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The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review.

ABSTRACT: BACKGROUND:A considerable proportion of adults with low back pain (LBP) suffer from depressive symptoms or depression. Those with depressive symptoms or depression may be at risk of poorer LBP recovery and require more health care. Understanding the role of prognostic factors for LBP is critically important to guide management and health services delivery. Our objective is to conduct a systematic review to assess the association between depressive symptoms or depression and health outcomes in adults with LBP with or without radiculopathy. METHODS:Electronic databases including MEDLINE, Embase, CINAHL, and PsycINFO will be searched from inception to April 2019 to identify relevant studies. Additional citations will be identified by searching reference lists of included studies and related systematic reviews. Cohort and case-control studies assessing the association between depressive symptoms/depression and health outcomes in adults aged 16?years and older with LBP with or without radiculopathy will be included. The following will be included: depressive symptoms as measured on standardized questionnaires (e.g., Center for Epidemiologic Studies Depression Scale, Beck Depression Index), and depression as standardized diagnoses (e.g., International Classification of Diseases codes) or self-reported depression diagnosis on standardized questionnaires. Outcomes of interest are standardized measures for pain, disability, overall health status, satisfaction with care, and health care utilization. These are informed by core outcome domains that international expert panels consider important for LBP research. Pairs of reviewers will screen articles retrieved from the search, extract data, and assess risk of bias using the Risk Of Bias In Non-randomized Studies-of Exposures (ROBINS-E) tool. Reviewers will use these criteria to inform their judgment on the internal validity of studies (e.g., low, moderate, or high risk of bias). If studies are deemed homogeneous, a random effects meta-analysis on the association between depressive symptoms and health outcomes will be performed. The results of the included studies will be descriptively outlined if studies are deemed heterogeneous. DISCUSSION:The impact of depressive symptoms and depression on health- and health care-related outcomes for LBP with or without radiculopathy will be assessed and quantified. Findings of this systematic review will advance our understanding of LBP prognosis, and guide decision-making and improve quality of care for adults with LBP. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42019130047.

SUBMITTER: Wong JJ

PROVIDER: S-EPMC6839250 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review.

Wong Jessica J JJ Tricco Andrea C AC Côté Pierre P Rosella Laura C LC

Systematic reviews 20191108 1

<h4>Background</h4>A considerable proportion of adults with low back pain (LBP) suffer from depressive symptoms or depression. Those with depressive symptoms or depression may be at risk of poorer LBP recovery and require more health care. Understanding the role of prognostic factors for LBP is critically important to guide management and health services delivery. Our objective is to conduct a systematic review to assess the association between depressive symptoms or depression and health outcom ...[more]

PMID: 31703727

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Project description:IntroductionSurgical rates for low back pain (LBP) have been increasing in Europe, North America and Asia. Many patients treated surgically will require postsurgical rehabilitation. Little is known about the effectiveness of postsurgical rehabilitation interventions on health outcomes or about patients' experiences with these interventions.ObjectivesTo conduct a mixed studies systematic review of quantitative and qualitative studies regarding: (1) the effectiveness and safety of postsurgical rehabilitation interventions for adults with LBP treated surgically and (2) the experiences of patients, healthcare providers, caregivers or others involved with the rehabilitation.Methods and analysisWe will search MEDLINE, Embase, PsycINFO, CINAHL, the Index to Chiropractic Literature, the Cochrane Controlled Register of Trials and the Rehabilitation & Sports Medicine Source for peer-reviewed empirical studies published from inception in any language. Studies using quantitative, qualitative and mixed methodologies will be included. We will also search reference lists of all eligible articles. Data extraction will include type of presurgical pathology, indication for surgery, surgical procedure, how the intervention was delivered and by whom, context and setting. We will conduct a quality assessment of each study and consider study quality in our evidence synthesis. We will use a sequential approach at the review level to synthesise and integrate data. First, we will synthesise the quantitative and qualitative studies independently, conducting a meta-analysis of the quantitative studies if appropriate and thematic synthesis of the qualitative studies. Then, we will integrate the quantitative and qualitative evidence by juxtaposing the findings in a matrix.Ethics and disseminationEthical approval is not required for this knowledge synthesis. Findings will be disseminated through knowledge translation activities including: (1) presentations at national and international conferences and scientific meetings; (2) presentations to local and international stakeholders; (3) publications in peer-reviewed journals and (4) posts on organisational websites.Prospero registration numberCRD42019134607.

Project description:BackgroundStudy results vary on whether depressive symptoms are associated with worse prognosis for low back pain (LBP). We assessed the association between depressive symptoms or depression and health outcomes in persons with LBP.MethodsWe searched MEDLINE, Embase, CINAHL, and PsycINFO from inception to June 2020. Eligible studies were cohort and case-control studies assessing the association between depressive symptoms (questionnaires) or depression (diagnoses) and health outcomes in persons aged ≥16 years with LBP in the absence of major pathology. Reviewers independently screened articles, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. We classified exploratory versus confirmatory studies based on phases of prognostic factor investigation. We conducted random-effects meta-analyses and descriptive synthesis where appropriate.ResultsOf 13,221 citations screened, we included 62 studies (63,326 participants; 61 exploratory studies, 1 confirmatory study). For acute LBP, depressive symptoms were associated with self-reported disability (descriptive synthesis: 6 studies), worse recovery (descriptive synthesis: 5 studies), and slower traffic injury-related claim closure (1 study), but not pain or work-related outcomes. Depressive symptoms were associated with greater primary healthcare utilization for acute LBP (1 confirmatory study). For chronic LBP, depressive symptoms were associated with higher pain intensity (descriptive synthesis: 9 studies; meta-analysis: 3 studies, 2902 participants, β=0.11, 95% confidence interval (CI) 0.05-0.17), disability (descriptive synthesis: 6 studies; meta-analysis: 5 studies, 3549 participants, β=0.16, 95% CI 0.04-0.29), and worse recovery (descriptive synthesis: 2 studies; meta-analysis: 2 studies, 13,263 participants, relative risk (RR)=0.91, 95% CI 0.88-0.95), but not incident chronic widespread pain (1 study).DiscussionDepressive symptoms may be associated with self-reported disability and worse recovery in persons with acute and chronic LBP, and greater primary healthcare utilization for acute LBP. Our review provides high-quality prognostic factor information for LBP. Healthcare delivery that addresses depressive symptoms may improve disability and recovery in persons with LBP. Confirmatory studies are needed to assess the association between depressive symptoms and health outcomes in persons with LBP.Protocol registrationPROSPERO database (CRD42019130047).

Project description:BackgroundAlthough metabolic syndrome (MetS) and depressive symptoms (DS) are predictors of low back pain (LBP), their combined effects and relative contributions to LBP have not been well studied. Using the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS), this study conducted cross-sectional and longitudinal analyses to investigate the impact of MetS on LBP, and the joint effects of MetS and DS on LBP.MethodsThis study included a cross-sectional analysis of 8957 participants aged at least 45 years from the CHARLS 2011 dataset and a longitudinal follow-up of 3468 participants without LBP from the CHARLS 2011, tracked over 9.25 years (from June 2011 to September 2020) with 4 times LBP assessment in CHARLS 2013, 2015, 2018, and 2020. To explore the association between MetS on LBP and the joint effects of MetS and DS on LBP, multivariable-adjusted multinomial logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Multivariable-adjusted COX proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% CIs. All statistical analyses were conducted using STATA (version SE16).ResultsIn the cross-sectional analysis, MetS was associated with a lower risk of LBP (adjusted OR = 0.85, 95% CI = 0.74-0.97), while there was no significance for this association in the longitudinal analysis. In the joint association of MetS and DS with LBP, participants with NoMetS + DS (adjusted OR = 2.31, 95% CI = 1.94-2.75), and MetS + DS (adjusted OR = 2.16, 95% CI = 1.81-2.59) were risk factors for LBP events, while those with MetS + NoDS (adjusted OR = 0.75, 95% CI = 0.62-0.90) was a protective factor for LBP events than those with NoMetS + NoDS. During the 9.25 years of follow-up, 1708 cases (49.25%) experienced incident LBP events. In the longitudinal analysis, a significantly negative association was not found in MetS + NoDS for LBP events. Three sensitivity analyses identified the robustness of the associations. Moreover, the nature of cross-sectional associations differed by age (45-64 and 65 + years).ConclusionsOur study found that MetS was linked to a lower incidence of LBP, but this effect does not persist over time. Importantly, the combination of MetS and DS significantly increased LBP risk, a joint effect not extensively studied before. These findings underscore the novel contribution of our research, advocating for the joint assessment of MetS and DS to enhance LBP risk stratification and inform prevention strategies.

Dataset Information

The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review.

Publications

The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review.

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