Measuring distress in musculoskeletal physiotherapy: An example of integrated care in action

Abstract

Introduction: musculoskeletal disorders (MSDs) are a major cause of pain and disability, constituting a significant societal burden. Psychological constructs are important predictors and mediators for developing and maintaining long term pain-related disability and a biopsychosocial approach to assessment and treatment of MSDs is recommended. Physiotherapists are a key professional group assessing and treating people with MSDs but screening by them for psychosocial risk factors is inconsistent. Embedding routine collection of patient-reported psychological factors such as depression, pain self-efficacy and avoidance behaviours, may improve quality of patient care and outcomes. Method: the primary aim of this project was to implement screening for psychological risk factors in people attending a NHS physiotherapy musculoskeletal service and characterise the prevalence of distress. To achieve this, self-report questionnaires were embedded within informatics associated with the Integrating Mental and Physical Health Research and Training (IMPARTS) programme to assess: depression, anxiety, risk of persistent disability secondary to back pain, fear avoidance beliefs, pain catastrophizing and pain self-efficacy. A secondary aim was to develop associated care pathways to guide physiotherapist decision making. These include group physical exercise, psychologically informed physiotherapy, Improving Access to Psychological Therapies (IAPT), Accident & Emergency (AE of 406 screened, 14% were identified as having probable major depression and 18% as having probable anxiety disorder. Of the 121 patients using the developed care pathway, 68% (N = 82) were allocated to group exercise or IAPT for symptoms of depression or anxiety, and 32% (N = 39) had severe levels of depression and or suicidal ideation and required a letter to the GP or A&E. Just over one third of those screened reported back pain as the primary reason for attendance. Of those, 40% scored at high risk of persistent pain-related disability. Conclusion: physiotherapy musculoskeletal service redesign to incorporate a systematic approach to identifying psychosocial risk factors in people with MSDs has highlighted the prevalence of comorbid distress. The need for physiotherapists to expand their approach and integrate psychologically-informed practices into consultations is paramount