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Tatta J. A Call to Action for Mental and Behavioral Health Stakeholders: Use Physical Therapists to Close the Gap in Depression Care. Phys Ther 2024; 104:pzad147. [PMID: 37930246 DOI: 10.1093/ptj/pzad147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Joe Tatta
- Integrative Pain Science Institute, New York, New York, USA
- Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
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Spoonemore SL, McConnell RC, Owen WE, Young JL, Clewley DJ, Rhon DI. The influence of pain-related comorbidities on pain intensity and pain-related psychological distress in patients presenting with musculoskeletal pain. Braz J Phys Ther 2023; 27:100532. [PMID: 37611373 PMCID: PMC10468365 DOI: 10.1016/j.bjpt.2023.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/22/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Musculoskeletal pain (MSP) is the largest contributor to chronic pain and frequently occurs alongside other medical comorbidities. OBJECTIVE Explore the relationships between the presence of pain-related comorbidities, pain intensity, and pain-related psychological distress in patients with MSP. METHODS A longitudinal assessment of individuals 18-90 years old in the Midwestern United States beginning a new episode of physical therapy for MSP. Electronic medical records were assessed the full year prior for care-seeking of diagnoses for pain-related comorbidities (anxiety, metabolic disorder, chronic pain, depression, nicotine dependence, post-traumatic stress disorder, sleep apnea, and sleep insomnia). Pain intensity and pain-related psychological distress (Optimal Screening for Prediction of Referral and Outcome - Yellow Flags tool) were captured during the physical therapy evaluation. Generalized linear models were used to assess the association between pain intensity, psychological distress, and pain-related co-morbidities. Models were adjusted for variables shown in the literature to influence pain. RESULTS 532 participants were included in the cohort (56.4% female; median age of 59 years, Interquartile Range [IQR]:47, 69). Comorbid depression (beta coefficient (β) = 0.7; 95%CI: 0.2, 1.2), spine versus lower extremity pain ((β = 0.6; 95%CI: 0.1, 1.1), and prior surgery (β = 0.8, 95%CI: 0.3, 1.4) were associated with higher pain intensity scores. No pain-related comorbidities were associated with pain-related psychological distress (yellow flag count or number of domains). Female sex was associated with less pain-related psychological distress (β = -0.2, 95%CI: -0.3, -0.02). CONCLUSIONS Depression was associated with greater pain intensity. No comorbidities were able to account for the extent of pain-related psychological distress.
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Affiliation(s)
- Steven L Spoonemore
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, United States; U.S. Public Health Service, Intrepid Spirit Center, Fort Carson, CO, United States.
| | - Ryan C McConnell
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, United States; Department of Physical Therapy, Belmont University, Nashville, TN, United States
| | - William E Owen
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, United States
| | - Jodi L Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, United States
| | - Derek J Clewley
- Physical Therapy Division, Duke University School of Medicine, Durham, NC, United States
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, United States; Department of Rehabilitation Medicine, School of Medicine, The Uniformed Services University of Health Sciences, Bethesda, MD, United States
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Heywood SE, Connaughton J, Kinsella R, Black S, Bicchi N, Setchell J. Physical Therapy and Mental Health: A Scoping Review. Phys Ther 2022; 102:pzac102. [PMID: 35926073 DOI: 10.1093/ptj/pzac102] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/17/2021] [Accepted: 05/09/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Coexistence of mental and physical health conditions is prevalent. To achieve optimal physical therapy outcomes, neither should be treated in isolation. This review aimed to map intersections between physical therapy and mental health. METHODS This was a scoping review searching MEDLINE, CINAHL, PsycInfo, Cochrane, and PEDro databases. Two independent researchers screened studies of physical therapy practice with adolescents/adults with mental health disorders or research using primary mental health outcomes in physical health conditions or clinicians' perspective. Data were extracted on study type, participants, topics, publication year, and country. RESULTS The search yielded 3633 studies with 135 included. Five studies included adolescents. More than one-half were published since 2015. Studies specific to participants with mental health diagnoses included schizophrenia (n = 12), depressive disorders (n = 8), eating disorders (n = 6), anxiety disorders (n = 4), bipolar disorders (n = 1), somatic disorders (n = 5), and trauma and stressor-related disorders (n = 8) or varied mental health diagnoses (n = 14). Forty-one studies had primary mental health outcomes or clinical practice approaches with a mental health emphasis with participants with physical health conditions (musculoskeletal [n = 13], neurological [n = 7], other [n = 21]). Systematic reviews or randomized controlled trials predominantly involved exercise therapy and/or physical activity. Descriptions of physical therapists as participants (n = 35) included 4 main topics: (1) mental health screening; (2) knowledge, attitudes, and experiences; (3) key practice components; and (4) research priorities. CONCLUSION Physical therapy intersects with people experiencing mental health disorders across a broad spectrum of diagnoses, covering a range of interventions with a small but growing evidence base. IMPACT Exercise and physical activity studies dominated the highest levels of evidence and future focus, although economic evaluations and consumer-driven or patient experience studies are needed. There is a contrast between the confidence and knowledge of specialized physical therapists working within mental health settings and those in general practice settings. Inspiring, integrated education is required to further improve health care outcomes following physical therapy for people with mental health disorders or symptoms.
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Affiliation(s)
- Sophie E Heywood
- Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Joanne Connaughton
- School of Physiotherapy, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Rita Kinsella
- Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Susie Black
- Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nadia Bicchi
- Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Varela AJ, Melvin A. The theatre of depression: a role for physical therapy. Physiother Theory Pract 2022:1-17. [DOI: 10.1080/09593985.2022.2041136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Antonio J Varela
- School of Physical Therapy, Arkansas College of Health Education, Fort Smith, AR, USA
| | - Ann Melvin
- School of Social and Behavioral Sciences, Capella University, Minneapolis, MN, USA
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Joyce C, Roseen EJ, Keysor JJ, Gross KD, Culpepper L, Saper RB. Can Yoga or Physical Therapy for Chronic Low Back Pain Improve Depression and Anxiety Among Adults From a Racially Diverse, Low-Income Community? A Secondary Analysis of a Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:1049-1058. [PMID: 33556352 DOI: 10.1016/j.apmr.2021.01.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine and compare the effect of yoga, physical therapy (PT), and education on depressive and anxious symptoms in patients with chronic low back pain (CLBP). DESIGN Secondary analysis of a randomized controlled trial. SETTING Academic safety net hospital and 7 community health centers. PARTICIPANTS A total of 320 adults with CLBP. INTERVENTION Yoga classes, PT sessions, or an educational book. OUTCOME MEASURE Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder 7-item Scale, respectively, at baseline, 12, and 52 weeks. We identified baseline and midtreatment (6-wk) factors associated with clinically meaningful improvements in depressive (≥3 points) or anxious (≥2 points) symptoms at 12 weeks. RESULTS Participants (female=64%; mean age, 46.0±10.7 years) were predominantly non-White (82%), low-income (<$30,000/year, 59%), and had not received a college degree (71%). Most participants had mild or worse depressive (60%) and anxious (50%) symptoms. At 12 weeks, yoga and PT participants experienced modest within-group improvements in depressive symptoms (mean difference [MD]=-1.23 [95% CI, -2.18 to -0.28]; MD=-1.01 [95% CI, -2.05 to -0.03], respectively). Compared with the education group, 12-week differences were not statistically significant, although trends favored yoga (MD=-0.71 [95% CI, -2.22 to 0.81]) and PT (MD= -0.32 [95% CI, -1.82 to 1.18]). At 12 weeks, improvements in anxious symptoms were only found in participants who had mild or moderate anxiety at baseline. Independent of treatment arm, participants who had 30% or greater improvement in pain or function midtreatment were more likely to have a clinically meaningful improvement in depressive symptoms (odds ratio [OR], 1.82 [95% CI, 1.03-3.22]; OR, 1.79 [95% CI, 1.06-3.04], respectively). CONCLUSIONS In our secondary analysis we found that depression and anxiety, common in this sample of underserved adults with CLBP, may improve modestly with PT and yoga. However, effects were not superior to education. Improvements in pain and function are associated with a decrease in depressive symptoms. More research is needed to optimize the integration of physical and psychological well-being in PT and yoga.
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Affiliation(s)
- Christopher Joyce
- Department of Rehabilitation Science, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, United States; School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences University, Worcester, Massachusetts, United States.
| | - Eric J Roseen
- Department of Rehabilitation Science, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, United States; Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States
| | - Julie J Keysor
- Department of Rehabilitation Science, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, United States; Department of Physical Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, United States
| | - K Douglas Gross
- Department of Rehabilitation Science, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, United States; Department of Physical Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, United States
| | - Larry Culpepper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States
| | - Robert B Saper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States
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Zhu Y, Jayagopal JK, Mehta RK, Erraguntla M, Nuamah J, McDonald AD, Taylor H, Chang SH. Classifying Major Depressive Disorder Using fNIRS During Motor Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2020; 28:961-969. [DOI: 10.1109/tnsre.2020.2972270] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Staples WH, Kays A, Richman R. Examination of the Correlation Between Physical and Psychological Measures in Community-Dwelling Older Adults. Clin Interv Aging 2020; 15:293-300. [PMID: 32184578 PMCID: PMC7060027 DOI: 10.2147/cia.s239053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction The purpose of this study was to determine if correlations exist between strength and mobility and psychological measures of anxiety and depression in community-dwelling older adults. Methods One hundred and eleven participants randomly completed trials of grip strength (GS), the Timed Up and Go (TUG), the 10-meter walk test (10MWT), the Geriatric Anxiety Scale (GAS), and the Geriatric Depression Scale (GDS) in a prospective, correlational study. Results This study found significant correlations between and within physical measures of strength and mobility and psychological measures. Age, GS, GDS, and education were significant predictors of gait speed (10MWT). Age, GS, and GDS were predictors of TUG scores. Grip strength was found to be a significant predictor of fall status; fallers had significantly weaker GS than non-fallers. Symptoms of anxiety (GAS) were predictive of symptoms of depression. Discussion Objective measures of physical performance can provide information regarding an individual’s symptoms of anxiety and depression. Health professionals should understand the correlations between mood and physical ability to better treat their patients.
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Affiliation(s)
- William H Staples
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA
| | - Adam Kays
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA
| | - Rachel Richman
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA
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