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Depression and patients attending outpatient physical therapy with musculoskeletal pain and disability

MOJ Orthopedics & Rheumatology
Adriaan Louw,1 Ashlyn Rulis,2  Gabrielle Mendoza,3  Fred Kassal,4  Jacob Brennan,5  Hailey Louw,6  Kevin Farrell7

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  1. Background:Depression is very prevalent and a comorbidity in musculoskeletal pain. Physical therapists treat high volumes of patients with musculoskeletal pain, thus warranting a need to screen patients for depression for safety and proper treatment. The aim of this study was to screen patients attending outpatient physical therapy for depression and determine what variables predict the presence of depression.
  2. Patients and methods: A convenience sample of patients attending outpatient physical therapy for musculoskeletal pain was asked to complete a survey consisting of demographic information and the Patient Health Questionnairre-9 (PHQ-9),nine-item depression scale.
  3. Results: The patient sample consisted of 320 patients with a mean age of 52.36 (±16.78) years with a mean duration of pain of 5.89 (±6.69) months. Mean PHQ-9 score at intake was 5.37±4.84) with 14.1% of the patients classified as moderate to severe depression. The variables most associated with a high PHQ-9 score were being disabled (β = 4.26, p = 0.01), having personal injury insurance (β = 4.04, p = 0.12) and a high body-mass index (β = 3.75, p = 0.30). Lower PHQ-9 scores were associated with getting more sleep (β = -0.76, p = 0.02) and higher minutes of exercise per week (β = -0.004, p = 0.25).
  4. Conclusions:Approximately one in seven patients attending outpatient PT for musculoskeletal pain present with moderate to severe depression. Various patient characteristics were identified that may indicate a higher likelihood of clinical depression, which may aid in the identification of depression in patients with musculoskeletal pain. Additional research is needed to validate these preliminary findings from this study.


depression, musculoskeletal pain, physical therapy, mental and behavioral health