The Role of Pain Catastrophizing and Depression in the Outcomes of Physical Therapy in a Prospective Osteoarthritis Cohort

Abstract

Background: Physical modalities have been safely used for decades for pain relief and for reducing physical disability in the conservative treatment of knee osteoarthritis (OA). However, patients’ response to treatment is highly variable, which may be related to certain patient-related factors such as pain catastrophizing and depression. Objectives: This study aimed to evaluate the effects of pain catastrophizing and depression on physical therapy outcomes and to identify the baseline factors predictive of poor outcomes in patients with knee OA. Study Design: This research used a prospective, cohort, observational study design. Setting: The research took place in an outpatient physical therapy unit within a tertiary hospital in Ankara, Turkey. Methods: Eighty-nine patients with knee OA underwent 10 sessions of physical therapy. At baseline, depression and pain catastrophizing were evaluated using the Beck Depression InventoryII (BDI-II) and the Pain Catastrophizing Scale (PCS). The therapeutic efficacy of physical therapy was assessed based on the level of pain and disability using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Changes in the VAS score and WOMAC were evaluated at 2 and 6 weeks following physical therapy. A multivariate logistic regression analysis was conducted to identify the predictors of poor outcomes. Results: Patients with low pain-catastrophizing and low depression scores tended to demonstrate better improvement at weeks 2 and 6. The results of a multivariate logistic regression analysis showed that the significant outcome predictor for both pain and function at week 6 was the baseline PCS score. The baseline depression score was not an independent predictor of a clinically poor outcome. Limitations: This study is limited owing to the combined use of several physical therapy modalities and short follow-up. Conclusions: This study suggests that the baseline PCS score is a predictive factor of poor response to physical therapy in patients with knee OA. Considering this factor before therapy and taking the necessary precautions may improve the outcomes of physical therapy. Key Words: Catastrophization, central nervous system sensitization, depression, disability evaluation, knee osteoarthritis, pain, physical therapy modalities, transcutaneous electric nerve stimulation.

Relación de las variables de catastrofismo y autoeficacia con la intensidad del dolor, la función y la discapacidad en pacientes de artrosis de rodilla y cadera: una revisión sistemática

“…La estrategia de búsqueda de estudios se presentó en forma de diagrama de flujo (Figura 1). Un total de 9 artículos (2 cohortes y 7 estudios transversales) se incluyeron en la revisión sistemática (Bieler et al, 2020;Degerstedt et al, 2020;Doğan et al, 2016;Harrison, 2004;Lazaridou et al, 2019;López-Bravo et al, 2021;Maly et al, 2007;Silva et al, 2020;Uckun et al, 2020). Las características de los artículos se muestran en la Tabla 1 y la Tabla 2.…”

“…La artrosis fue diagnosticada en la mayoría de los estudios (Bieler et al, 2020;Doğan et al, 2016;Harrison, 2004;Lazaridou et al, 2019;Maly et al, 2007;Uckun et al, 2020), gracias a los criterios de la American College of Rheumatology (ACR) (Wu et al, 2005). La ACR analiza la ubicación, el tamaño y la profundidad del daño del cartílago.…”

“…Un total de 4003 pacientes con artrosis de rodilla o cadera participaron en el estudio (Bieler et al, 2020; Degerstedt et al, 2020;Doğan et al, 2016;Harrison, 2004;Lazaridou et al, 2019;López-Bravo et al, 2021;Maly et al, 2007;Silva et al, 2020;Uckun et al, 2020) y se realizó un seguimiento mínimo de 3 meses. La edad de los participantes de los distintos estudios estaba establecida entre los 27 y 93 años.…”

“…El sexo femenino fue predominante en la muestra de población de los estudios elegidos. Participaron 2900 mujeres en los estudios, respecto a 1103 hombres (Bieler et al, 2020;Degerstedt et al, 2020;Doğan et al, 2016;Harrison, 2004;Lazaridou et al, 2019;López-Bravo et al, 2021;Maly et al, 2007;Silva et al, 2020;Uckun et al, 2020).…”

Pain Catastrophizing and Kinesiophobia Affect Return to Sport in Patients Undergoing Hip Arthroscopy for the Treatment of Femoroacetabular Impingement

“…Pain catastrophizing has been shown to negatively influence physical therapy outcomes for other orthopaedic pathologies such as osteoarthritis, and it is plausible that greater levels of pain catastrophizing would negatively affect therapy following hip arthroscopy for the treatment of FAI. 51 As the intensity of physical therapy increases beginning at 6 weeks and progressively intensifies until RTS, it is no surprise that patients who are able to better perform in physical therapy would be more likely to RTS and achieve clinical improvement. These patients are likely able to prevent muscular imbalance and gait abnormalities associated with weakness in the operative extremity and feel more comfortable performing in sports-related activity than those who could not fully participate.…”