Does self-reported severe anxiety and depression have an impact on patient expectations of an initial musculoskeletal physiotherapy appointment?


Anxiety and depressive disorders have shown to result in poorer outcomes of physiotherapy interventions and increased healthcare utilisation. It is not known if higher levels of anxiety/depression (A/D) influence patient expectations of MSK physiotherapy services. To ensure a service achieves best outcomes and high patient satisfaction it is important to explore expectations. The EQ-5D is a measure of health related quality of life; it captures mental health through a single domain-the A/D dimension. This project compared expectations of patients who self-reported severe A/D versus no A/D when attending an initial MSK Physiotherapy appointment at a central London NHS Foundation Trust.

of patients with severe A/D patients also presented with low back pain


A cross-sectional questionnaire was completed before and after the initial physiotherapy appointment (available in English, Spanish and Portuguese). The EQ-5D was used to collect self-reported A/D responses, this quantitative data was summarised using descriptive statistics. Data was analysed relating to: expectations of physiotherapy, satisfaction, reason for referral and important aspects of physiotherapy (chosen from a preselected list completed pre and post appointment). Initial appointments were undertaken by therapists with a range of experience representative of an NHS outpatient department.


Results: 340 completed questionnaires, 290 responded to the A/D component of the EQ-5D with no A/D reported by 140 patients (48%) and 37 patients (13%) severe A/D. Severe A/D patients more likely presented with low back (27% vs 17%) and multi-joint pain (32% vs 15%). Expectations of both groups were, treatment and to learn about the problem. Patients with severe A/D were more likely to expect onward referral (29% vs 9%), non A/D patients were more likely to expect diagnosis (40% vs 27%). Large changes were observed when comparing important parts of physiotherapy pre and post initial appointment. Post, the severe A/D group placed increased importance on education (35% vs 20%) and physical assessment (50% vs 40%); however, importance of hands of treatment (16% vs 31%) reduced. Post, the no A/D group increased importance of physical assessment (53% vs 35%) and education (41% vs 24%); however, importance of pain relief (32% vs 43%) reduced.

Conclusion(s): Patients with severe A/D are more likely to present with back or multi-joint pain. Similar primary expectations of an initial MSK appointment however, severe A/D patients were more likely to expect onward referral and less likely to expect diagnosis. Clinicians appear able to meet expectations and there were high levels of satisfaction reported in both groups. Important parts of physiotherapy appear to change following an initial appointment for both groups, further research is needed to identify how this occurs.

Cost and savings

No further information. 


MSK physiotherapists are aware of the importance of A/D in relation to prognosis of MSK disorders. The results demonstrate that patients with self-reported severe A/D have differences in expectation and what is regarded as important aspects of physiotherapy in an initial appointment. It is important these topics are explored in the initial appointment to facilitate appropriate and timely education/information. Future work may look closely at the needs of this population, screening all patients for A/D prior to the appointment and the potential to tailor physiotherapy input based on this.

Top three learning points

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Funding acknowledgements