Improvements in physical function and pain interference are required for clinically meaningful improvements in anxiety, but not depression symptoms, according to study results published in JAMA Network Open.
Researchers conducted a cohort study involving adult patients treated by an orthopedic department of a US academic medical center from June 22, 2015, to February 9, 2022. The study aimed to examine if improvements in physical function and pain interference led to meaningful improvements in anxiety and depression symptoms among patients seeking musculoskeletal care. Linear mixed-effects models were used to investigate if there is a correlation between enhancements in PROMIS Anxiety and PROMIS Depression scores, and betterment in PROMIS Physical Function or Pain Interference scores. Clinically meaningful improvement was defined as a minimum of 3.0 points for PROMIS Anxiety and 3.2 points or higher for PROMIS Depression.
Statistically and meaningfully improved anxiety symptoms were associated with improvements in physical function (β=-0.14; 95% CI, -0.15 to -0.13; P for false discovery rate (FDR) <.001) and pain interference (β=0.26; 95% CI, 0.25-0.26; P for FDR <.001).
Statistically significant improvements were observed in physical function (β=-0.05; 95% CI, -0.06 to -0.04; P for FDR <.001) and pain interference (β=0.04; 95% CI, 0.04-0.05; P for FDR <.001). However, these improvements did not have a meaningful impact on depression symptoms.
Among several study limitations, the study’s observational nature limits the causality attributed to the associations between physical and mental health identified. The patient cohort was not racially diverse. Additional sociodemographic and clinical variables were not available to include as possible confounders.
“[M]usculoskeletal clinicians and patients cannot assume that exclusively
structure-based treatment of a musculoskeletal condition will necessarily result in improved symptoms of depression or potentially even anxiety,” the study authors concluded. “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.”
Zhang W, Singh SP, Clement A, Calfee RP, Bijsterbosch JD, Cheng AL. Improvements in physical function and pain interference and changes in mental health among patients seeking musculoskeletal care. JAMA Netw Open. Published online June 28, 2023. doi:10.1001/jamanetworkopen.2023.20520