Depressed Mood Harms Adherence and Possibly Results in Dishonest Reporting
Research supports the use of exercise and educational-based programs as they relate to a person’s improved pain levels, quality of life and self-efficacy (1). When completing a physical therapy exercise program, a more depressed mood could decrease adherence and slow progress, leading to increased functional impairment (2.) Oftentimes there is a gap when it comes to collecting data about a patient’s mood. Recupe collects this data from the patient before and after every exercise session. From this data, various effects and outcomes of mood can be seen.
Recupe is a mobile application that is connected to a wearable, strapless motion sensor. The patient is guided through daily exercise programs while the technology records various health data including pain, range of motion, adherence, and a symptom checklist. Behavioral data is also collected before and after each session, including that of a patient’s mood. Using this type of data, Recupe healthcare professionals and health coaches can customize a patient’s home rehabilitation program, proactively detect and help prevent problems, as well as provide additional levels of encouragement when necessary.
Results
Using the Recupe application, mood ratings were recorded by offering patients three moods to choose from: “Happy”, “Neutral”, and “Sad”. These options were presented visually by using emoji facial expressions. In total, mood ratings were captured from 487 patients over the course of the exercise plan. Age was another data point recorded. The average age across patients was 58.29 (sd 15.79). Of this group of patients, 51.3% were female and 48.7% were male. Note: the populations recorded below consist of patients in both group health settings as well as those receiving worker’s compensation benefits.
Patients’ adherence to their exercise programs was also recorded in the form of exercise repetitions and time spent exercising. The results are documented below:
| Avg. Reps | Avg. PT Time (minutes) | |
|---|---|---|
| Happy | 217.6 | 30.8 |
| Neutral | 164.9 | 8.24 |
| Sad | 144.59 | 1.49 |
Discussion
The results show a clear correlation between mood and patient adherence to their exercise programs. Patients who are in more depressed moods report higher pain levels, and demonstrate consistently decreased exercise times and repetition counts. Within the Recupe application, significantly decreased exercise time was recorded for those patients who chose a mood of “Sad”. It is important to also note that within Recupe, there is an option to mark an exercise complete, without need to actively complete it. From the data, it could be assumed that those patients who marked “Sad” for their mood, likely also chose the “Mark as Complete” option for majority of their exercises without actively completing them. Patients who marked “Neutral” for their mood, also had a decrease in overall exercise time and number of repetitions completed, although not nearly as significant as those who marked “Sad”. These patterns were expected as research has shown decreased moods and levels of self-efficacy create barriers to treatment adherence with physical therapy (3).
When looking at the demographics, the average age was recorded as about the same for all mood categories. This shows that there is no direct correlation between age, mood and exercise adherence (exercise time and repetition count). Relating to gender, the most statistically significant correlation is that of more females recording a mood of “Sad” compared to males. Research suggests that when reporting higher levels of depression, women also report higher level of disability (4). This higher level of disability would likely affect their ability to perform exercises.
In summary, the more depressed a patient’s mood is, the less likely they are to complete their physical therapy exercises, ultimately leading to poorer outcomes. Healthcare professionals should take more care and focus when it comes to incorporating mood encouragement practices in their rehabilitation programs. With females reporting higher levels of depression, being at more risk of disability, additional attention should be paid to coaching females through their rehabilitation programs as well.
Recupe collects data that provides many useful and important insights. The above is just one of those insights. Utilizing Recupe throughout a patient’s rehabilitation journey provides a customized exercise and education program that works to optimize recovery leading to improved outcomes across the board.
