Open AccessThe Role of Pain Catastrophizing and Depression in the Outcomes of Physical Therapy in a Prospective Osteoarthritis Cohort
Author(s) -
Aslı Çalışkan Uçkun,
Burcu Köse Dönmez,
Fatma Gül Yurdakul,
Yeşim Garip,
Hatice Bodur
Publication year - 2020
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2020/23/209
Subject(s) - medicine , physical therapy , womac , osteoarthritis , pain catastrophizing , depression (economics) , prospective cohort study , beck depression inventory , logistic regression , cohort study , visual analogue scale , chronic pain , anxiety , psychiatry , alternative medicine , pathology , economics , macroeconomics
Background: Physical modalities have been safely used for decades for pain relief and forreducing physical disability in the conservative treatment of knee osteoarthritis (OA). However,patients’ response to treatment is highly variable, which may be related to certain patient-relatedfactors such as pain catastrophizing and depression.Objectives: This study aimed to evaluate the effects of pain catastrophizing and depression onphysical therapy outcomes and to identify the baseline factors predictive of poor outcomes inpatients with knee OA.Study Design: This research used a prospective, cohort, observational study design.Setting: The research took place in an outpatient physical therapy unit within a tertiary hospitalin Ankara, Turkey.Methods: Eighty-nine patients with knee OA underwent 10 sessions of physical therapy. Atbaseline, depression and pain catastrophizing were evaluated using the Beck Depression InventoryII (BDI-II) and the Pain Catastrophizing Scale (PCS). The therapeutic efficacy of physical therapywas assessed based on the level of pain and disability using the Visual Analog Scale (VAS) and theWestern Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Changes in the VASscore and WOMAC were evaluated at 2 and 6 weeks following physical therapy. A multivariatelogistic regression analysis was conducted to identify the predictors of poor outcomes.Results: Patients with low pain-catastrophizing and low depression scores tended to demonstratebetter improvement at weeks 2 and 6. The results of a multivariate logistic regression analysisshowed that the significant outcome predictor for both pain and function at week 6 was thebaseline PCS score. The baseline depression score was not an independent predictor of a clinicallypoor outcome.Limitations: This study is limited owing to the combined use of several physical therapymodalities and short follow-up.Conclusions: This study suggests that the baseline PCS score is a predictive factor of poorresponse to physical therapy in patients with knee OA. Considering this factor before therapy andtaking the necessary precautions may improve the outcomes of physical therapy.Key Words: Catastrophization, central nervous system sensitization, depression, disabilityevaluation, knee osteoarthritis, pain, physical therapy modalities, transcutaneous electric nervestimulation.