The Effect of Depressive Emotional State on the Efficacy of Physical Therapy in Patients with Low Back Pain

Abstract

Objective: The aim was to investigate the effect of depressive emotional state on the efficacy of physical therapy in patients with chronic mechanical low back pain (LBP). Methods: Sixty patients with chronic LBP were included in the study. The patients were evaluated by a psychiatrist according to the Hamilton Depression Rating Scale (HAM-D) and separated into 2 groups regarding the cut off score. Group 1 consisted of 31 patients without depressive emotion while group 2 included 29 patients with depressive emotion. An exercise program consisting of lumbar dynamic stabilization exercises was instructed to all of the patients for 8 weeks. Infrared, ultrasound and TENS were applied to both groups for 15 seance. The pain was evaluated by visual analog scale (VAS), disability and quality of life was evaluated by Oswestry disability index and the Short-Form 36(SF-36) at baseline and 3rd and 8th weeks. Results: İmprovement at pain severity during ADL, rest and sitting position was found to be significantly higher in group 2 compared to group 1 patients at the 8th week (p<0.05). Oswestry scores and some subscale of SF-36; physical functioning, general health perception, vitality, mental health scores of group 2 were significantly higher compared to group 1 at baseline and the 8th week (p<0.05). Improvement of Oswestry scores between groups was not significantly different at 8th week (p>0.05), but improvement of some SF-36 subscale scores (pain, emotional role functioning, mental health) of groups significantly lower in group 2 compared to group 1 at the 8th weeks (p<0.05). Conclusions: Patients with chronic LBP and a depressive emotional state are inclined to have more disability and poorer quality of life, while physical therapy and exercises yield to less improvement in scores of pain and some subscales of the SF-36 in these patients than those without depressive affect.