Effects of Pain on Functioning and Well-Being in Older Adults With Osteoarthritis of the Knee

Short-Form Video Applications Usage and Functionally Dependent Adults' Depressive Symptoms: A Cross-Sectional Study Based on a National Survey

Objective

This study constructed a theoretical model based on the social compensation theory and used it to investigate the effects of short-form video applications usage on depressive symptoms among functionally dependent adults.

Methods

An empirical analysis was conducted based on a national sample of 8752 adults aged 45+ from China Family Panel Studies (CFPS) wave 2020. This study examined the effects of short-form video applications usage on depressive symptoms in functionally dependent adults by constructing linear regression models. Further, the mediating effect of interpersonal relationship, and the moderating effect of video games were then sequentially analyzed with the help of macro PROCESS4.0 tool.

Results

Results showed that: (1) short-form video applications usage significantly reduced the level of depressive symptoms among functionally dependent adults; (2) interpersonal relationship exerted a mediating effect of 10.36% in the process of short-form video applications usage reducing the level of depressive symptoms among functionally dependent adults; (3) video games attenuated the healing effect of short-form video applications usage on the level of depressive symptoms in functionally dependent adults, but not significantly in the functionally dependent adults aged 60+.

Conclusion

New electronic media, represented by short-form video applications, have the potential to intervene in the mental health of functionally dependent adults. Social policymakers should consider adopting relevant e-healing measures to enhance the well-being of vulnerable groups.

Localized Multi-Site Knee Bioimpedance as a Predictor for Knee Osteoarthritis Associated Pain Within Older Adults During Free-Living

The drastic increase in the aging population has increased the prevalence of osteoarthritis in the United States. The ability to monitor symptoms of osteoarthritis (such as pain) within a free-living environment could improve understanding of each person's experiences with this disease and provide opportunities to personalize treatments specific to each person and their experience. In this work, localized knee tissue bioimpedance and self-reports of knee pain were collected from older adults ([Formula: see text]) with and without knee osteoarthritis over 7 days of free-living to evaluate if knee tissue bioimpedance is associated with persons' knee pain experience. Within the group of persons' with knee osteoarthritis increases in 128 kHz per-length resistance and decreases in 40 kHz per-length reactance were associated with increased probability of persons having active knee pain ([Formula: see text] and [Formula: see text]).

INFLUENCE OF FEMORAL OFFSET ON FUNCTIONAL CAPACITY OF PATIENTS WITH TOTAL HIP ARTHROPLASTY

Objective

To correlate vertical (VFO) and horizontal (HFO) femoral offset with hip range of motion (ROM), peak muscle torque (PT), functional, capacity, and lower limb length in patients with total hip arthroplasty (THA).

Methods

A cross-sectional case control study, in which 22 individuals (10 men and 12 women) - aged 61 (41-72), and within 23 (10-40) postoperative days - were evaluated for active hip ROM (fleximetry); Isometric PT (portable dynamometer); functional capacity (Timed up and Go test (TUG) and Harris Hip Score questionnaire); lower limb length (measuring tape); and VFO and HFO (radiographs).

Results

The operated limb showed a reduction in length (p = 0.006), ROM for abduction (p = 0.001), flexion (p = 0.003), and external rotation (p = 0.003), as well as in all PT (p < 0.05) when compared with the contralateral limb. Moderate correlations were observed between VFO and external rotators (r = 0.487; p = 0.021); HFO and external rotators PT (r = -0.508; p = 0.016); and the difference between the VFO (operated and non-operated limb) and the TUG (r = -0.570; p = 0.006).

Conclusion

Changes to the femoral offset seem to influence functional capacity, as well as the movement and external rotators PT of the hips in patients with THA, considering the postoperative period evaluated. Level of Evidence III, Case Control Study.

Nutritional Status and Health-Related Quality of Life among Knee and Hip Osteoarthritis Patients under Rehabilitation Care in Kuala Nerus, Terengganu, Malaysia

Introduction:

The World Health Organisation (WHO) has estimated that 80% of people with osteoarthritis (OA) have movement limitations while 25% of them cannot perform their major daily activities, thus resulting in a decline of their nutritional status and quality of life (QOL). Therefore, this study aimed to compare the nutritional status and health-related quality of life (HRQOL) of OA patients between gender and age group.

Material and Methods:

A cross-sectional study was conducted on 131 OA patients in Rehabilitation Health Organisation, Terengganu. Socio-demographic, clinical, lifestyle histories, 24-hour dietary intake and HRQOL were assessed using a structured questionnaire.

Results:

Knee and/or hip OA patients recruited consisted of 19.1% of men and 80.9 % of women collectively with a mean age of 61.81 (9.28) years ranging from 38 to 83 years. The percentages of underweight, normal, overweight, and obese patients were 1.5%, 12.2%, 36.7%, and 49.6%, respectively. Further assessment of HRQOL showed that the highest mean score was obtained by the social functioning (SF) domain of 41.25 (27.16), while the mental domain scored the least mean score of 21.15 (20.92). In terms of gender breakdown, the males had significantly greater weight and height but lower body fat (BF) compared to their female counterparts, as well as a significantly higher energy, carbohydrate and protein intake. According to the age group, patients aged < 60 years had significantly greater weight, height, and BF than those aged ≥ 60 years.

Conclusion:

This study is an important baseline reference for proper OA management and prevention by providing crucial nutritional status and HRQOL information.

Quantifying Mediators of Racial Disparities in Knee Osteoarthritis Outcome Scores: A Cross-Sectional Analysis

Studies on symptomatic osteoarthritis suggest that Black patients report worse pain and symptoms compared with White patients with osteoarthritis. In this study, we aimed to quantify the relationship among variables such as overall health and socioeconomic status that may contribute to disparities in patient-reported outcomes.

Pain, Goal Engagement, and Eudaemonic Well-Being: Moderation by Autonomous Motivation

OBJECTIVES

Pain may decrease well-being in older adults by limiting social and leisure activities. However, some activities can exacerbate pain. We hypothesized that autonomously motivated goal engagement could ameliorate negative effects of pain on goal engagement and amplify positive effects of goal engagement on eudaemonic well-being (EWB).

METHOD

Midlife and older women (N=200) were oversampled for chronic pain. Daily diaries (n=10,697) including goal lists and ratings, pain, and EWB were completed for 7 days every 3 months for 2 years.

RESULTS

Pain was not a correlate of goal engagement. More engagement was associated with higher EWB when motivation was autonomous. However, more goal engagement correlated with lower EWB the next day and, when not autonomously motivated, higher pain.

DISCUSSION

Goal engagement can benefit people with or without physical pain, but the motivation behind goal engagement is equally if not more important. Goals motivated by autonomous sources increase EWB and may protect against maladaptive patterns of activity associated with pain.

[Validation of the living with osteoarthritis in Spanish population]

OBJECTIVE

Present the psychometric results of the Living with Osteoarthritis (LW-OA) in Spanish population.

DESIGN

Observational, cross-sectional and multicenter study, with retest on a fraction of the sample.

LOCATION

Public and private centres of primary and secondary healthcare, as well as patient associations from Navarra, La Rioja, Madrid, Valencia and Malaga.

PARTICIPANTS

The sample was composed by 291 patients with OA with a medical diagnosis in every stage of the disease from primary or secondary healthcare, Spanish nationality and not hospitalized.

INTERVENTIONS

In addition to LW-OA, a sociodemographic questionnaire was included, as well as scales to evaluate social support perceived from the patient (DUFSS), quality of life (WHOQOL-BREF) and satisfaction with life.

MAIN MEASUREMENTS

Psychometric properties of the LW-OA were measured, as viability and acceptability, reliability (internal consistency and reproducibility), precision and construct validity (convergent, internal and known-groups).

RESULTS

100% of the data were computable. Excellent data quality was obtained. Cronbach's alpha for the scale total was 0.87 and the homogeneity index 0.22. ICC for the scale total was 0.88. As for precision, the SEM was 5.18 (<½DE=7.47).

CONCLUSIONS

The LW-OA is a valid and feasible measure to evaluate the process of living with OA in Spain.

The impact of social interactions and pain on daily positive and negative affect in adults with osteoarthritis of the knee

This study utilized experience sampling methodology (ESM) to examine the relationship of social interactions with daily pain and mood symptoms in people with osteoarthritis (OA) of the knee. Two hundred sixty-eight adults with physician-diagnosed OA of the knee underwent a baseline in-person interview and subsequent week-long ESM protocol to assess their daily activity patterns, pain, and mood via phone interview four times a day. A coding system was developed to assess presence and type of social interactions based on subject self-report of activity patterns. Multilevel modeling was used to examine between- and within-subject variation in outcomes based on both global and momentary measures of social activities, pain, and mood, while controlling for key demographic and potentially confounding variables. Positive associations were demonstrated between the ratio of positive to negative affect and both global (β = 0.49, p < .001) and momentary, especially positive (β = 0.24, p < .05), social activity patterns. Additionally, the association between negative affect and pain (β = -0.07, p < .01) was attenuated in those with more baseline social interactions. Social interaction has the potential to influence mood in adults with OA of the knee, both on a global scale, and through daily variations in interactions. These interactions seem to be directly related to mood, as well as the apparently attenuating the relationship between pain and depression. Daily social interactions showed a robust positive association with contemporaneous positive affect.

Pharmacological and biochemical properties of Zingiber zerumbet (L.) Roscoe ex Sm. and its therapeutic efficacy on osteoarthritis of knee

Osteoarthritis (OA) as the most frequent form of knee arthritis is one of the most annoying complications amongst old peoples. There are different pharmacological and non-pharmacological remedies which could be applied for treatment of knee OA. It's while, significant side effects mostly in patients who are older are the dangerous limiting factors. Integrative, supplementary, traditional remedies have been applied from long time ago in treatment of such chronic diseases like OA. Various topical and oral remedies have been presented in treatment of OA worldwide. In spite of the fact there are multiple remedies for reduction symptoms of patients who suffer from disorders and related inabilities which could enhance their life quality. Remedies which have been applied for a long time for treatment of OA have newly discovered to induce injury to some patients. On the other side, additional knowledge about alternative and supplementary remedies is a main way for enhancing health of patients who suffer from OA disorders. Zingiber zerumbet (Z. zerumbeton) is a kind of herb of the ginger family and is a natural compound with various biomedical characteristics like anti-proliferative, anti-inflammatory, and antioxidant effect. However, Z. zerumbet could be applied for reduction of OA symptoms because of its circulatory stimulant and anti-inflammatory effects. Anyway, up to now there is not any methodical literature review for evaluating the Z. zerumbet clinical effectiveness productiveness in treatment of OA. The main aim of the current study is to review scientific resources around therapeutic effectiveness of Zingiber zerumbet in treatment of adverse symptoms of OA disorder.

Vibroacoustic treatment to improve functioning and ability to work: a multidisciplinary approach to chronic pain rehabilitation

PURPOSE

To study the use of Vibroacoustic treatment and an added self-care intervention for improving the functioning and ability to work of patients with chronic pain and potential comorbid depressive and anxious symptoms.

MATERIALS AND METHODS

A mixed methods study with four single cases. Participants received bi-weekly Vibroacoustic practitioner-led treatment sessions for five weeks, followed by a one-month washout period without treatments. Then, participants conducted four self-care vibroacoustic sessions per week for five weeks, followed by another month-long washout period. Participants kept diaries of their experiences during this time. Quantitative scales included the World Health Organization Disability Assessment Schedule 2.0, Visual Analogue Scales (pain, mood, relaxation, anxiety, and ability to work), Beck's Depression Inventory-II, and Hospital Anxiety and Depression Scale (Anxiety only). The use of physiological markers was also explored.

RESULTS

The greatest improvement was from the practitioner-led sessions, but self-care was beneficial for pain relief and relaxation. Participants became more aware of sensations in their own bodies, and during washout periods noticed more clearly the treatment effects when symptoms returned. An added self-care phase to standard Vibroacoustic treatment could be beneficial for maintaining the effects from the more intensive Vibroacoustic treatment as part of multidisciplinary rehabilitation.Implications for rehabilitationChronic pain and comorbid mood disorders negatively impact functioning and ability to work.Vibroacoustic treatment with a self-care phase could be beneficial for managing the symptoms of chronic pain if implemented within a naturalistic multidisciplinary rehabilitation context.In four single cases, this study shows functioning, pain, and depression improved after Vibroacoustic treatment with self-care.

Multidimensional Frailty and Pain in Community Dwelling Elderly

Objective

To examine the relationship between frailty and pain, particularly to analyze whether pain predicts physical, psychological and social frailty, after controlling for the effects of life-course determinants and comorbidity.

Design

Cross-sectional.

Methods

A nonprobabilistic sample of 252 community dwelling elderly was recruited. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator and pain was measured with the Pain Impact Questionnaire. Hierarchical and logistic regression analyses were conducted.

Results

In this study, 52.4% of the participants were aged 80 years and over, and 75.8% were women. Pain and frailty were higher in women, and physical frailty was higher in those aged ≥80 years. After controlling for the effects of the determinants and comorbidity, pain predicted 5.8% of the variance of frailty, 5.9% of the variance of physical frailty, and 4.0% of the variance of psychological frailty, while the prediction of social frailty was nonsignificant. Overall, a greater pain impact score was associated with the presence of frailty (odds ratio 1.06; 95% CI 1.03–1.10; P < 0.001).

Conclusion

Frailty was independently predicted by pain, emphasizing the importance of its treatment, potentially contributing to the prevention of vulnerability, dependency, and mortality. Nonetheless, longitudinal studies are required to better understand the possible association between pain and frailty.

Updated systematic review and meta-analysis of acupuncture for chronic knee pain

OBJECTIVE

To assess the effectiveness and safety of acupuncture for the treatment of chronic knee pain (CKP).

METHODS

We searched the MEDLINE, EMBASE, Cochrane CENTERAL, CINAHL and four Chinese medical databases from their inception to June 2017. We included randomised controlled trials of acupuncture as the sole treatment or as an adjunctive treatment for CKP. The primary outcome was pain intensity measured by visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and 11-point numeric rating scale. Secondary outcome measurements included the 36-Item Short Form Health Survey and adverse events. The quality of all included studies was evaluated using the Cochrane risk-of-bias criteria and the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) checklist.

RESULTS

Nineteen trials were included in this systematic review. Of these, data from 17 studies were available for analysis. Regarding the effectiveness of acupuncture alone or combined with other treatment, the results of the meta-analysis showed that acupuncture was associated with significantly reduced CKP at 12 weeks on WOMAC pain subscale (mean difference (MD) -1.12, 95% confidence interval (CI) -1.98 to -0.26, I²=62%, 3 trials, 608 participants) and VAS (MD -10.56, 95% CI -17.69 to -3.44, I²=0%, 2 trials, 145 patients). As for safety, no difference was found between the acupuncture and control groups (risk ratio 1.08, 95% CI 0.54 to 2.17, I²=29%).

CONCLUSION

From this systematic review, we conclude that acupuncture may be effective at relieving CKP 12 weeks after acupuncture administration, based on the current evidence and our protocol. However, given the heterogeneity and methodological limitations of the included trials, we are currently unable to draw any strong conclusions regarding the effectiveness of acupuncture for chronic knee pain. In addition, we found that acupuncture appears to have a satisfactory safety profile, although further studies with larger numbers of participants are needed to confirm the safety of this technique.

STRENGTHS

Systematic review without language restrictions.

LIMITATIONS

Only a few high-quality and consistent trials could be included in this review.

A qualitative study of pain experiences in patients requiring hip and knee arthroplasty

The aim of this study was to conduct an in-depth investigation of experiences with pain before knee and hip replacement surgery. A total of 20 patients were interviewed, and interpretative phenomenological analysis was used to identify themes. These were as follows: living with pain, pain conceptualised, pain treatments and healthcare system. Pre-surgical pain is very disabling and is viewed as biological. There was an associated loss of independence. Pharmaceutical management is used by all but not entirely effective, psychological therapies are underutilised. Patients were frustrated, angry, and confused about qualifying for surgery. Many areas of care could be improved to help these pre-surgical patients.

Prevalence and impact of pain in adults aging with a physical disability: comparison to a US general population sample

OBJECTIVES

To describe rates of pain and pain interference in a large sample of adults aging with long-standing physical disabilities, relative to a normative US population sample.

METHODS

Self-report survey data was collected for a sample of 1877 individuals with spinal cord injury, neuromuscular disease, postpolio syndrome, or multiple sclerosis. Rates of pain severity and pain interference in these samples were then compared with those taken from a large normative sample (>20,000) collected through the NIH Patient Reported Outcomes Measurement Information System (PROMIS).

RESULTS

Individuals with long-standing physical disabilities reported higher levels of pain and pain interference across the lifespan as compared with individuals in the normative sample. In general, individuals with disability did not experience an age-related decrease in pain and pain impact in contrast to those in the normative sample. For 3 disability groups (neuromuscular disease, postpolio syndrome, and multiple sclerosis), pain interference remained elevated and significantly higher than national norms in the "postretirement" period (ie, age 65 to 74).

DISCUSSION

Results from this study provide a large scale data on prevalence rates of pain and pain interference in this population. Findings underscore the prevalence and impact of pain in persons with disabilities and suggest that individuals with disability may not experience the same degree of decrease in pain interference in later life that is typical of the US population. Those aging with disability may be especially at risk for pain-related impairment in later life.

'Keeping going': chronic joint pain in older people who describe their health as good

It is common for people with chronic conditions to report their health as good, although models of healthy ageing do not account for this. The concept of successful ageing focuses on overcoming problems, in contrast to the concept of resilience, which can acknowledge vulnerability. Osteoarthritis (OA) is the main cause of joint pain in older people, but research in this area has tended to focus on OA as an illness. Consequently, our research aimed to explore OA from the perspective of wellness. We undertook a longitudinal qualitative study to explore 'wellness and resilience' in a group of older people who reported chronic joint pain and considered themselves healthy. We interviewed 27 people and followed them up with monthly diary sheets, responding to reports of changes using their chosen contact method. This article focuses on how resilience relates to how people consider themselves to be well. Participants' experience of the adversity of their pain varied, and was influenced by context and meaning. Participants described 'keeping going' in body, mind and everyday life. Flexibility and pragmatism were key aspects of keeping going. The findings support a broader version of resilience that incorporates vulnerabilities. In the context of health care we suggest that treating the frail body should not come at the expense of undermining an older person's sense of a resilient self.

Preserving knee function following osteoarthritis diagnosis: a sustainability theory and social ecology clinical commentary

To sustain natural systems, there must be an ongoing balance between environmental, social, and economic considerations. A key element of sustainability theory is to identify the most vulnerable surroundings. The most vulnerable knee tissue is the articular cartilage as it is the last line of osteoarthritis (OA) defense. This tissue has a poor capacity for healing. Based on sustainability theory and social ecology concepts we propose that several key factors contribute to knee function preservation. Factors include health history, genetic predisposition, personal behaviors, and socio-environmental factors in addition to local-regional-global physiological system function. Addressing only some of these factors or any one factor in isolation may lead to less than optimal treatment effectiveness. The purpose of this commentary is to introduce a medical, surgical and rehabilitation management approach for patients with knee OA that considers more than physical function improvement. This approach also considers social, emotional, and environmental factors to better ensure patient satisfaction, fulfilled expectations and successful outcomes. A clinical care pathway is presented for a 57-year-old patient with medial compartment knee OA who is contemplating early arthroplasty versus a knee function preservation treatment approach. Early arthroplasty refers to high revision likelihood based on a minimum 15 year prosthesis life-expectancy.

Risk factors associated with reduced work productivity among people with chronic knee pain

OBJECTIVE

To determine the burden and risk factors associated with reduced work productivity among people with chronic knee pain.

METHOD

A longitudinal study, nested within a randomised controlled trial (RCT) evaluating the long-term effects of dietary supplements, was conducted among people with chronic knee pain in paid employment (n = 360). Participants recorded days off work (absenteeism) and reduced productivity while at work (presenteeism) for seven days every two months over a 12-month period in a study specific diary. Examined risk factors included knee pain severity, occupational group, radiographic disease severity, physical activity, body mass index (BMI), health-related quality of life (SF-12) and co-morbidity.

RESULTS

Over the 12-month follow up period, 50 (14%) participants reported one or more days off work due to knee problems, while 283 (79%) reported reduced productivity while at work (presenteeism <100%). In multivariate analysis, the only significant risk factor for absenteeism was having an SF-12 Mental Component Summary (MCS) score <40 (OR: 2.49 [95% CI: 1.03-5.98]). Significant risk factors for presenteeism included; reporting an; SF-12 Physical Component Summary (PCS) score <50 (OR: 1.99 [95% CI: 1.05-3.76]), semi-manual labour (OR: 2.23 [1.09-4.59]) or manual labour (OR: 6.40 [1.44-28.35]) or a high maximum knee pain (4-6 out of 10) (OR: 2.29 [1.17-4.46]).

CONCLUSIONS

This longitudinal study found that among this cohort of people with chronic knee pain, the burden of reduced work productivity is mainly attributable to presenteeism rather absenteeism. This study demonstrated that effective strategies to increase work productivity should focus on reducing knee pain or physical disability especially among workers in manual or semi-manual labour.

Well-being among older adults with OA: direct and mediated patterns of control beliefs, optimism and pessimism

OBJECTIVES

To assess the contribution of important psychological resources (i.e. optimism, pessimism, control beliefs) to the psychological well-being of older adults with Osteoarthritis (OA); to assess the direct and mediated association of these psychosocial resources to outcomes (depressive symptoms, life satisfaction, and self-esteem). These objectives are important because OA is a significant stressor, treatments are limited, and psychological functioning is at risk for those coping with the condition, even compared to other chronic illnesses.

METHOD

A cross-sectional survey of 160 community-dwelling older adults with OA (81% women). Participants were not randomly selected, but nonetheless reflected the demographic makeup of the selection area.

RESULTS

Ordinary least squares regression analyses using the PROCESS macro revealed that optimism and pessimism were associated with higher depressive symptoms and lower self-esteem indirectly through constraints beliefs. The analysis of life satisfaction showed that optimism and pessimism were each partially mediated through mastery and constraints beliefs.

DISCUSSION

These results suggest that prior research, which has assessed these psychological resources as having singular relationships to outcomes, may have underestimated the importance of the relationship between these variables. We discuss possible points of intervention for older adults with OA who may experience increasing constraints beliefs over time.

Age and the role of restricted activities in adjustment to disability-related pain

Chronic pain is common in individuals with multiple sclerosis and spinal cord injury and is associated with depressed mood. This may be because pain creates interference in performing and enjoying valued activities. The importance of pain interference may also vary with age, since older adults may have lowered expectations regarding function. This study analyzed relationships among pain variables, age, and mood in 521 individuals with multiple sclerosis or spinal cord injury. As predicted, pain interference mediated the relationship between pain severity and depressed mood. There was no evidence that older adults were less distressed by pain interference than were younger adults.

The clinical effectiveness of Ginger (Zingiber officinale) in adults with osteoarthritis

Background  Osteoarthritis (OA) is a degenerative joint disease, which is associated with increased pain and disability, and a simultaneous decline in the quality of life of sufferers. While there is no cure for OA, there are numerous treatments that aim to reduce sufferers' symptoms and disability, and improve their quality of life. Medications, which have long been integral interventions for the management of OA, have recently been found to cause harm in some patients. Simultaneously, the increasing recognition of complementary and alternative therapies as part of mainstream health care, has seen many sufferers of OA use these therapies. Ginger has been commonly prescribed by herbalists for sufferers of OA due to its anti-inflammatory and circulatory stimulant effects. However, to date there has been no systematic review of the literature to evaluate the clinical effectiveness of Ginger for OA. Objective  The objective of this systematic review was to evaluate the safety and effectiveness of Ginger in adults with OA. Data sources  A comprehensive search was undertaken on 18 electronic databases from their inception to January 2007, including AARP Ageline, AMED, AMI, BioMed central gateway, CAM on PubMed, CENTRAL, CINAHL, Cochrane library, Current controlled trials, Current contents connect, DARE, Dissertations Abstract International, EMBASE, Health Source Nursing/Academic edition, International Pharmaceutical Abstract, MEDLINE, Natural medicines comprehensive database and TRIP. Review methods  Randomised controlled trials or clinical controlled trials were sought, which evaluated the effectiveness of mono-preparations of ginger in adults with OA of the knee or hip. Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments. Data extraction was via the Joanna Briggs Institute standard data extraction form for evidence of effectiveness. Results  Five randomised controlled trials were identified from the search, of which three met the inclusion criteria. The methodological quality of the included studies was good. However, given that studies were clinically and methodologically heterogeneous, meta-analysis could not be conducted. Instead, evidence was summarised in narrative form. For changes in pain severity, studies comparing ginger extract (n = 110) to placebo (n = 111) reported mixed findings in support of the use of Ginger. Studies comparing ginger to an active control found participants who received Ibuprofen (n = 96) had a greater change in median pain intensity compared with participants who received Ginger (n = 110), and while findings were statistically significant for only one of the two studies, the results had limited clinical significance. Similarly, while two placebo-controlled studies reported differences between ginger (n = 70) and placebo (n = 71) for changes in disability and functional capacity, the difference was statistically and clinically significant for only one study. In one study comparing ginger to an active control, participants receiving Ibuprofen (n = 56) reported a statistically significant improvement in disability and functional capacity over time when compared with participants receiving Ginger (n = 56). In terms of safety, Ginger was well tolerated when compared with Ibuprofen, with infrequent reports of mild, and predominantly gastrointestinal, adverse effects. Conclusion  Current evidence is weak for the use of Ginger in adults with OA of the knee and/or hip. Much of this can be attributed to significant heterogeneity between studies. Improvements in research design, instrumentation and ginger dosage, which more closely reflect current clinical practice, may help to demonstrate the safe and effective use of Ginger in OA sufferers.

Duloxetine for the management of pain in older adults with knee osteoarthritis: randomised placebo-controlled trial

BACKGROUND

pain is the leading symptom of osteoarthritis (OA) and is often chronic in nature, leading to significant morbidity and decreased quality of life. Duloxetine, a selective serotonin norepinephrine reuptake inhibitor has been demonstrated to have a centrally acting analgesic effect.

OBJECTIVES

the aim of the present study was to investigate the efficacy of duloxetine in reducing pain in older adults with knee OA.

METHODS

totally, 288 patients aged 65 years and above with primary knee OA were enrolled in this study. Patients were randomised 1:1. Totally, 144 received 60 mg/day of duloxetine HCL and 144 received placebo for 16 weeks. Outcome measures included pain reduction and improvement in physical functioning scores. Pain was assessed using the visual analogue pain scale (VAS; 0-100 mm). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used to assess function.

RESULTS

two-hundred and seventy four of the 288 patients completed the study. There was a statistically significant reduction in pain and a significant improvement in WOMAC scores at 16 weeks in the duloxetine group versus the placebo group. No serious side effects were reported.

CONCLUSIONS

the findings of the present study provide evidence for the efficacy and tolerability of duloxetine in reducing pain and subsequently improving function in older adults with knee OA.

TRIAL REGISTRATION

NCT01425827.

Social determinants and osteoarthritis outcomes

Osteoarthritis (OA) is one of the most frequently occurring musculoskeletal diseases, posing a significant public health problem due to its impact on pain and disability. Traditional risk factors fail to account for all of the risk observed for OA outcomes. In recent years, our view of disease causation has broadened to include health risks that are created by an individual's socioeconomic circumstances. Early research into social determinants has focused on social position and explored factors related to the individual such as education, income and occupation. Results from these investigations suggest that low education attainment and nonprofessional occupation are associated with poorer arthritis outcomes. More recently, research has expanded to examine how one's neighborhood socioeconomic environment may be relevant to OA outcomes. This narrative review proposes a framework to help guide our understanding of how social context may interact with pathophysiological processes and individual-level variables to influence health outcomes in those living with OA.

Fibromyalgia symptoms, physical function, and comorbidity in middle-aged and older adults

BACKGROUND

Multiple studies report on symptoms or physical function in people with fibromyalgia; however, limited studies have been focused on older adults with fibromyalgia.

OBJECTIVES

The aims of this study were to describe the occurrence, frequency, severity, and distress of symptoms and to examine differences in symptoms and physical function between a middle-aged and an older group.

METHOD

Questionnaires were mailed to a random sample of 533 adults with fibromyalgia over 50 years of age, using a large tertiary care database. These questionnaires included an investigator-developed 29-item symptom questionnaire that measured the frequency (1-4), severity (1-4), and distress (0-4) of FM symptoms. The participants also completed the Late Life Function and Disability Instrument and the Charlson Comorbidity Index.

RESULTS

Fifty-three percent of the sample reported at least 20 symptoms in the last 7 days. The most frequent and severe symptoms were pain, nonrefreshing sleep, fatigue, stiffness, difficulty staying asleep, difficulty falling asleep, and profuse sweating. The most distressing symptoms were fear of symptoms worsening, followed by difficulty staying asleep, fatigue, nonrefreshing sleep, and restless legs. Participants reported moderate functional limitations (M ± SD = 52.7 ± 9.0). Comorbidities were low (1.7 ± 1.5; range = 0-7). The middle-aged group experienced a greater number of total symptoms (21.4 ± 5.9 vs. 19.3 ± 5.2; p < .01).

DISCUSSION

Middle-aged adults with fibromyalgia were more symptomatic than older adults. Further study is needed to understand the relationship between fibromyalgia symptoms and age and physical function.

Poor vision, functioning, and depressive symptoms: a test of the activity restriction model

PURPOSE

This study tested the applicability of the activity restriction model of depressed affect to the context of poor vision in late life. This model hypothesizes that late-life stressors contribute to poorer mental health not only directly but also indirectly by restricting routine everyday functioning.

METHOD

We used data from a national probability-based sample of older adults (N = 1,178; M = 69.2 years, approximately 50% female). Vision was assessed both subjectively (via self-report) and objectively (via a visual acuity test). Respondents also reported on their levels of physical and driving limitations, feelings of social isolation, and symptoms of depression.

RESULTS

Path analyses indicated a strong fit of the data to the activity restriction model for subjective vision. In addition to directly contributing to higher depressive symptomatology, subjective vision contributed to depressive symptoms indirectly by predicting more physical limitations and feelings of social isolation that, in turn, contributed to more symptoms of depression; driving limitations did not mediate the relationship between subjective vision and depressive symptomatology. Objective vision contributed significantly to physical and driving limitations but was unrelated to feelings of social isolation and depressive symptomatology. 

IMPLICATIONS

Supporting the activity restriction model, poorer self-rated vision in late life contributes to lower mental health directly and also indirectly by restricting individuals' ability to carry out routine day-to-day physical activities and increasing their feelings of social isolation. Interventions for older adults with vision-related problems could focus on maintaining or enhancing their physical and social functioning in order to promote their adaptation to poor vision.

It's all in how you view it: pessimism, social relations, and life satisfaction in older adults with osteoarthritis

OBJECTIVES

Current treatments for osteoarthritis (OA) continue to leave those burdened by the condition with pain and disability which affects physical and psychological well-being. The present study examines other psychosocial factors, such as dispositional personality and social relationships, in order to investigate their influence on the well-being of 160 older adults with OA (80% women).

METHOD

Older adults were recruited for self-reported knee or hip OA. Participants completed self-report measures of optimism and pessimism, social support, social strain, and life satisfaction using the computer program MediaLab. Measures were taken twice 9-12 months apart.

RESULTS

Results showed that, both cross-sectionally and longitudinally, pessimism was related to lower social support and higher social strain. In addition, pessimism was mediated by social support in its relationship to life satisfaction.

DISCUSSION

Our models support the combined roles of pessimism and social support influencing life satisfaction over time. Future interventions may want to concentrate on improving the social relationships of people with OA to enhance psychological well-being.

Disability in end-stage knee osteoarthritis

OBJECTIVE

To examine the attributes of disability in end-stage knee osteoarthritis (OA) by analyzing the relationships between self-reported disability and objectively measured physical function after controlling pain, personal characteristic factors, and pathophysiological factors.

METHODS

The present study adopted a cross-sectional design. The subjects (n=88, aged 60-80 years) were scheduled for primary unilateral total knee arthroplasty (TKA) due to knee OA. Self-reported disability and pain were measured with the Western Ontario and McMaster Universities OA Index (WOMAC) and the RAND 36-item Health Survey 1.0 (RAND-36). Physical performance tests included a 15-m walk test and stair performance. Knee isometric muscle strength was measured. A clinical examination included analyses of comorbidity, body mass index (BMI), and a detailed knee examination: The flexion range of motion (ROM) was measured; the presence of varus/valgus malalignments and antero-posterior laxity was assessed. Radiographs were analyzed with the Kellgren-Lawrence grading scale.

RESULTS

In the linear regression model the WOMAC pain score, antero-posterior laxity of the knee, age, and BMI accounted for 54.8% of the variance in the WOMAC function score. In the bivariate analyses the WOMAC function score had a positive correlation with the 15-m walk (r(s)=0.32, p=0.003), stairs up (r(s)=0.40, p=0.001), and stairs down (r(s)=0.38, p=0.001) tests, and a negative correlation with RPT extension (r(s)=-0.45, p < 0.001) and RPT flexion (r(s)=-0.39, p=0.001) of the affected side and RPT flexion (r(s)=-0.39, p <0.001) of the contralateral side. The results of the physical performance tests also correlated with the RAND-36 Physical function (PF) score. Comorbid diseases and pain deteriorated the results of the physical performance tests and self-reported disability. Female gender deteriorated the results of the physical performance tests and the RAND-36 PF, but not the WOMAC function score. Malalignments, restriction in the flexion ROM of the knee, and the radiologic severity of knee OA did not affect self-reported disability.

CONCLUSION

Pain, BMI, and antero-posterior laxity of the knee joint were major attributes of self-reported disability. The negative effect of comorbid diseases and female gender on health-related quality of life was significant. The results of objectively measured physical performance tests correlated with self-reported disability.

Explaining the relationship between pain and depressive symptoms in African-American and white women with arthritis

Arthritis is a common chronic illness that disproportionately affects women and African Americans and is often associated with depression. The mechanisms through which arthritis-related pain are associated with depression remain unclear. This study examined the relationship between arthritis-related pain and depressive symptoms to determine if functional impairment and sense of mastery mediated this relationship. Participants included 77 African-American and 98 white women with arthritis (aged 45-90) who completed structured questionnaires assessing pain, functional impairment, sense of mastery and depressive symptoms. Regression analyses showed that sense of mastery and functional impairment partially mediated the relationship between pain and depressive symptoms for whites such that the previously significant pain-depression relationship (beta = 0.40, p < 0.001) was no longer significant (beta = 0.05, p = 0.62). Only sense of mastery partially mediated between pain and depressive symptoms for African Americans. Again, the previously significant pain-depression relationship (beta = 0.32, p < 0.01) was reduced (beta = 0.16, p = 0.19). Implications of the study suggest that it is important for service providers and healthcare professionals to be aware of different lifetime experiences and perceptions of illness in order to better serve the needs of women from different race groups.

The relationship between pain and functional disability in Black and White older adults

In this study we examined pain and disability in 115 community-dwelling, urban, older adults (mean age = 74 years; 52% Black, 48% White). Participants completed a survey of pain (pain presence, intensity, locations, and duration) and disability (Sickness Impact Profile). Sixty percent of the sample reported pain; Black and White adults did not differ on any pain variable. In structural equation models controlling for socioeconomic factors and health, pain did not mediate the relationship between race and disability. Race moderated the pain-disability relationship; pain was more associated with disability among Whites than Blacks. This study highlights the need for greater understanding of health disparities between Black and White older adults as they relate to pain and disability.

Management of knee osteoarthritis in primary care: pain and depression are the major obstacles

OBJECTIVES

Osteoarthritis (OA) management is a challenge, as OA consists of a spectrum of pathologies requiring a multifaceted treatment approach. Patient education programmes (PEP) are attractive, as they may be cost effective and potentially efficacious. The goals of the study were to determine what may hinder the efficacy of a PEP for knee OA by determining the relevance of depression, pain, disease knowledge and physical ability in patients to their response to a PEP.

METHODS

Clinical and demographic data relating to 170 patients who completed a trial of a PEP were analysed to determine how they interrelate during patient management.

RESULTS

All patients showed a progressive decrease in mental health over the duration of the study (P<.001). Greater pain was associated with reduced coping, increased depression and reduced physical ability (P<.05). Women were more likely to experience disability (P<.05). Disability was associated with reduced ability to cope, increased depression and the experience of more pain (P<.05). Subjects with a Caucasian background were significantly (P<.05) more likely to possess knowledge of OA than other ethnic groups. The lowest knowledge group experienced more pain; the highest knowledge group was coping better and had less depression (P<.05).

CONCLUSION

A complex interrelationship between depression, pain, disease knowledge, and physical ability in patients with knee OA has been demonstrated. Specifically, the treatment of depression and pain may be paramount to the successful treatment of knee OA, and these factors should be considered in each patient and management priorities made.

Coping with chronic pain among younger, middle-aged, and older adults living with neurological injury and disease

Objective. This article compares use of pain coping strategies among older, middle-aged, and younger adults living with chronic pain and seeks to determine whether the relationship between pain severity and coping is moderated by age. Method. Participants were 464 adults reporting chronic pain secondary to multiple sclerosis, spinal cord injury, or neuromuscular disease. Participants completed a survey including measures of pain severity and the Chronic Pain Coping Inventory. Results. After controlling for clinical and demographic variables, older adults (older than 60) reported a wider range of frequently used strategies and significantly more frequent engagement in activity pacing, seeking social support, and use of coping self-statements than did younger or middle-aged adults. Moderation analyses suggest that, for younger adults, efforts at coping generally increased with greater pain severity, whereas this relationship did not exist for older adults. Discussion. These data suggest differences in the quantity and quality of pain coping among age groups.

The clinical effectiveness of Ginger (Zingiber Officinale) in adults with osteoarthritis

BACKGROUND

Osteoarthritis (OA) is a degenerative joint disease, which is associated with increased pain and disability, and a simultaneous decline in the quality of life of sufferers. While there is no cure for OA, there are numerous treatments that aim to reduce sufferers' symptoms and disability, and improve their quality of life. Medications, which have long been integral interventions for the management of OA, have recently been found to cause harm in some patients. Simultaneously, the increasing recognition of complementary and alternative therapies as part of mainstream health care, has seen many sufferers of OA use these therapies. Ginger has been commonly prescribed by herbalists for sufferers of OA due to its anti- inflammatory and circulatory stimulant effects. However, to date there has been no systematic review of the literature to evaluate the clinical effectiveness of Ginger for OA.

OBJECTIVE

The objective of this systematic review was to evaluate the safety and effectiveness of Ginger in adults with OA.

DATA SOURCES

A comprehensive search was undertaken on 18 electronic databases from their inception to January 2007, including AARP Ageline, AMED, AMI, BioMed central gateway, CAM on PubMed, CENTRAL, CINAHL, Cochrane library, Current controlled trials, Current contents connect, DARE, Dissertations Abstract International, EMBASE, Health Source Nursing/Academic edition, International Pharmaceutical Abstract, MEDLINE, Natural medicines comprehensive database and TRIP.

REVIEW METHODS

Randomised controlled trials or clinical controlled trials were sought, which evaluated the effectiveness of mono-preparations of ginger in adults with OA of the knee or hip. Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments. Data extraction was via the Joanna Briggs Institute standard data extraction form for evidence of effectiveness.

RESULTS

Five randomised controlled trials were identified from the search, of which three met the inclusion criteria. The methodological quality of the included studies was good. However, given that studies were clinically and methodologically heterogeneous, meta-analysis could not be conducted. Instead, evidence was summarised in narrative form. For changes in pain severity, studies comparing ginger extract (n = 110) to placebo (n = 111) reported mixed findings in support of the use of Ginger. Studies comparing ginger to an active control found participants who received Ibuprofen (n = 96) had a greater change in median pain intensity compared with participants who received Ginger (n = 110), and while findings were statistically significant for only one of the two studies, the results had limited clinical significance. Similarly, while two placebo-controlled studies reported differences between ginger (n = 70) and placebo (n = 71) for changes in disability and functional capacity, the difference was statistically and clinically significant for only one study. In one study comparing ginger to an active control, participants receiving Ibuprofen (n = 56) reported a statistically significant improvement in disability and functional capacity over time when compared with participants receiving Ginger (n = 56). In terms of safety, Ginger was well tolerated when compared with Ibuprofen, with infrequent reports of mild, and predominantly gastrointestinal, adverse effects.

CONCLUSION

Current evidence is weak for the use of Ginger in adults with OA of the knee and/or hip. Much of this can be attributed to significant heterogeneity between studies. Improvements in research design, instrumentation and ginger dosage, which more closely reflect current clinical practice, may help to demonstrate the safe and effective use of Ginger in OA sufferers.

Research on persistent pain in late life: current topics and challenges

Older women often experience pain in their daily lives. This article provides an overview of topics addressed in the geriatric pain research published between 1999 and 2004. New areas of emphasis of research have emerged such as the recognition of body mass and weight as a factor in persistent pain, while other areas have expanded, including the focus on pain among elders with cognitive impairments and the use of alternative treatment approaches. Understanding of pain in late life is hindered by study samples that lack diversity, treatment approaches that are narrowly focused, and a lack of attention to quality of life issues.

Pain, positive and negative social exchanges, and depressive symptomatology in later life

OBJECTIVES

Pain in older adulthood is correlated with both depressive symptomatology and positive and negative social exchanges, but the direction of these relationships remains unclear. This study investigated whether (a) pain is associated with increases in negative exchanges and decreases in positive exchanges and (b) negative exchanges play a greater role than positive exchanges in accounting for the association between pain and depressive symptomatology.

METHODS

Data were derived from the Later Life Study of Social Exchanges, a longitudinal survey of noninstitutionalized older adults. Interviews assessed participants' sociodemographic and biopsychosocial characteristics, as well as their interactions with network members.

RESULTS

Pain was significantly associated with negative exchanges, and both pain and negative exchanges predicted greater depressive symptomatology over time. Positive social exchanges, however, were not related to either pain or depression.

DISCUSSION

The findings underscore the value of examining older adults' social exchanges in efforts to understand pain-induced depressive symptomatology.

Cross-sectional study of pain and disability at knee replacement surgery for osteoarthritis in 299 patients

OBJECTIVE

To evaluate pain and disability at the time of knee replacement surgery for osteoarthritis.

METHODS

In this multicenter cross-sectional study, 299 patients at 12 orthopedic surgery centers in Lyon, France were evaluated on the day before knee replacement surgery. Pain severity was assessed on a visual analog scale (VAS) and function using the Lequesne index and the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC).

RESULTS

There were 207 women and 92 men with a mean age of 73 years. Mean (+/-SD) VAS pain score upon walking was 55.8+/-24mm. Compared to patients with very severe disability (Lequesne index>12), those with mild-to-severe disability (Lequesne index<or=12) were more likely to be older than 70 years (odds ratio [OR], 2.85; 95% confidence interval [95%CI], 1.25-5) and male (OR, 2.5; 95%CI, 1.3-5); they were less likely to have a body mass index>27kg/m(2) (OR, 2.2; 95%CI, 1.3-3.3) and to engage in sporting activities (OR, 3.3; 95%CI, 1.4-10).

CONCLUSION

Patients about to undergo knee replacement surgery had high levels of pain and disability, with little variation across centers. Nevertheless, the severity of pain and disability may depend in part on age, gender, body mass index, and sporting activities, which probably influence the decision to perform knee replacement surgery.

Efficacy and safety of opioids for osteoarthritis: a meta-analysis of randomized controlled trials

OBJECTIVES

To determine the analgesic effectiveness, the effect on physical function and the safety of opioids in patients with osteoarthritis (OA).

SEARCH STRATEGY

A systematic literature search was performed in electronic databases up to October 2006. A hand search of references was also performed.

SELECTION CRITERIA

All randomized controlled trials evaluating the efficacy and/or the safety of opioids vs placebo or non-opioid analgesics in patients with OA were selected.

DATA COLLECTION AND ANALYSIS

Data were collected using a predetermined form. Statistical analysis determined in each trial the effect size to assess the magnitude of treatment effect and the number needed to harm (NNH) to evaluate opioids safety.

MAIN RESULTS

Eighteen randomized placebo-controlled trials were analyzed, i.e., a total of 3244 participants who received opioids and 1612 who received placebo. The mean trial duration was 13+/-18 weeks. The pooled effect sizes of all opioids vs placebo for pain intensity and physical function were -0.79 (95% confidence interval, CI, -0.98 to -0.59) and -0.31 (95% CI -0.39 to -0.24), respectively. The NNH was calculated to be 5 vs placebo. The number of studies (n=4) that compared opioids with non-opioid analgesics (paracetamol and non-steroidal anti-inflammatory drugs) was too limited to provide robust data.

CONCLUSIONS

Opioids significantly decrease pain intensity and have small benefits on function compared with placebo in patients with OA. Adverse events, although reversible and not life threatening, often cause participants to stop taking the medication and could limit opioid usefulness. Moreover, the long-term efficacy and safety of these drugs for OA is yet to be determined due to the short mean trial duration.

Age differences in the pain-depression link for women with osteoarthritis. Functional impairment and personal control as mediators

PURPOSE

This study examines functional impairment and personal control as mediators between pain and depressive symptoms in middle-aged and older women with osteoarthritis (OA).

METHOD

Ninety-nine middle-aged and older women with OA completed face-to-face interviews to assess pain, functional impairment, personal control, depressive symptoms, and self-rated health.

RESULTS

Controlling for self-rated health, functional impairment mediated the relationship between pain and depressive symptoms for middle-age women but not for older women. Alternately, personal control was a mediator for older women but not for middle-aged women.

CONCLUSIONS

Functional limitations at least partially explain the relationship between pain and depression for middle-aged women who are juggling many roles and do not expect trouble with daily activities. For older women, functional limitations are expected, but personal control becomes more important. Implications for intervention are discussed.

Effect of Depression Treatment on Depressive Symptoms in Older Adulthood: The Moderating Role of Pain

OBJECTIVES

To investigate whether pain severity and interference with normal work activities moderate the effects of depression treatment on changes in depressive symptoms over time in older adults in primary care.

DESIGN

Patient-randomized, clinical trial.

SETTING

Multisite: three clinics located in Veterans Affairs Medical Centers.

PARTICIPANTS

Adults aged 60 and older (n=524) who screened positive for depression and participated in the Primary Care Research in Substance Abuse and Mental Health for the Elderly Study.

INTERVENTION

Integrated care versus enhanced specialty referral care.

MEASUREMENTS

Pain severity, the degree to which pain interferes with work inside and outside of the home, and depressive symptoms were examined at baseline and 3, 6, and 12 months.

RESULTS

Intention-to-treat analyses revealed that both treatment groups showed reduced depressive symptoms over time, although self-reported pain moderated reductions in depressive symptoms. At higher levels of pain severity and interference with work activities, improvements in depressive symptoms were blunted. Furthermore, pain interference appeared to have a greater effect on depressive symptoms than did pain severity; in individuals with major depression, pain interference fully accounted for the moderating effects of pain severity on changes in depressive symptoms over time.

CONCLUSION

Pain and its interference with functioning interfere with recovery from depression. Findings highlight the importance of addressing multiple domains of functioning (e.g., physical and social disability) and the degree to which pain and other forms of physical comorbidity may hinder or minimize treatment-related improvements in depressive symptoms.

Physical and Psychological Correlates of Disability among a Cohort of Individuals with Knee Osteoarthritis

While the physical correlates of knee osteoarthritis are well documented, less well documented are aspects of psychological functioning that may affect overall health and functional status. This paper describes the findings of a cross-sectional analysis that examined the strength of the relationship between selected psychological factors and the walking ability of adults with knee joint osteoarthritis. The variables assessed were pain, depression, levels of self-efficacy for pain and other-symptoms management, walking endurance, walking speed, and perceived exertion when walking. The sample, including 57 persons with unilateral and 43 persons with bilateral radiographic and symptomatic knee osteoarthritis, mean age, 69.9 ± 1 years, underwent standard assessment procedures on a single test occasion using several validated questionnaires and a series of walking tests on level ground. Bivariate and multiple regression analyses revealed that (a) higher pain and other-symptoms self-efficacy scores were associated with lower levels of pain (r= −0.29, −0.20.), perceived exertion during a walking task (r= −0.29, −0.31), and depression scores (r= −0.46, −0.54) (p< 0.001); (b) subjects with higher levels of self-efficacy for managing symptoms other than pain also recorded faster and fast speed walking velocities than those with lower self-efficacy scores (r= 0.30, 0.31) (p< 0.001); (c) self-efficacy for pain was the strongest predictor of pain intensity, and self-efficacy for symptom management was the strongest predictor of perceived exertion during walking, depression, and pain self-efficacy. Although no cause–effect relationship can be deduced from a cross-sectional analysis, these data imply that efforts to heighten self-efficacy for pain and other-symptoms management may influence the affective status, function, and effort-related perceptions of people with knee osteoarthritis quite significantly.

Predictors of depression in a sample of 1,021 primary care patients with osteoarthritis

OBJECTIVE

Although there is a strong relationship between depression, chronic pain, and physical activity, there are few findings regarding the prevalence and predictors of depression in patients with osteoarthritis (OA). The goal of the present study was to assess the prevalence and severity of depression in a large sample of patients with OA and to reveal predictors of depression.

METHODS

Patients were approached consecutively in 75 general practices. Of 1,250 distributed questionnaires, 1,021 were returned and analyzed. Besides sociodemographic data, medication and comorbidities, depression, and arthritis were assessed using the Patient Health Questionnaire (PHQ-9) and the Arthritis Impact Measurement Scale. A stepwise multiple linear regression analysis with the PHQ-9 score as the dependent variable was performed.

RESULTS

On the PHQ-9, 19.76% of men and 19.16% of women achieved a score of >or=15, indicating at least a moderately severe depression. Significant sex differences could not be revealed. The strongest predictor for depression severity was perceived pain (beta = 0.243, P < 0.001) and few social contacts (beta = 0.218, P < 0.001). Further predictors were physical limitation of the lower body (beta = 0.157, P < 0.001) and upper body (beta = 0.163, P < 0.001), age (beta = -0.168, P < 0.001), and body mass index (beta = 0.080, P = 0.020).

CONCLUSION

These findings suggest an increased prevalence of depression among patients with OA and emphasize the need for recognition and appropriate treatment. Most of the revealed predictors are influenceable and should be potential targets in a comprehensive treatment of OA to interrupt the vicious circle of pain, physical limitation, and depression.

The relationship of optimism, pain and social support to well-being in older adults with osteoarthritis

Improving the psychological well-being of individuals with osteoarthritis (OA) is an important concern because the condition is highly prevalent and has no known cure. Few studies have assessed the joint contribution of social, personality, and physical factors in relation to well-being for OA patients. In a cross-sectional sample of older adults with OA (n = 73, 73% female), we assessed the role of support perceptions, optimism and pain in depressive symptoms and life satisfaction. Greater optimism and support were significantly related to both greater life satisfaction and lower depressive symptoms. Further, optimism partially mediated the relationship of pain to life satisfaction, while support partially mediated the role of pain in depressive symptoms. The interplay of these variables in relation to well-being is discussed in the context of chronic illness and older adulthood.