Depression among people with low back pain: a cross-sectional descriptive survey of Irish musculoskeletal triage physiotherapists’ screening and referral practices

Background: Low back pain (LBP) is associated with a poorer prognosis when there is concomitant depression. Musculoskeletal (MSK) triage physiotherapists clinically assess a significant proportion of LBP referrals to public hospital outpatient waiting lists. Objectives: To establish depression screening and referral practices of MSK triage physiotherapists, and to compare confidence in depression screening to red flag (e.g. cauda equina syndrome) and yellow flag (e.g. fear avoidance beliefs) screening. Methods: Using a descriptive cross-sectional design, a bespoke e-survey was distributed to MSK triage physiotherapists in adult public hospital outpatient services in Ireland following ethical approval. Results: Thirty-six surveys were completed and submitted (55% response rate). A minority of respondents (3/36, 8%) directly ask all patients with LBP about depression, while more than one third (13/36, 36%) never screened for depression. Reported barriers included lack of training or skill, time constraints, and absence of referral pathways. Confidence in screening for depression was lower than for red flags or yellow flags. There was some indication that a day or more of training improved depression screening confidence and practice. Discussion: This study provides insight into current depression screening practices for people with LBP and the factors influencing decision-making among MSK triage physiotherapists working in advanced practice roles. Conclusion: Few MSK triage physiotherapists in this sample directly screen for depression, and screening confidence was low. Understanding the current processes and determinants of practice, including the potential positive impact of targeted training, may support strategies to improve depression screening practices. Contribution of the Paper: • This is the first study, to the authors’ knowledge, that details depression screening practices in a cohort of LBP patients by MSK triage physiotherapists in advanced practice roles. • This study presents novel information on confidence in screening for depression compared to screening for red flags or yellow flags. • The findings from this niche group of clinicians are likely reflective of MSK triage physiotherapists worldwide. While the study focused on LBP populations, we hope that it encourages readers to reflect on their own confidence and practice when screening for depression, which may also be relevant to other patient groups.