The relationship between depression, anxiety, and pain interference with therapy referral and utilization among patients with hand conditions.
Shannon K Cochrane, Ryan P Calfee, Macyn M Stonner and 1 others
PMID 33250395WHAT IT FOUND
Depression, anxiety, and pain interference scores were not associated with referral to hand therapy.
Traumatic conditions were referred more often. Among treated patients, high depression tracked with fewer long-term goals, but this study did not prove that depression caused poorer goal attainment.
Key findings
01Depression, anxiety, and pain interference scores were not associated with hand therapy referral; traumatic conditions were referred at 68% versus 40% for nontraumatic conditions.
02Among 96 patients seen by a hand therapist, average visits were 2.9, and high depression, anxiety, or pain scores were linked to about one more visit, but differences were not statistically significant.
03Patients with high depression met long-term goals at 50% versus 69% for low depression, but the difference was not statistically significant; anxiety and pain scores showed no goal attainment differences.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was retrospective and single-center, so it cannot show that depression, anxiety, or pain caused changes in referral, visits, or goals. Patients without PROMIS data or without a new patient appointment in the study period were excluded, and missing electronic record data could bias the sample. PROMIS scores are self-reported, and past depression diagnoses or medication were incompletely captured, so symptom burden may have been misclassified. Therapy visit and goal data came only from 96 patients seen by a hand therapist at the center, a smaller subset than the full sample. Therapy goals were set individually by treating therapists and judged achieved if short- or long-term goals were marked achieved, so goal attainment was not standardized. The study did not test any intervention, so it cannot tell therapists whether screening or extra support improves outcomes.
Declared interests
The authors declared no conflicts of interest. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not conclude that PROMIS screening or treating mental health symptoms will improve hand therapy referral, visits, or goal attainment. The study was observational, the mental health and pain differences were not statistically significant, and no intervention was tested.