Citation

Wideman TH, Scott W, Martel MO, Sullivan MJ. J. Orthop. Sports Phys. Ther. 2012; 42(11): 957-967.

Copyright

(Copyright © 2012, Orthopaedic Section and Sports Physical Therapy Section of the American Physical Therapy Association)

DOI

10.2519/jospt.2012.4182

PMID

22711267

Abstract

STUDY DESIGN: Prospective cohort. OBJECTIVES: 1) Determine the trajectory of depressive symptoms over the course of physical therapy; 2) Identify variables that best predict the resolution of depressive symptoms; 3) Explore the relationship between recovery from depressive symptoms and long-term outcomes. BACKGROUND: 25 to 50% of patients referred to physical therapy for orthopaedic injuries suffer from symptoms of depression. Depressive symptoms have been identified as an influential risk factor for problematic response to physical therapy. Despite these findings, there is a dearth of research specifically exploring the trajectory, and determinants, of patients' depressive symptoms over the course of physical therapy; thus impeding the evidence-based management of patients with depressive symptoms. METHODS: 106 patients with work-related musculoskeletal injuries and symptoms of depression received 7-weeks of physical therapy, and were followed 1-year after treatment onset. Pain intensity, depressive symptoms and other psychosocial factors were evaluated throughout treatment; follow-up data was collected 1-year later. RESULTS: Depressive symptoms resolved for 40% of patients; resolution was linked to pain and disability at one-year follow-up. Persistence of depressive symptoms at treatment completion was predicted by elevated levels of depressive symptoms and pain catastrophizing at pre-treatment, and lack of improvement in levels of depressive symptoms and pain self-efficacy at mid-treatment. CONCLUSION: For many patients, depressive symptoms resolve over the course of physical therapy, and resolution is associated with long-term improvements in pain and disability. These findings will help identify patients whose depressive symptoms are least likely to respond to physical therapy and may therefore warrant additional treatment. LEVEL OF EVIDENCE: Therapy, Level 2b.

Language: en