Abstract
BackgroundDepressive symptoms are a major comorbidity in older adults with knee osteoarthritis (OA). However, the type of activity-induced knee pain associated with depression has not been examined. Furthermore, there is conflicting evidence regarding the association between depression and performance-based physical function. This study aimed to examine (i) the association between depressive symptoms and knee pain intensity, particularly task-specific knee pain during daily living, and (ii) the association between depressive symptoms and performance-based physical function, while considering other potential risk factors, including bilateral knee pain and ambulatory physical activity.MethodsPatients in orthopaedic clinics (n = 95; age, 61–91 years; 67.4% female) who were diagnosed with radiographic knee OA (Kellgren/Lawrence [K/L] grade ≥ 1) underwent evaluation of psychological health using the Geriatric Depression Scale (GDS). Knee pain and physical function were assessed using the Japanese Knee Osteoarthritis Measure (JKOM), 10-m walk, timed up and go (TUG), and five-repetition chair stand tests.ResultsOrdinal logistic regression analysis showed that depression, defined as a GDS score ≥ 5 points, was significantly associated with a worse score on the JKOM pain-subcategory and a higher level of task-specific knee pain intensity during daily living, after being adjusted for age, sex, body mass index (BMI), K/L grade, and ambulatory physical activity. Furthermore, depression was significantly associated with a slower gait velocity and a longer TUG time, after adjusting for age, sex, BMI, K/L grade, presence of bilateral knee pain, and ambulatory physical activity.ConclusionsThese findings indicate that depression may be associated with increased knee pain intensity during daily living in a non-task-specific manner and is associated with functional limitation in patients with knee OA, even after controlling for covariates, including bilateral knee pain and ambulatory physical activity.
Highlights
Depressive symptoms are a major comorbidity in older adults with knee osteoarthritis (OA)
Contrary to our second hypothesis, depression was significantly associated with slower gait velocity and longer timed up and go (TUG) time, even after considering covariates, such as bilateral knee pain and objectively measured ambulatory physical activity
JKOM Japanese Knee Osteoarthritis Measure, odd ratio (OR) Odds ratio; 95% confidence intervals (CIs): 95% confidence interval a Proportional OR for a greater quartile (1–4; 1 [< 25th percentile] indicates better function and 4 [≥75 percentile] indicates worse function) was calculated to indicate predictive ability of the presence of depression while simultaneously including age, sex, body mass index, index knee radiographic tibiofemoral joint Kellgren/Lawrence grade, objectively measured physical activity, and presence of bilateral knee pain (0: absence, 1: presence) in the ordinal regression model See Additional file 1: Table S1 for details of quartiles in JKOM “activities of daily living” and each performance-based physical function Bold represents statistically significant result may exacerbate depressive symptoms
Summary
Depressive symptoms are a major comorbidity in older adults with knee osteoarthritis (OA). This study aimed to examine (i) the association between depressive symptoms and knee pain intensity, task-specific knee pain during daily living, and (ii) the association between depressive symptoms and performance-based physical function, while considering other potential risk factors, including bilateral knee pain and ambulatory physical activity. Some investigators have reported a significant association [11, 12], while others have found none [13,14,15] This may be due to potential risk factors for performance-based physical function, such as bilateral knee pain [16, 17] and objectively measured physical activity [18, 19], not being assessed in previous studies. One study considered self-reported physical activity as a covariate on the association between depression and performance-based physical function [11], self-reported physical activity may overestimate physical activity compared to objectively measured physical activity [20]
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