Barriers to Change in Depressive Symptoms Following Multidisciplinary Rehabilitation for Whiplash

The Role of Perceived Injustice
Objective: Depressive symptoms complicate patients' recovery following musculoskeletal injury. There is strong evidence to support the utility of multidisciplinary approaches for treating comorbid pain and depressive symptoms. Despite this, a significant proportion of patients may not experience meaningful reductions in depressive symptoms following intervention. The purpose of this study was to identify barriers to change in depressive symptom during multidisciplinary rehabilitation for patients with whiplash injuries.
Methods: 53 patients with clinically meaningful levels of depressive symptoms prior to participating in a standardized multidisciplinary rehabilitation program participated in this study. Patients completed self-report measures of depressive symptoms, demographic factors, pain intensity, disability, post-traumatic stress symptoms, pain catastrophizing and self-efficacy upon commencement and completion of the rehabilitation program. Analyses examined whether pre-treatment variables predicted change in depressive symptoms over treatment and the maintenance of clinically meaningful levels of depressive symptoms at post-treatment.
Results: Duration of work absence and perceived injustice were significant unique predictors of percent change in depressive symptoms in a linear regression analysis. Perceived injustice was the only significant unique predictor of the presence of clinically meaningful levels of depressive symptoms at post-treatment in a logistic regression analysis.
Conclusions: The results suggest that the identification of patients with high levels of perceived injustice and implementation of targeted interventions for these patients might contribute to greater improvements in their depressive symptomatology.

Source: Scott W, Trost Z, Milioto M, Sullivan MJ. Clin. J. Pain. 2014.

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