred
within the previous month, lasting at least one day. Both of these
factors will have underestimated the incidence of forearm pain.
A further concern is that several possible causative factors were
overlooked. 60% of patients with forearm pain were found to be unemployed
at onset. However, the only psychosocial factors assessed were those at
work, thus excluding over half of the study population. Activities and
stresses at home, and any co-existing disease were also ignored.
Overall the context of the study was unclear, mentioning nothing
about the importance of forearm pain and its impact on the individual in
the community, or in an occupational setting. The authors fail to explain
the implications of their study, for example, disability, number of
working days lost, and cost to the NHS.
Macfarlane et al. rightly conclude that there are factors other than
mechanical strain contributing to forearm pain. However, in view of the
limitations of this study, we feel that further research is necessary.
Malika Mohabeer, Lindsay Beahan, Gemma Anson, Joanne Dawson.
4th year medical students,
Department of Public Health and Epidemiology
University of Newcastle-upon-Tyne
Macfarlane GJ, Hunt IM, Silman AJ. Role of mechanical and
psychosocial factors in the onset of forearm pain: prospective population-
based study. BMJ 2000; 321: 676-9
Competing interests: No competing interests