Recovery from Depressive Symptoms over the Course of Physical Therapy.

Recovery from Depressive Symptoms over the Course of Physical Therapy
This  study looked at adults who had work related back or neck pain for 3-12 weeks since injury and clinical depression (BDI >13) who underwent 7 weeks of physio treatment 3 times a week (treatment included range of motion, joint manips, progressive strengthening exercises in a functional rehab program). They found that  53% of workers with work related back or neck pain for 3-12 weeks since injury had clinical depression (BDI >13) at initial assessment and following physio treatment, 41% were no longer depressed ( 74% of this group returned to work whereas only 46% of those still depressed returned to work post treatment at 1 year follow up i.e. twice as likely not to RTW if still depressed after treatment). Those  with elevated pain catastrophising (>23 on PCS) and higher levels of depression (BDI >16) pre treatment did not respond as well following physiotherapy treatment and early changes in pain self efficacy significantly predicted who was no longer depressed post treatment.

The study recommends a mental health referral for clients who do not show early treatment improvement in pain self efficacy or pain catastrophising or whose depressive symptoms do not improve after 3-4 weeks of physiotherapy (i.e make a decision at mid treatment and not too early).  Treatment should include education, reassurance, activity monitoring, graded activity, thought monitoring/cognitive restructuring may reduce depressive symptoms.  They also  referred to a past paper by Dunn etal 2005  who found regular exercise over a 12 week period led to a 47% improvement in severity of depressive symptoms and another study by Sullivan and Adams 2010 where a psychosocial dimension added to usual physio treatment  led to 51% reduction in depressive symptoms.

Journal of Orthopaedic and Sports Physical Therapy Vol 42, No. 11 pp 957-967. 2012