Biopsychosocial Factors Affecting Functional Disability and Depression in Patients with Osteoarthritis in Surakarta, Central Java

Wahyu Tri Sudaryanto, Ambar Mudigdo, RB Soemanto


Background: Osteoarthritis (OA) is a major cause of disability in the elderly. OA can cause chronic pain, disability, and the patient's quality of life. This study aimed to determine the biopsychosocial factors affecting functional disability and depression in patients with OA in Surakarta, Central Java.

Subjects and Method: This was an analytic and observational study with a case-control design. The study was conducted at Dr. Moewardi Hospital and Dr. Soeharso Orthopedic Hospital, Surakarta, Central Java, from January to February 2018. A sample of 200 OA patients was selected by simple random sampling. The dependent variables were functional disability and depression. The independent variables were age, sex, grade of OA, duration, body mass index (BMI), history of injury, pain level, family support, and peer support. Depression data were measured by Beck’s Depression Inventory (BDI). Functional disability data were measured by The Western Ontario and McMaster University Arthritis Index (WOMAC). The other variables were collected by questionnaire. The data were analyzed by path analysis.

Results: The risk of depression increased with higher BMI (b= 0.23; SE= 0.10; p= 0.021), pain level (b= 0.16; SE= 0.07; p= 0.022), duration (year) (b= 0.27; SE= 0.12; p= 0.025), and poor functional disability (b= 0.19; SE= 0.04; p<0.001). Depression decreased with stronger family support (b= -0.05; SE= 0.03; p= 0.031) and stronger peer support (b= -0.09; SE= 0.05; p= 0.001). The risk of functional disability increased with female sex (b= 3.36; SE= 1.21; p= 0.006), age (b= 0.14; SE= 0.06; p= 0.016), BMI (b= 0.31; SE= 0.17; p= 0.070), had experienced injury (b= 2.27; SE= 1.16; p= 0.051), higher grade of OA (b= 1.32; SE= 0.65; p= 0.041), and higher pain level (b= 0.41; SE= 0.12; p<0.001). The risk of functional disability decreased with stronger family support (b= -0.16; SE= 0.04; p<0.001) and stronger peer support (b= -0.29; SE= 0.08; p<0.001).

Conclusion: Depression in OA patients is affected by BMI, pain level, duration (year), functional disability family support, and peer support. Functional disability is affected by sex, age, BMI, injury experience, grade of OA, pain level, family support, and peer support.

Keywords: osteoarthritis, depression, functional disability, pain, BMI, family support, peer support

Correspondence: Wahyu Tri Sudaryanto. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: Mobile: 085640637769.

Journal of Epidemiology and Public Health (2018), 3(2): 292-306

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Abou Raya S, Abou Raya A, Helmii M (2012). Duloxetine for the management of pain in older adults with knee osteoarthritis: randomised placebo controlled trial. Age Ageing. 41(5): 646–652.

Alkan BM, Fidan F, Tosun A, Ardıçoğlu O (2014). Quality of life and self reported disability in patients with knee osteoarthritis. Modern Rheumatology, 24(1): 166–171.

Bijlsma JW, Berenbaum F, Lafeber FP (2011). Osteoarthritis: an update with relevance for clinical practice. Lancet. 377(9783): 2115-26.

Blagojevic M, Jinks C, Jeffery A, Jordan KP (2010). Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and metaanalysis. Osteoarthritis and cartilage, 18:24-33.

Boutron I, Rannou F, Jardinaud Lopez M, Meric G, Revel M, Poiraudeau S (2008). Disability and quality of life of patients with knee or hip osteoarthritis in the primary care setting and factors associated with general practitioners' indication for prosthetic replacement within 1 year. Osteoarthritis Cartilage. 16(9):1024–1031.

Ciombor DM, Aaron RK, Wang S, et al (2003). Modification of osteoarthritis by pulsed electromagnetic field—a morphological study. Osteoarthr Cartil.11: 455–62.

Clauw D, Witter J (2009). Pain and rheumatology: thinking outside the joint. Arthritis Rheum. 60(2): 321–324.

Cubukcu D, Sarsan A, Alkan H (2012). Relationship between pain, function and radiographic findings in osteoarthritis of the knee: a crosssectional study. Arthritis. 1-5.

da Cruz Dde A, Pimenta CA, Kurita GP, de Oliveira AC (2004). Caregivers of patients with chronic pain: responses to care. Int J Nurs Terminol Classif. 15(1): 5-14.

Dekker J, Dijk GM, Veenhof C (2009). Risk factors for functional decline in osteoarthritis of the hip or knee. Current Opinion in Rheumatology. 21: 520–524.

Dieppe PA, Lohmander LS (2005). Pathogenesis and management of pain in osteoarthritis. Lancet, 365(9463): 965–973.

Dunlop DD, Semanik P, Song J, et al. (2005). Risk factors for functional decline in older adults with arthritis. Arthritis Rheum. 52:1274–1282.

Felson DT, Niu J, McClennan C, et al. (2007). Knee buckling: prevalence, risk factors, and associated limitations in function. Ann Intern Med. 147:534–540.

Grotle M, Hagen KB, Natvig B, et al (2008). Obesity and osteoarthritis in knee, hip and/or hand: An epidemiological study in the general population with 10 years follow up. BMC Musculoskeletal disorders. 9: 132.

Haq I, Murphy E, Dacre J (2003). Osteoarthritis. Postgrad Med J, 79: 377–383.

Herva A, Laitinen J, Miettunen J, Veijola J, Karvonen JT, Laksy K, Joukamaa M (2006). Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study. Int J Obes (Lond). 30: 520-527.

Holla J, Roorda LD, Leeden M, Dekker J (2014). FRI0408 Body mass index and depression are independently associated with knee pain and activity limitations in knee osteoarthritis: Results from the AMS OA cohort. Annals of the Rheumatic Diseases. 71(3): 452-452.

Hootman JM, Helmick CG (2006). Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 54: 226-229.

Hung M, Bounsanga J, Voss MW, Crum AB, Chen W, dan Birmingham WC (2016). The relationship between family support; pain and depression in elderly with arthritis. Journal Psychology, Health & Medicine. 22(1): 75-86.

Hunter D, McDougall J, Keefe F (2008). The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin North Am. 34(3):623–643.

Ilori T, Ladipo MM, Ogunbode AM, Abimbola M (2016). Knee osteoarthritis and perceived social support amongst patients in a family medicine clinic Knee osteoarthritis and perceived social support amongst patients in a family medicine clinic. South African Family Practice, 58(6): 202-206.

Jarvholm B, Lewold S, Malchau H, Vingard E (2005). Age, bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men. Eur J Epidemiol. 20: 537-42.

Keefe FJ, Buffington ALH, Studts JL, Smith SJ, Gibson J, Caldwell DS (2002). Recent Advances and Future Directions in the Biopsychosocial Assessment and Treatment of Arthritis. Journal of Consulting and Clinical Psychology, 70(3): 640–655.

Kocak FU, Unver B, Karatosun V, Bakirhan S (2009). Associations between R adiographoc Changes and Function, Pain, Range of Motion, Muscle Strenght and Knee Function Score in Patients with Osteoarthritis of the Knee. J. Phys. Ther. Sci. 21: 93-97.

Kucuksen S, Yılmaz H, Karahan AY, Bagcaci S (2014). The prevalence of depression and its relevance to clinical and radiological characteristics among older adults with knee osteoarthritis. Clinical Medicine Research. 3(2): 25-30.

Kulcu DG, Yanik B, Atalar H, Gülsen G (2010). Associated Factors with Pain and Disability in Patients With Knee Osteoarthritis. Turk J Rheumatol. 25: 77-81.

Lau EC, Cooper C, Lam D, Chan VN, Tsang KK, Sham A (2000). Factors associated with osteoarthritis of the hip and knee in Hong Kong Chinese: obesity, joint injury, and occupational activities. Am J Epidemiol, 152(9): 855–862.

Laupattarakasem W, Laopaiboon, Laupatta rakasem P, Sumananont C (2008). Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev. 23(1): CD005118.

Mallen CD, Peat G, Thomas E, et al (2007). Predicting poor functional outcome in community dwelling older adults with knee pain: prognostic value of generic indicators. Ann Rheum Dis. 66: 1456–1461.

McIntyre RS, Rasgon NL, Kemp DE, Nguyen HT, Law CWY, Hon, Taylor VH, et al. (2009). Metabolic Syndrome and Major Depressive Disorder: Cooccurrence and Pathophysiologic Overlap. Current Diabetes Reports. 9: 51–59.

Mesci E, Icagasioglu A, Mesci N, Turgut ST (2015). Relation of physical activity level with quality of life, sleep and depression in patients with knee osteoarthritis. North Clin Istanbul. 2(3):215–221.

Mounach A, Nouijai A, Ghozlani I, Ghazi M, Achemlal L, Bezza A, et al (2007). Risk factors for knee osteoarthritis in Morocco. A case control study. Clin Rheumatol. 3: 323-6.

Murphy SL, Lyden AK, Phillips K, Clauw DJ, Williams DA (2011). The Association between Pain, Radiographic Severity, and Centrally mediated Symptoms in Women with Knee Osteoarthritis. Arthritis Care Res (Hoboken). 63(11): 1543–1549.

Musumeci G, Szychlinska MA, Mobasheri A (2015). Age related degeneration of articular cartilage in the pathogenesis of osteoarthritis: Molecular markers of senescent chondrocytes. Histol. Histopathol. 30: 1–12.

Park M, Unutzer J (2011). Geriatric Depression in Primary Care. Psychiatr Clin North Am. 34(2): 469–x.

Pooye S, Barbara B (2010). Cultural Factors Leading to Overweight and Obesity: Cross Cultural Analysis of Japan and The United States of America. Bachelor Thesis Marketing 2009-2010. ANR: 256491. Universiteit Van Tilburg.

Rydevik K, Fernandes L, Nordsletten L, Risberg MA (2010). Functioning and Disability in Patients With Hip Osteoarthritis With Mild to Moderate Pain. Journal of Orthopaedic & Sports Physical Therapy, 40(10): 617-624.

Rosemann T, Grol R, Herman K, Wensing M, Szecsenyi J (2008). Association between obesity, quality of life, physical activity and health service utilization in primary care patients with osteoarthritis. Int J Behav Nutr Phys Act. 5:4.

Sharma A, Kudesia P, Shi Q, Gandhi R (2016). Anxiety and depression in patients with osteoarthritis: impact and management challenges. Rheumatology: Research and Reviews. 8: 103-113.

Shimura Y, Kurosawa H, Tsuchiya M, Kaneko H, Liu L, Sadatsuki R, Yusup A, et al. (2014). Association between synovitis and depression in patients with knee osteoarthritis: a crosssectional study. Osteoarthritis and Cartilage 22: S57–S489.

Steultjens MP, Dekker J, Bijlsma JW (2002). Avoidance of activity and disability in patients with osteoarthritis of the knee: the mediating role of muscle strength. Arthritis Rheum. 46: 1784–1788.

Theis K, Helmick C, Hootman J (2007). Arthritis burden and impact are greater among U.S. women than men: intervention opportunities. J Womens Health. 16(4): 441–453.

van der Esch M, Steultjens M, Harlaar J, et al. (2007). Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee. Arthritis Rheum. 57:787–793.

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al (2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990e2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380(9859): 216-3e96.

Woo J, Lau E, Lee P, et al (2004). Impact of osteoarthritis on quality of life in a Hong Kong Chinese population. J Rheumatol. 31: 2433–8.

Yoshimura N, Nishioka S, Kinoshita H, Hori N, Nishioka T, Ryujin M, et al (2004). Risk factors for knee osteoarthritis in Japanese women: heavyweight, previous joint injuries, and occupational activities. J Rheumatol. 31: 157-62.

Zoico E, Di FV, Guralnik JM, Mazzali G, Bortolani A, Guariento S, Sergi G, et al. (2004). Physical disability and muscular strength in relation to obesity and different body composition indexes in a sample of healthy elderly women. Int J Obes Relat Metab Disord. 28: 234-241.


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