Improvements in function may not yield psychological improvements in musculoskeletal care
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Key takeaways:
- Significant improvements in physical function and pain interference led to improvements in anxiety.
- Improvements in physical function and pain interference were not associated with improvements in depression.
Patients seeking musculoskeletal care required substantial improvements in physical function and pain interference to significantly improve anxiety symptoms, according to results published in JAMA Network Open.
In addition, researchers found no association between improvements in physical function and pain interference with improvements in depression symptoms.
“Patients seeking musculoskeletal care clinicians providing treatment cannot assume that addressing physical health will result in improved symptoms of depression or potentially even sufficiently improved symptoms of anxiety,” Wei Zhang, PhD, of the Mallinckrodt Institute of Radiology at Washington University School of Medicine, and colleagues wrote.
Zhang and colleagues used linear mixed effects models to determine whether improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and PROMIS depression scores were associated with improved PROMIS physical function or pain interference scores after controlling for age, gender, race and PROMIS depression (for the anxiety model) or PROMIS anxiety (for the depression model).
Overall, researchers included 11,236 patients (mean age, 57 years; 64.2% were women; 86.4% were white) seeking musculoskeletal care in the primary cohort. Results showed an association between improvements in physical function and pain interference with statistically and meaningfully improved anxiety symptoms. Zhang and colleagues found that a clinically meaningful improvement in anxiety symptoms required an improvement of 21 or more PROMIS points for physical function or 12 or more PROMIS points for pain interference.
Researchers also found improvements in physical function and pain interference had a statistically but not meaningfully improvement in depression symptoms. To reach a clinically meaningful improvement in depression symptoms, physical function or pain, interference scores would require an associated improvement of 64 or more PROMIS points, according to results.
“We advocate for clinicians to thoughtfully and intentionally address the mental health-related contributors to, and sequelae of, musculoskeletal conditions when counseling patients and creating person-centered treatment plans,” the researchers wrote in the study. “Further investigation is needed to identify methods of addressing mental health in the context of musculoskeletal care that are both feasible and effective.”
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Zhang W, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.20520.
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