TY - JOUR
T1 - The relationship between depression, anxiety, and pain interference with therapy referral and utilization among patients with hand conditions
AU - Cochrane, Shannon K.
AU - Calfee, Ryan P.
AU - Stonner, Macyn M.
AU - Dale, Ann Marie
N1 - Funding Information:
Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. The authors would like to thank Skye Buckner-Petty, Anna M. Kinghorn, and Dr Bradley Evanoff in the Washington University School of Medicine in St. Louis Occupational Safety and Health Research Lab for their contributions.
Publisher Copyright:
© 2020 Hanley & Belfus
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Introduction: Patients with upper extremity conditions may also experience symptoms of depression, anxiety, and pain that limit functional recovery. Purpose of the Study: This study examined the impact of mental health and pain symptoms on referral rates to therapy and utilization of therapy services to achieve functional recovery among patients with common hand conditions. Study Design: This is a retrospective cohort study of patients from one orthopedic center. Methods: Data extraction provided demographics, the International Classification of Diseases, 10th revision diagnoses, therapy referral, therapy visit counts, treatment goal attainment, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Pain Interference scores. The chi-square test, t-test, and logistic regression analyses assessed associations between baseline PROMIS depression, anxiety, and pain interference to therapy referral, the number of therapy visits, and goal attainment. Results: Forty-nine percent (172/351) of patients were referred to hand therapy. There was no relationship between three baseline PROMIS scores based on physician referral (t-test P values .32-.67) and no association between PROMIS scores and therapy utilization or goal attainment (Pearson correlation (r): 0.002 to 0.020, P > .05). Referral to therapy was most strongly associated with having a traumatic condition (P < .01). Patients with high depression, anxiety, and pain interference scores on average required one more therapy visit to achieve treatment goals (average visits: 3.7 vs 3.1; 4.1 vs 2.7; 3.4 vs 2.3, respectively). Fewer patients with high depression scores (50%) achieved their long-term goals than patients with low depression scores (69%, P = .20). Conclusions: Patients' baseline level of depressive symptoms and anxiety do not predict referrals to hand therapy by orthopedic hand surgeons. There is some indication that patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals, suggesting that mental health status may affect response to therapy. Therapists may address mental health needs in treatment plans. Future studies should examine if nonreferred patients with depressive symptoms achieve maximal functional recovery.
AB - Introduction: Patients with upper extremity conditions may also experience symptoms of depression, anxiety, and pain that limit functional recovery. Purpose of the Study: This study examined the impact of mental health and pain symptoms on referral rates to therapy and utilization of therapy services to achieve functional recovery among patients with common hand conditions. Study Design: This is a retrospective cohort study of patients from one orthopedic center. Methods: Data extraction provided demographics, the International Classification of Diseases, 10th revision diagnoses, therapy referral, therapy visit counts, treatment goal attainment, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Pain Interference scores. The chi-square test, t-test, and logistic regression analyses assessed associations between baseline PROMIS depression, anxiety, and pain interference to therapy referral, the number of therapy visits, and goal attainment. Results: Forty-nine percent (172/351) of patients were referred to hand therapy. There was no relationship between three baseline PROMIS scores based on physician referral (t-test P values .32-.67) and no association between PROMIS scores and therapy utilization or goal attainment (Pearson correlation (r): 0.002 to 0.020, P > .05). Referral to therapy was most strongly associated with having a traumatic condition (P < .01). Patients with high depression, anxiety, and pain interference scores on average required one more therapy visit to achieve treatment goals (average visits: 3.7 vs 3.1; 4.1 vs 2.7; 3.4 vs 2.3, respectively). Fewer patients with high depression scores (50%) achieved their long-term goals than patients with low depression scores (69%, P = .20). Conclusions: Patients' baseline level of depressive symptoms and anxiety do not predict referrals to hand therapy by orthopedic hand surgeons. There is some indication that patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals, suggesting that mental health status may affect response to therapy. Therapists may address mental health needs in treatment plans. Future studies should examine if nonreferred patients with depressive symptoms achieve maximal functional recovery.
KW - Clinical course
KW - Functional performance
KW - Mental health
KW - PROMIS
KW - Therapy
KW - Treatment goals
UR - http://www.scopus.com/inward/record.url?scp=85097096699&partnerID=8YFLogxK
U2 - 10.1016/j.jht.2020.10.006
DO - 10.1016/j.jht.2020.10.006
M3 - Article
C2 - 33250395
AN - SCOPUS:85097096699
SN - 0894-1130
VL - 35
SP - 24
EP - 31
JO - Journal of Hand Therapy
JF - Journal of Hand Therapy
IS - 1
ER -