Priorities for Advancing Mental and Social Health Among People Presenting for Care of Musculoskeletal Symptoms

Ring, David

doi:10.1007/s10880-022-09865-w

Cited by 7 publications

(6 citation statements)

References 46 publications

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“… 37 , 38 Current orthopedic literature underscores avenues for physician improvement in addressing mental health including improved screening and interdisciplinary collaboration. 39 - 41 A concerted effort by orthopedic surgeons and musculoskeletal care providers to be aware of and address mental and physical health during visits has the potential to improve both patient access to care and ultimately patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Low-Income, Poor Physical Health, Poor Mental Health, and Other Social Risk Factors Are Associated With Decreased Access to Care in Patients With Carpal Tunnel Syndrome

Boddu,

Lin,

Gill

et al. 2024

J Prim Care Community Health

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Background: Carpal Tunnel Syndrome (CTS) is associated with a significant personal and societal burden. Evaluating access to care can identify barriers, limitations, and disparities in the delivery of healthcare services in this population. The purpose of this study was to evaluate access to overall healthcare and healthcare utilization among patients with CTS. Methods: This is a retrospective cohort study conducted with the All of Us database. Patients diagnosed with CTS that completed the access to care survey were included and matched to a control group. The primary outcomes were access to care across 4 domains: (1) delayed care, (2) could not afford care, (3) skipped medications, and (4) over 1 year since seeing provider. Secondary analysis was then performed to identify patient-specific factors associated with reduced access to care. Results: In total, 7649 patients with CTS were included and control matched to 7649 patients without CTS. In the CTS group, 33.7% (n = 2577) had delayed care, 30.4% (n = 2323) could not afford care, 15.4% (n = 1180) skipped medications, and 1.6% (n = 123) had not seen a provider in more than 1 year. Within the CTS cohort, low-income, worse physical health, and worse mental health were associated with poor access to care. Conclusion: Patients experience notable challenges with delayed care, affordability of care, and medication adherence regardless of having a diagnosis of CTS. Targeted interventions on modifiable risk factors such as low income, poor mental health, and poor physical health are important opportunities to improve access to care in this population.

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Section: Discussionmentioning

confidence: 99%

Low-Income, Poor Physical Health, Poor Mental Health, and Other Social Risk Factors Are Associated With Decreased Access to Care in Patients With Carpal Tunnel Syndrome

Boddu,

Lin,

Gill

et al. 2024

J Prim Care Community Health

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“…Musculoskeletal clinicians also have discrepant opinions regarding whether addressing patients’ mental health falls within their professional role . Some musculoskeletal clinicians are interested in additional resources to better address mental health within the musculoskeletal care setting, but acquisition of these resources has remained challenging without widespread agreement regarding the need for this investment . A better understanding of the associations between physical health and mental health changes can guide musculoskeletal clinicians in: (1) the importance they place on addressing mental health–related symptoms as a component of their patient care, and (2) how they counsel patients regarding expectations of their symptom trajectory as their physical impairment is addressed.…”

Section: Introductionmentioning

confidence: 99%

Improvements in Physical Function and Pain Interference and Changes in Mental Health Among Patients Seeking Musculoskeletal Care

Zhang,

Singh,

Clement

et al. 2023

JAMA Netw Open

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ImportanceAmong patients seeking care for musculoskeletal conditions, there is mixed evidence regarding whether traditional, structure-based care is associated with improvement in patients’ mental health.ObjectiveTo determine whether improvements in physical function and pain interference are associated with meaningful improvements in anxiety and depression symptoms among patients seeking musculoskeletal care.Design, Setting, and ParticipantsThis cohort study included adult patients treated by an orthopedic department of a tertiary care US academic medical center from June 22, 2015, to February 9, 2022. Eligible participants presented between 4 and 6 times during the study period for 1 or more musculoskeletal conditions and completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures as standard care at each visit.ExposurePROMIS Physical Function and Pain Interference scores.Main Outcomes and MeasuresLinear mixed effects models were used to determine whether improvements in 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). Clinically meaningful improvement was defined as 3.0 points or more for PROMIS Anxiety and 3.2 points or more for PROMIS Depression.ResultsAmong 11 236 patients (mean [SD] age, 57 [16] years), 7218 (64.2%) were women; 120 (1.1%) were Asian, 1288 (11.5%) were Black, and 9706 (86.4%) were White. Improvements in physical function (β = −0.14; 95% CI, −0.15 to −0.13; P &lt; .001) and pain interference (β = 0.26; 95% CI, 0.25 to 0.26; P &lt; .001) were each associated with improved anxiety symptoms. To reach a clinically meaningful improvement in anxiety symptoms, an improvement of 21 PROMIS points or more (95% CI, 20-23 points) on Physical Function or 12 points or more (95% CI, 12-12 points) on Pain Interference would be required. Improvements in physical function (β = −0.05; 95% CI, −0.06 to −0.04; P &lt; .001) and pain interference (β = 0.04; 95% CI, 0.04 to 0.05; P &lt; .001) were not associated with meaningfully improved depression symptoms.Conclusions and RelevanceIn this cohort study, substantial improvements in physical function and pain interference were required for association with any clinically meaningful improvement in anxiety symptoms, and were not associated with any meaningful improvement 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.

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“…9,13,17 Some musculoskeletal clinicians are interested in additional resources to better address mental health within the musculoskeletal care setting, 18 but acquisition of these resources has remained challenging without widespread agreement regarding the need for this investment. 13,17,19 A better understanding of the relationship between physical health and mental health changes can guide musculoskeletal clinicians in: 1) the importance they place on addressing mental health related symptoms as a component of their patient care, and 2) how they counsel patients regarding expectations of their symptom trajectory as their physical impairment is addressed.…”

Section: Introductionmentioning

confidence: 99%

Relationships between improvement in physical function, pain interference, and mental health in musculoskeletal patients

Zhang¹,

Singh

Clement³

et al. 2023

Preprint

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IMPORTANCE: Among patients seeking care for musculoskeletal conditions, there is mixed evidence regarding whether traditional, structure-based care is associated with improvement in patients' mental health. OBJECTIVE: To determine whether improvements in physical function and pain interference are associated with meaningful improvements in anxiety and depression symptoms among patients seeking musculoskeletal care. DESIGN: Retrospective cohort study from June 22, 2015 to February 9, 2022. SETTING: Orthopedic department of a tertiary care US academic medical center. PARTICIPANTS: Consecutive sample of adult patients who presented to the musculoskeletal clinic 4 to 6 times during the study period and completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures as standard care at each visit. EXPOSURE: PROMIS Physical Function and Pain Interference scores. MAIN OUTCOMES AND MEASURES: Linear mixed effects models were used to determine whether: 1) PROMIS Anxiety and 2) PROMIS Depression scores improved as a function of improved PROMIS Physical Function or Pain Interference scores, after controlling for age, gender, race, and PROMIS Depression (for the Anxiety model) and PROMIS Anxiety (for the Depression model). Clinically meaningful improvement was defined as ≥3.0 points for PROMIS Anxiety and ≥3.2 points for PROMIS Depression. RESULTS: Among 11,236 patients (mean [SD] age 57 [16] years), 9,706 (86%) were White, and 7,218 (64%) were women. Improvements in physical function (β=-0.14 [95% CI -0.15— -0.13], p<0.001) and pain interference (β=0.26 [0.25-0.26], p<0.001) were each associated with improved anxiety symptoms. To reach a clinically meaningful improvement in anxiety symptoms, an improvement of ≥21 [20-23] PROMIS points on Physical Function or ≥12 [12-12] points on Pain Interference would be required. Improvements in physical function (β=-0.05 [-0.06— -0.04], p<0.001) and pain interference (β=0.04 [0.04-0.05], p<0.001) were not associated with meaningfully improved depression symptoms. CONCLUSIONS AND RELEVANCE: In this cohort study, substantial improvements in physical function and pain interference were required for association with any clinically meaningful improvement in anxiety symptoms and were not associated with any meaningful improvement in depression symptoms. Among patients seeking musculoskeletal care, musculoskeletal clinicians and patients cannot assume that addressing physical health will result in improved symptoms of depression or potentially even sufficiently improved symptoms of anxiety.

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Priorities for Advancing Mental and Social Health Among People Presenting for Care of Musculoskeletal Symptoms

Cited by 7 publications

References 46 publications

Low-Income, Poor Physical Health, Poor Mental Health, and Other Social Risk Factors Are Associated With Decreased Access to Care in Patients With Carpal Tunnel Syndrome

Low-Income, Poor Physical Health, Poor Mental Health, and Other Social Risk Factors Are Associated With Decreased Access to Care in Patients With Carpal Tunnel Syndrome

Improvements in Physical Function and Pain Interference and Changes in Mental Health Among Patients Seeking Musculoskeletal Care

Relationships between improvement in physical function, pain interference, and mental health in musculoskeletal patients

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