Approaching Depression Related to Chronic Musculoskeletal Disorders with Interprofessional Collaboration

Background and Significance: In patients with chronic joint pain, the therapeutic intervention of physical activity has been reported to be highly effective, yet underutilized. Depression is a common reason for this underutilization and may coexist in up to 48% of patients. By increasing screening for coexistent depression in patients with chronic joint pain using interprofessional collaboration (IPC), depression can be detected. If managed appropriately patients may interrupt the pain-depression cycle, increase utilization of physical activity and thereby improve outcomes for chronic joint pain sufferers.

Purpose/Aims: The purpose of this project was to increase the rate of depression screening for patients with chronic musculoskeletal disorders in the physical therapy setting.

Methods: The institutional review board at Arizona State University approved this study with exempt status.

Depression screening with a Patient Health Questionnaire (PHQ-9) was completed by adult clients in three outpatient physical therapy clinics in the Midwest and Southwest United States (n=165). Degree of depression and patient response rates were measured and analyzed using descriptive statistics.

Staff were surveyed prior to and post project completion regarding their viewpoints on IPC and depression in this patient population. Staff demographics were analyzed and they were evaluated on their change in perception of the problem and their likelihood of sustainability with a Wilcoxin Signed Ranks Test.

Outcomes: Patient response rate was 91.5% (n=165) exposing a mean PHQ-9 score of 5.01 (mild depression). More notably, patients whom had an existing diagnosis of depression had a mean PHQ-9 score 10.47 (moderate depression) indicating poorly controlled symptoms.

After an educational session to increase knowledge, staff perception of the problem did not significantly change, with a mean score of 2.25 out of 5 predicting “somewhat” likelihood of project sustainability.

Conclusion: Implementing a PHQ-2 rather than PHQ-9 depression screening into patient’s electronic medical records would resolve staff and patient concerns of time consumption while simultaneously improving the rates of depression screening and management in patients with chronic musculoskeletal disorders.