“It’s an Uncomfortable subject”—a qualitative exploration of the challenges and potential solutions to depression screening in low back pain

Importance: Comorbid depression in people with low back pain(LBP)is associated with poorer prognosis. Objective: The objective was to understand the challenges faced by musculoskeletal (MSK) triage physical therapists when screening for depression in LBP populations ,and to generate action able recommendations for over coming these challenges. Design: This study adopted a pragmatic hybrid descriptive qualitative approach, integrating element of ethnography and action research. Setting: Interviews were conducted in the Republic of Ireland and used purposive sampling of physical therapists working in MSK triage roles. Participants: To be included, participants were required to have managed at least 1 person with LBP each week in the 3 months prior to recruitment. Intervention(s) or Exposure(s): The context explored was MSK triage physical therapists’ experience with depression screening in people with LBP. Main Outcomes and Measure(s): The main outcomes were insights regarding challenges and potential solutions to depression screening. Semi-structured interviews were employed, with data analysis following a Reflexive Thematic Analysis framework. Results: Fourteen MSK triage physical therapists participated. Challenges were organized into 3 themes: capacity (personal, professional, and system), culture (clinic, societal), and circuitous communication. Potential solutions were organized into 5 themes: training and education, standardized pathways, knowledge of and access to resources ,screening tools ,and normalizing depression screening in MSK triage equivalent to red flags screening.