Relationships of Fear, Anxiety, and Depression With Physical Function in Patients With Knee Osteoarthritis

Abstract

Objectives To explore whether the psychologic variables anxiety, depression, and fear-avoidance beliefs, and interactions between these variables, are associated with physical function in patients with knee osteoarthritis (OA). We hypothesized lower levels of function would be related to higher anxiety, higher depression, and higher fear-avoidance beliefs, and that high levels of 2 of these factors simultaneously might interact to have a greater adverse effect on physical function. Design Cross-sectional, correlational design. Setting Institutional practice. Participants Subjects included patients with knee OA (N=182; age, mean ± SD, 63.9±8.8y; 122 women). Interventions Not applicable. Main Outcome Measures Self-report measures of function included the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, the Lower Extremity Function Scale (LEFS), and the Knee Outcome Survey-Activity of Daily Living Scale. The Get Up and Go test was used as a physical performance measure of function. Self-report measures for psychologic variables included the Beck Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Fear Avoidance Belief Questionnaire-Physical Activity Scale modified for the knee. Results Higher anxiety was related to poorer function on the WOMAC physical function. Both high anxiety and fear avoidance beliefs were related to poorer function on the LEFS and Knee Outcome Survey-Activity of Daily Living Scale. There was no association between the psychologic variables and the Get Up and Go test. The anxiety X depression interaction was associated with the LEFS. Conclusions Anxiety and fear-avoidance beliefs are associated with self-report measures of function in patients with knee OA. Depression may influence scores on the LEFS under conditions of low anxiety.

People's beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study

“…Many participants found themselves in a negative cycle about fear of wear and tear, and reduced activity. This is commonly reported in the literature surrounding osteoarthritis [23]. In this instance the participants, (none of whom had osteoarthritis) had entered a cycle of fear- Negative belief systems were demonstrated through fear-avoidance, but in some participants catastrophising was also portrayed.…”

Fear-Avoidance Beliefs and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain Conditions

“…22 Fear of pain and reinjury was associated with function for patients in the return-to-sports phase of rehabilitation following anterior cruciate ligament reconstruction, 3 and also with self-report of disability in patients with foot and ankle pain. 23 In other studies for lower extremity conditions, fear-avoidance beliefs were associated with selfreport of knee function in patients with knee osteoarthritis 32 and were predictive of pain and function outcomes in patients with patellofemoral pain. 29 Collectively, these studies suggest that the FAM is not specific to low back pain and may have clinical applications for a variety of musculoskeletal pain conditions.…”

“…Previous studies in physical therapy settings have indicated that the FABQ-W might have better predictive validity for outcomes than the FABQ-PA. 4,8,11 The current study focused on the FABQ-PA because, unlike the FABQ-W, it has been used across different anatomical areas. 5,12,29,32 Our data are, therefore, only applicable to the FABQ-PA, and should not be generalized to studies or clinical environments that used the FABQ-W.…”

“…The FABQ-PA was the focus of the current study, because it has been the most commonly reported scale in studies of other anatomical regions. 5,12,29,32 Furthermore, in a recent psychometric analysis, 16 elevated FABQ-PA scores were found to be similar across different diagnostic categories. Examples of items from the FABQ-PA are "Physical activity makes my pain worse" and "I should not do physical activities which (might) make my pain worse."…”

“…Though we did not assess the psychometric properties of these modifications, the validity of similar modifications to the FABQ has been reported in prior studies of musculoskeletal pain. 5,12,29,32 The FABQ contains 2 scales: a 7-item FABQ work scale (FABQ-W; range, 0 to 42) and a 4-item FABQ physical activity scale (FABQ-PA; range, 0 to 24). Patients indicate their responses on a 7-point Likert scale, ranging from "completely disagree" to "completely agree."…”