Relationships between improvement in physical function, pain interference, and mental health in musculoskeletal patients.
Relationships between improvement in physical function, pain interference, and mental health in musculoskeletal patients.
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肌肉骨骼患者身体功能改善、疼痛干扰和心理健康之间的关系。
DOI：
10.1101/2023.02.12.23285824
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Cheng,AbbyL
中科院分区：
文献类型：
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作者：
Zhang,Wei;Singh,SomP;Clement,Amdiel;Calfee,RyanP;Bijsterbosch,JanineD;Cheng,AbbyL
ImportanceAmong patients seeking care for musculoskeletal conditions，there is mixed evidence about whether traditional，structural based care is associated with improvement in patients' mental health.ObjectiveTo determine whether improvements in physical function and pain interference are associated with significant improvement in anxiety and depression symptoms among patients seeking musculoskeletal care.DesignRetrospective cohort study from June 22，2015年2月9日，2022.设置三级护理美国学术医疗中心的骨科。研究人员在研究期间到肌肉骨骼诊所就诊4至6次并完成患者报告结局测量信息系统（PROMIS）的成年患者的对比样本ExposurePROMIS身体功能和疼痛干扰评分。主要结局和指标线性混合效应模型用于确定是否：1）PROMIS焦虑和2）在控制年龄、性别、种族和PROMIS抑郁（对于焦虑模型）和PROMIS焦虑（对于抑郁模型）后，PROMIS抑郁评分作为改善的PROMIS身体功能或疼痛干扰评分的函数而改善。临床有意义的改善定义为PROMIS焦虑≥3.0分和PROMIS Depression.ResultsAmong 11，236例患者（平均[SD]年龄57 [16]岁），9，706例（86%）为白色，7，218例（64%）为女性。身体功能的改善（β=-0.14 [95%CI-0.15- -0.13]，p<0.001）和疼痛干预（β=0.26 [0.25-0.26]，p<0.001）均与焦虑症状的改善相关。为了使焦虑症状得到有临床意义的改善，需要身体功能改善≥21 [20-23]分或疼痛干扰改善≥12 [12-12]分。改善身体功能（β=-0.05 [-0.06- -0.04]，p<0.001）和疼痛干扰（β=0.04 [0.04-0.05]，p<0.001）与抑郁症状的显著改善无关。身体功能和疼痛干预的实质性改善需要与焦虑症状的任何临床有意义的改善相关，而与焦虑症状的任何临床有意义的改善无关。抑郁症症状的显著改善。在寻求肌肉骨骼护理的患者中，肌肉骨骼临床医生和患者不能假设解决身体健康问题会导致抑郁症状的改善，甚至可能充分改善焦虑症状。Key Pointsweeping在寻求肌肉骨骼护理的患者中，身体功能和疼痛干扰的改善与焦虑和抑郁症状的有意义的变化相关吗？结果在这项大型队列研究中，PROMIS身体功能改善≥2.3人群水平标准差（SD）或PROMIS疼痛干预改善≥1.2 SD与焦虑症状的任何有意义的改善相关。身体功能和疼痛干扰的改善与抑郁症状的有意义改善无关。MeaningMusculoskeletal临床医生和患者不能认为专门解决肌肉骨骼疾病的身体方面会改善抑郁症状或潜在甚至焦虑。
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.DesignRetrospective cohort study from June 22, 2015 to February 9, 2022.SettingOrthopedic department of a tertiary care US academic medical center.ParticipantsConsecutive 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.ExposurePROMIS Physical Function and Pain Interference scores.Main Outcomes and MeasuresLinear 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.ResultsAmong 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 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. 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.Key PointsQuestionAmong patients seeking musculoskeletal care, are improvements in physical function and pain interference associated with meaningful changes in symptoms of anxiety and depression?FindingsIn this large cohort study, improvement by ≥2.3 population-level standard deviations (SD) on PROMIS Physical Function or ≥1.2 SD on PROMIS Pain Interference were required for any association with meaningful improvement in anxiety symptoms. Improvements in physical function and pain interference were not associated with meaningfully improved depression symptoms.MeaningMusculoskeletal clinicians and patients cannot assume that exclusively addressing the physical aspect of a musculoskeletal condition will improve symptoms of depression or potentially even anxiety.