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Pain Severity and Depression in Knee OA Examined

Osteoarthritis Cartilage; ePub 2018 Aug 6; Rathbun, et al

Pain severity mediated approximately one-fifth of the association between depressive symptoms and physical performance in persons with radiographic knee osteoarthritis (OA), and the diminishing incremental effects may explain why unimodal treatment strategies with a single disease target are often ineffective in depressed OA patients. This according to a recent study that analyzed 3 years of annual data from participants (n=1,463) with radiographic knee OA in the Osteoarthritis Initiative. Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D) scale. Pain severity was evaluated with the Western Ontario and McMaster Universities Arthritis Index. Physical performance was assessed via standardized gait speed. Researchers found:

  • Direct and indirect effects for a difference in CES-D score of 0-1 were -0.0051 and -0.0016 standard deviations in gait speed, respectively.
  • Higher depressive symptom severity exhibited diminishing, incremental, direct and indirect effects and for a difference in CES-D score of 15-16 were -0.0045 and -0.0009 standard deviations in gait speed, respectively.
  • Therefore, the magnitude of the mediated, indirect effect, was never larger than 24%.


Rathbun AM, Shardell MD, Stuart EA, et al. Pain severity as a mediator of the association between depressive symptoms and physical performance in knee osteoarthritis. [Published online ahead of print August 6, 2018]. Osteoarthritis Cartilage. doi:10.1016/j.joca.2018.07.016.

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