The Effectiveness of Psychological Interventions to Improve Mental Health in Patients with Chronic Musculoskeletal Conditions, a Rapid Review.
Creators: name: Kennedy, Darren
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Medical Sciences
subject: Medicine and Health Sciences
subject: Rehabilitation and Therapy
subject: Medical Education
subject: Mental and Social Health
subject: Health and Medical Administration

description: Review question This review will explore the effectiveness of psychological interventions to improve mental health in patients with chronic musculoskeletal conditions. Anticipated start date November 2021 Anticipated completion date April 2022 Contact details Team members and affiliations Darren Kennedy Neil O’Connell Elmar Kal Royal National Orthopedic Hospital (RNOH) Funding sources/sponsors Brunel University &amp; Royal National Orthopedic Hospital (RNOH). Participants/population. We will include studies that included adults with MSK and co-existing mental health disorders such as depression and/or anxiety. Inclusion criteria will consist of legally deemed adults (18+), patients with a chronic MSK condition, patients with chronic pain and those suffering from anxiety or depression. I will include both traumatic and non-traumatic injuries in order to include injuries such as fractures and dislocations. However, for the purpose of this review, chronic will be deemed symptoms lasting for greater than 3 months. This means that any traumatic injury will only be included should the patient be experiencing symptoms and/or pain a minimum of 3 months after injury. Exclusion criteria will be anyone with life altering traumatic injuries, such as traumatic brain injury (TBI) or road traffic accident (RCT) because of other causative factors that may be contributing to a poor mental health outcome. Other mental health disorders, such as schizophrenia or other psychotic disorders, where pharmaceutical intervention are the mainstay of the treatment and any other conditions that are not musculoskeletal in origin will be also excluded. Other excluding circumstances include things such as stroke, multiple sclerosis and cancer, as these are mostly all degenerative conditions that carry with them a certain expectation of concurring mental health issues. Intervention(s), exposure(s). Any interventions that target mental health primarily. For the purpose of my study I will include, but not limit to cognitive behavioral training (CBT), meditation, mindfulness, talking therapies or expressive therapy. If other interventions fit the criteria, then this list can be amended. Definitions below may also be amended to reflect how each intervention is described in the research. Cognitive behavioral therapy: NICE guidelines define CBT as ‘CBT is based on the idea that the way we feel is affected by our thoughts and beliefs and by how we behave. CBT encourages people to engage in activities and to write down their thoughts and problems. It helps them to identify and counteract negative thoughts (Treatments for mild to moderate depression | Information for the public | Depression in adults: recognition and management | Guidance | NICE, 2022). Meditation: Can be defined as a complex group of attentional and emotional training strategies, developed for numerous reasons, including the growth of well-being and emotional balance. (Lutz, Slagter, Dunne and Davidson, 2008) Mindfulness: Can be defined as ‘the awareness that emerges through paying attention to purpose, in the present moment, and nonjudgmentally to the unfolding experience moment by moment’ (Kabat-Zinn, 2003) Talking Therapy: ‘Talking therapy involves talking to a trained professional about your thoughts, feelings and behaviour. Describing what’s going on in your head and how that makes you feel can help you notice any patterns you may want to change. It can help you work out where your negative feelings and ideas come from and why they are there.’ (Talking therapies, 2021) Expressive therapy: ‘the use of art, music, dance/movement, drama, poetry/creative writing, play, and sandtray within the context of psychotherapy, counselling, rehabilitation, or health care.’ (Malchiodi, 2007) Hybrid therapy: Due to the accessibility of these therapies, and cost- effectiveness, it may be possible to use a hybrid of two or more of these therapies (mentioned above). (E.g.; CBT and mindfulness combined). If a ‘hybrid’ method is found in the research, this will be explored further individually, ie as an intervention in itself. Comparator(s)/control. We will include studies where the comparative group received usual care (rehabilitation for the MSK condition) or no additional treatment. There is also the possibility of a ‘sham’ control, such as passive attention control. If this is the case, it will be analysed separately to those who are receiving usual care because of the fact that it will test intervention vs placebo. Types of study to be included. Randomized Control Trials and linked papers only. Exclusion: Research studies of any methodological design including systematic reviews, meta-analyses and meta syntheses, and narrative reviews; methodology not clearly reported. Main outcome(s). The primary outcomes of this review are: • To measure anxiety, depression, after a MSK injury defined as chronic (&gt;3months) and any of our selected interventions. We will include studies that include any outcome of interest such as anxiety, depression, quality of life, among others used before and after the use of any non-pharmaceutical intervention. Any additional outcomes that can be combined will be added at a later date. Context I will include studies that were undertaken in the community, hospital settings, non-mental hospitals. Areas where studies are undertaken are not limited to these areas, but must fit a clinical setting that incorporates our intervention and inclusion/exclusion criteria. Additional outcome(s). It is not the intention to have any additional outcomes but with the examination of the research. Should there be a limit in research regarding the primary outcome, then the effect of psychological interventions on outcomes effecting MSK injuries will be reviewed. This includes, but not limited to pain intensity, disability and health related quality of life (HRQoL). These additional outcomes will be decided upon review of the literature. Searches. We will search CINAHL, MEDLINE and CENTRAL from 2000 to September 2021 using a combination of precise vocabulary, i.e medical subject headings (MeSH), and free text terms to identify published articles. In addition, we will check reference lists of reviews and retrieved articles for additional studies. The study will be limited to randomised controlled trials (RCT). We will only include studies written in English. URL to search strategy. (Draft) 1. Exp Musculoskeletal (157,468) 2. (MSK Conditions or MSK disorders or injury) (1,600,997) 3. 1 or 2 .ab,ti(138,465) 4. Exp Non-pharmacological (intervention or therapy or treatment) (10,665,930) 5. Psychological (intervention or therapy or treatment) (46,082) 6. Exp CBT or Cognitive Behavioral therapy (54,842) 7. Exp Mindfulness or meditation (29,104) 8. Expression therapy or talking therapy (10,863) 9. 4 or 5 or 6 or 7 or 8 (10,677,578) 10. EXP Mental (Health, illness, disorder) (722,664) 11. exp Anxiety or apprehension (385,805) 12. exp Depression or Dysthymia (649,014) 13. 9 or 10 or 11 (1,436,408) 14. NOT Traumatic brain injury, or brain injury or head injury or TBI (190,962) 15. 3 AND 8 AND 12 AND 13 (195) 16. Randomized Control trial, Randomized, randomly, trial Data extraction (selection and coding). Only RCTs will be included in this study. One reviewer will extract the relevant data (the effect of any one intervention on mental health parameters; anxiety/depression) from the included studies using a standardised data extraction form that will be piloted, while another reviewer will assess the selected data and whether it is relevant for inclusion in our study. Any disagreements on the inclusion of any particular study will be independently reviewed by a member of the Royal National Orthopaedic Hospital (RNOH) and reassessed in a group setting between all 3 reviewers. This approach is considered acceptable for rapid reviews. Authors will not be contacted to obtain missing data. Recording of data will be secured on a password protected One Drive which is approved by the ethical committee of Brunel University London. Risk of bias (quality) assessment. Risk of bias tool that will be used will be Cochrane’s ‘Risk of Bias Tool.’ (Armijo-Olivo et al., 2010). One reviewer will assess the quality of research included and referral to a second reviewer in the case of uncertainty. We will assess the methods of recruitment, convenience sampling, blinded allocation to either intervention or control groups and whether appropriate control groups were used in the study in order to accurately define whether any particular intervention is successful in reducing severity of mental health disorder highlighted in this study. Any disagreements in respect to bias will be assessed by an independent reviewer from RNOH. Strategy for data synthesis. If the research fits our inclusion/exclusion criteria and has been reviewed for risk of bias, it can be included in the synthesis. As the research in this area is limited (MSK and co-existing mental health disorders), including all relevant data will be important in order to achieve a respected opinion on whether any intervention is effective in our study. A meta-analysis may be carried out to pool the search results together in order to understand whether any of our interventions are statistically significant in improving the mental health of our populations. It is for this reason that there must be an outcome measure used in the study (such as VAS/Quality of Life Scale) that measures the severity of the mental health impact before the use of an intervention, during and after. Should there be a variety of outcome measures in the research, then grouping of the results will be done by standardised mean difference. We will only be using a meta-analysis should there be a number of studies that are clinically homogeneous. Because of the probable variety in studies, then I will most likely be using a random effects model of meta-analysis. I will analyse each intervention separately (CBT, mindfulness, talking therapy etc) as it is my opinion that they are each their own entity, and will give more clarity to the study to demonstrate which of the interventions are most effective, or nil effect. A descriptive synthesis of the findings will be performed if there is a large variation between the studies. If descriptive synthesis is used, then each of the interventions will be assessed separately, with effect in the short term (immediate), medium term (up to 6 months) and long term (more than 6 months). The compiled information from the tables will be noted, with the number of participants, method of psychological intervention and effect on the mental health condition that it will be acting on (such as depression/anxiety). We will also monitor the effect of usual care (in this case will be normal rehabilitation) to see whether physical activity alone is enough to contribute to a lessening of mental health issues. Analysis of subgroups or subsets. Subgroups of anything outside the domain of MSK conditions will not be included in this study, as we aim to achieve an accurate representation of the general population who are suffering from MSK conditions. There is potential scope to assess the effect of the intervention on subgroups of MSK conditions, such as the area of the body affected. This will be decide upon when the research has been analysed, but the priority will be the aforementioned effect on MSK populations as a whole. Type and method of review: RCT, rapid review. Language: English Country: England Keywords Musculoskeletal, injury, mental health disorders, chronic, anxiety, depression, stress References 1. Armijo-Olivo, S., Stiles, C., Hagen, N., Biondo, P. and Cummings, G., 2010. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. Journal of Evaluation in Clinical Practice, 18(1), pp.12-18. 2. Gureje, O., Simon, G. and Von Korff, M., 2001. A cross-national study of the course of persistent pain in primary care. Pain, 92(1), pp.195-200. 3. Lutz, A., Slagter, H., Dunne, J. and Davidson, R., 2008. Attention regulation and monitoring in meditation. Trends in Cognitive Sciences, 12(4), pp.163-169. 4. Kabat-Zinn, J., 2003. Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), pp.144-156. 5. Kroenke, K., 1994. Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Archives of Family Medicine, 3(9), pp.774-779. 6. Mental Health Foundation. 2021. Talking therapies. [online] Available at: [Accessed 12 November 2021]. 7. Malchiodi, C., 2007. Expressive therapies. New York: Guilford Press. 8. Nice.org.uk. 2022. Treatments for mild to moderate depression | Information for the public | Depression in adults: recognition and management | Guidance | NICE. [online] Available at: [Accessed 7 January 2022]. 9. WHO.2004. Promoting mental health: Concepts, emerging evidence, practice.Geneva: