Longitudinal Changes in Psychosocial Factors and Their Association With Knee Pain and Function After Anterior Cruciate Ligament Reconstruction Multiple Psychological Factors Are Associated With Poorer Functioning in a Sample of Community-Dwelling Knee Osteoarthritis Patients The relationship of anxiety and depression with self-reported knee pain in the community: data from the Baltimore Longitudinal Study of Aging. Predictors of pain outcomes in patients with chronic musculoskeletal pain co-morbid with depression: results from a randomized controlled trial. Impact of chronic musculoskeletal pathology on older adults: a study of differences between knee OA and low back pain. Psychological determinants of problematic outcomes following Total Knee Arthroplasty Factors associated with change in pain and disability over time: a community-based prospective observational study of hip and knee osteoarthritis. Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain The Dominant Role of Psychosocial Risk Factors in the Development of Chronic Low Back Pain Disability Does Teaching Physical Therapists to Deliver a Biopsychosocial Treatment Program Result in Better Patient Outcomes? A Randomized Controlled Trial Intrinsic Risk Factors for the Development of Anterior Knee Pain in an Athletic Population: A Two-Year Prospective Study * A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis. Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study: design and practical implications of an intervention for comorbid pain and depression. The association of comorbid conditions with patient-reported outcomes in Veterans with hip and knee osteoarthritis Mood and Attitude Predict Pain Outcomes Following Arthroscopic Knee Surgery Determinants of pain and functioning in knee osteoarthritis: a one-year prospective study
Background Evidence in the musculoskeletal rehabilitation literature suggests that psychosocial factors can influence pain levels and functional outcome . Objective The purpose of this study was to examine changes in select psychosocial factors and their association with knee pain and function over 12 weeks after anterior cruciate ligament ( ACL ) reconstruction . Design This was a prospect i ve , longitudinal , observational study . Methods Patients with ACL reconstruction completed self-report question naires for average knee pain intensity ( numeric rating scale [ NRS ] ) , knee function ( International Knee Documentation Committee Subjective Knee Form [ IKDC-SKF ] ) , and psychosocial factors ( pain catastrophizing [ Pain Catastrophizing Scale ] , fear of movement or reinjury [ shortened version of the Tampa Scale for Kinesiophobia ( TSK-11 ) ] , and self-efficacy for rehabilitation tasks [ modified Self-Efficacy for Rehabilitation Outcome Scale ( SER ) ] ) . Data were collected at 4 time points after surgery ( baseline and 4 , 8 , and 12 weeks ) . Repeated- measures analyses of variance determined changes in question naire scores across time . Hierarchical linear regression models were used to examine the association of psychosocial factors with knee pain and function . Results Seventy-seven participants completed the study . All question naire scores changed across 12 weeks . Baseline psychosocial factors did not predict the 12-week NRS or IKDC-SKF score . The 12-week change in modified SER score predicted the 12-week change in NRS score ( r2=.061 ) , and the 12-week change in modified SER and TSK-11 scores predicted the 12-week change in IKDC-SKF score ( r2=.120 ) . Limitations The psychometric properties of the psychosocial factor question naires are unknown in people with ACL reconstruction . The study focused on short-term outcomes using only self-report measures . Conclusions Psychosocial factors are potentially modifiable early after ACL reconstruction . Baseline psychosocial factor levels did not predict knee pain or function 12 weeks postoperatively . Interventions that increase self-efficacy for rehabilitation tasks or decrease fear of movement or reinjury may have potential to improve short-term outcomes for knee pain and function Background Knee osteoarthritis ( OA ) is the most common type of arthritis and imposes a heavy burden on individual welfare among elderly people . There is preliminary evidence that psychological factors play a role in functional ability and pain in knee OA patients , particularly with respect to the surgery outcome . Less is known about psychological factors among community-dwelling patients with knee OA . Objectives We aim ed to determine which psychological factors are associated with pain and functional ability among community-dwelling knee OA patients using a comprehensive set of psychological question naires . Methods In the cross-sectional baseline setting of a prospect i ve , r and omized controlled intervention study , 111 patients aged from 35 to 75 years with clinical symptoms and radiographic grading of knee OA were included . They completed a comprehensive set of psychological question naires , including measures of re sources and coping , fear and catastrophizing , and distress . Results In cross-sectional comparisons , pain self-efficacy , fear of movement , pain catastrophizing , and elevated anxiety were associated with pain and a poorer functional ability . In logistic regression analysis , independent association was seen between pain self-efficacy and poorer functioning . Knee OA patients also reported elevated levels of anxiety . Conclusions The results reveal that both pain self-efficacy and negatively charged emotion and expectations toward pain are important factors when dealing with knee OA patients . Failure to consider these will probably contribute to prolonged disability and further pain . The results call for the routine assessment of multiple psychological factors in knee OA OBJECTIVE To investigate the relationship between anxiety and depression and reporting of knee pain in the community . METHODS Subjects ( n = 374 ) were community volunteers aged 40 years and above who are participants in the Baltimore Longitudinal Study of Aging , a prospect i ve multidisciplinary research study of normative aging . Knee pain was defined by the First National Health and Nutrition Examination Survey question " have you ever had pain in or around your knee on most days for at least one month ? " ; anxiety and depression were measured by the relevant subscales of the Arthritis Impact Measurement Scales question naire . All subjects had st and ing anteroposterior radiographs  , read for Kellgren and Lawrence ( K + L ) grade . RESULTS After adjustment for age , women reporting " ever " knee pain had significantly higher anxiety scores than those reporting " never " pain ( 3.06 + /- 0.26 versus 2.35 + /- 0.17 ; P = 0.025 ) . Pain reporting was related neither to anxiety scores in men , nor to depression in either sex . Analysis stratified by radiographic severity , adjusted for age and gender , showed that differences in anxiety were confined to those reporting knee pain in the absence of radiographic change ( i.e. , K + L grade 0 ) . CONCLUSIONS In the community , women reporting knee pain in the absence of radiographic osteoarthritis have higher anxiety scores than those without pain . Depression was not significantly related to knee pain in this population . Psychosocial factors may explain some of the discrepancy between reported knee pain and structural change as seen on x-ray OBJECTIVE The combination of chronic musculoskeletal pain and depression is associated with worse clinical outcomes than either condition alone . In this study , we report the predictors of pain intensity and activity interference in primary care patients with co-morbid pain and depression . METHODS This is a secondary data analysis of the 250 persons who participated in a r and omized clinical trial design ed to test the effectiveness of 12 weeks of optimized antidepressant therapy for both depression and pain . Using multivariate linear regression analysis , we assessed the predictive value of baseline  self-efficacy , fear of movement , pain  beliefs  , and demographic and clinical factors on 3-month Grade d Chronic Pain Scale pain intensity and activity interference outcomes . RESULTS In the full model , significant sociodemographic predictors of less activity interference included being non-white ( beta-5.8 , P = 0.04 ) and being employed ( beta-13.3 , P < 0.0001 ) . The latter was also predictive of less pain intensity ( beta-5.6 , P = 0.01 ) . As expected , the optimized antidepressant treatment arm was associated with improved outcomes ( pain intensity : beta-3.7 , P = 0.0005 and activity interference : beta-6.4 , P = 0.01 ) . Whereas stronger perceived pain control ( beta 3.6 , P = 0.01 ) was associated with greater activity interference , higher degree of fear of movement ( or fear avoidance ) predicted greater pain intensity ( beta 0.46 , P = 0.04 ) and activity interference ( beta 0.57 , P = 0.05 ) . Neither the location ( low back vs hip/knee ) nor duration of pain were predictive of pain intensity or interference outcomes . CONCLUSION The findings are consistent with a bio-psychosocial model , implicating the need to consider the impact of sociodemographic variables and pain-related beliefs and cognition on pain-related outcomes for patients with co-morbid musculoskeletal pain and depression OBJECTIVES The study aim ed to compare the psychological and physical characteristics of older adults with knee osteoarthritis ( OA ) vs those of adults with chronic low back pain ( CLBP ) and to identify psychological and physical predictors of function as measured by gait speed . DESIGN Secondary data analysis . METHOD AND PATIENTS Eighty-eight older adults with advanced knee OA and 200 with CLBP who had participated in separate r and omized controlled trials were selected for this study . MEASURES Inclusion criteria for both trials included age > or = 65 and pain of at least moderate intensity that occurred daily or almost every day for at least the previous 3 months .  Psychological constructs ( catastrophizing , fear avoidance , self-efficacy , depression , affective distress ) and physical measures ( comorbid medical conditions , pain duration , pain severity , pain related interference , self-rated health ) were obtained . RESULTS Subjects with CLBP had slower gait ( 0.88 m/s vs 0.96 m/s , P = 0.002 ) and more comorbid conditions than subjects with knee pain ( mean 3.36 vs 1.97 , P < 0.001 ) . All the psychological measures were significantly worse in the CLBP group except the Multidimensional Pain Inventory-Affective Distress score . Self-efficacy , pain severity , and medical comorbidity burden were associated with slower gait regardless of the location of the pain . CONCLUSIONS Older adults with chronic pain may have distinct psychological and physical profiles that differentially impact gait speed . These findings suggest that not all pain conditions are the same in their psychological and physical characteristics and may need to be taken into consideration when developing treatment plans ABSTRACT The primary objective of the present study was to examine the role of pain‐related psychological factors in predicting pain and disability following Total Knee Arthroplasty ( TKA ) . The study sample consisted of 75 ( 46 women , 29 men ) individuals with osteoarthritis of the knee who were scheduled for TKA .  Measures of pain severity , pain catastrophizing , depression , and pain‐related fears of movement  were completed prior to surgery . Participants completed measures of pain severity and self‐reported disability 6 weeks following surgery . Consistent with previous research , cross‐sectional analyses revealed significant correlations among measures of pre‐surgical pain severity , pain catastrophizing , depression and pain‐related fears of movement . Prospect i ve analyses revealed that pre‐surgical pain severity and pain catastrophizing were unique predictors of post‐surgical pain severity ( 6‐week follow‐up ) . Pain‐related fears of movement were predictors of post‐surgical functional difficulties in univariate analyses , but not when controlling for pre‐surgical co‐morbidities ( e.g. back pain ) . The results of this study add to a growing literature highlighting the prognostic value of psychological variables in the prediction of post‐surgical health outcomes . The results support the view that the psychological determinants of post‐surgical pain severity differ from the psychological determinants of post‐surgical disability . The results suggest that interventions design ed to specifically target pain‐related psychological risk factors might improve post‐surgical outcomes BACKGROUND Hip and knee osteoarthritis are frequent causes of primary care consultations . They are considered slowly progressive disorders , often result ing in severe pain or disability and the need for joint replacements . There have been few longitudinal studies of progression to inform individual prognoses in primary care . AIM To describe the degree of progression and investigate predictors of change in hip or knee pain and disability . DESIGN OF STUDY Prospect i ve community-based cohort . SETTING An age-sex stratified survey of 27 000 people registered with 40 general practice s in Avon and Somerset yielded 2437 reporting hip and /or knee symptoms at baseline ( 1992 - 1994 ) . A 25 % r and om sample of 587 individuals was followed up between 1998 and 1999 . METHOD Pain or disability was measured at baseline and followup using the New Zeal and score  . For the worst joint according to the New Zeal and score at baseline , hip and knee problems were analysed separately . Regression models ascertained characteristics of nonresponders and factors associated with change in scores . Seven sociodemographic , seven comorbidity , and two healthcare utilisation variables were considered . RESULTS Generally pain and disability worsened over the 7 years , but 35 % and 29 % of those initially reporting hip and knee pain respectively had improved . Reporting " other health problems " was associated with greater deterioration for both hip and knee disease , as was cardiovascular morbidity for hip disease and lower social class , being retired , hypertension , and higher body mass index for knee disease . Deteriorations in scores were strongly associated with individuals consulting their GP about joint problems . CONCLUSION Osteoarthritis does not invariably deteriorate , but when it does social as well as biological factors appear to be important . These findings may aid outcome prediction . Future research on osteoarthritis should be conducted within a biopsychosocial rather than a purely biological paradigm OBJECTIVE Clinical tools are needed to identify and target a neuropathic-like phenotype , which may be associated with central sensitization ( CS ) , in osteoarthritis ( OA ) . The modified painDETECT question naire ( mPD-Q ) has face and content validity for identifying neuropathic-like symptoms in knee OA . To further vali date the mPD-Q , this study assessed the unknown relationship between mPD-Q scores and signs of CS on quantitative sensory testing ( QST ) in knee OA . DESIGN 36 Individuals were recruited with chronic , symptomatic , knee OA without other pain/neurological conditions . Reference QST data were obtained from 18 controls/32 eligible knees , enabling identification of sensory abnormalities/CS among case knees . A st and ardized question naire assessed psychological factors ( depressive symptoms and pain catastrophizing ) , and for individual knees , mPD-Q and pain intensity scores . A st and ardized/comprehensive QST protocol was conducted for each knee . QST signs of CS were defined as : mechanical hyperalgesia and /or enhanced temporal summation and /or allodynia . The relationship between the presence of CS ( yes/no ) and a pre-selected mPD-Q score ( ≤12 or > 12 ) , by knees , was assessed using generalized estimating equations . RESULTS Among 57 eligible case knees , 45.6 % had ≥1 sign of CS . Controlling for age , knees with higher mPD-Q scores ( > 12.0 ) had higher odds of having QST signs of CS ( adjusted odds ratio ( OR ) = 5.6 ; 95 % confidence interval ( CI ) , 1.3 - 22.9 ) . This relationship was unaffected by controlling for depression and pain intensity , but was attenuated by pain catastrophizing . CONCLUSIONS Among painful OA knees , higher mPD-Q scores were associated with greater odds of having signs of CS . Thus , the mPD-Q may aid the identification of CS in people with chronic knee OA Purpose The purpose of the study was to investigate if changes in psychological variables are related to the outcome in pain and disability in patients with chronic anterior knee pain . Methods A longitudinal observational study on 47 patients with chronic anterior knee pain was performed in a secondary healthcare setting .  Pain was measured with the visual analogue scale and disability with the Lysholm scale . The psychological variables , such as anxiety , depression , pain coping strategies , catastrophizing and fear to movement beliefs , were studied by using self-administered question naires . Results Among the pain coping strategies , only the catastrophizing subscale showed a significant reduction . Similarly , anxiety , depression and kinesiophobia were significantly reduced after treatment . Those patients who decreased the catastrophizing , kinesiophobia , anxiety and depression showed a greater improvement in pain and disability after a purely biomedical treatment . A multiple regression analysis revealed that changes in catastrophizing predicted the amount of improvement in pain severity and that changes in both catastrophizing and anxiety predicted changes in disability after treatment . Conclusion What has been found suggests that clinical improvement in pain and disability is associated with a reduction in catastrophizing and kinesiophobia . Therefore , co- interventions to reduce catastrophizing thinking and kinesiophobia may enhance the results .Level of evidence Prospect i ve Cohort Study , Level I for prognosis Study Design An inception cohort design was used in which 421 patients were evaluated systematic ally with a st and ard battery of psychosocial assessment tests ( Structured Interview for DSM-III-R Diagnosis , Minnesota Multiphasic Personality Inventory , and Million Visual Pain Analog Scale ) within 6 weeks of acute back pain onset . Objectives The present study evaluated the predictive power of a comprehensive assessment of psychosocial and personality factors in identifying acute low back pain patients who subsequently develop chronic pain disability problems  ( as measured by job-work status at 1-year follow-up evaluation ) . Summary of Background Data There has been a relative paucity of prospect i ve research in the United States comprehensively evaluating potential psychoscial risk factors that are associated with those injured workers who subsequently fail to return to work and productivity after 1 year because of low back pain disability . Such research has been quite limited because of the time and cost involved in conducting prospect i ve studies . Methods All study patients were symptomatic with lumbar pain syndrome for no more than 6 weeks , These acute patients were tracked every 3 months , culminating in a structured telephone interview being conducted 1 year after the initial evaluation to document return-to-work status . Results Logistic regression analyses , conducted to differentiate between patients who were back at work after 1 year versus patients who were not because of the original back injury , revealed the importance of three psychosocial measures : self-reported pain and disability , scores on Scale 3 of the Minnesota Multiphasic Personality Inventory , and workers ' compensation and personal injury insurance status . The model generated correctly classified 90.7 % of the cases . Results revealed that major psychopathology , such as depression and substance abuse , did not precede or cause the development of chronic pain disability . Conclusions These results show the presence of a robust “ psychosocial disability factor ” that is associated with those injured workers who are likely to develop chronic low back pain disability problems .  Based on these data , a statistical algorithm has been generated that can identify those acute patients who will require early intervention to prevent the development of chronic disability . The second major result is that preinjury or concomitant psychopathology does not appear to predispose patients to chronic pain disability , although high rates of psychopathology have been shown in chronic low back pain . Future research should be directed at emotional vulnerability and psychosocial events in the period after the injury that may lead to chronicity Background Psychosocial prognostic factors are important in the development of chronic pain , but treatment providers often lack knowledge and skills to assess and address these risk factors . Objective The aim of this study was to examine the effects on outcomes ( pain and disability ) in patients of a course about psychosocial prognostic factors for physical therapists . Design This study was a r and omized , controlled trial . Setting The setting was primary care practice . Participants Forty-two primary care physical therapists attended an 8-day university course ( over 8 weeks ) aim ed at identifying and addressing psychosocial risk factors . Intervention The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Measurements We measured physical therapists ' attitudes and beliefs about psychosocial factors , knowledge , and skills before and after the course . We measured patients ' pain , disability , catastrophizing , and mood at the start of treatment and at a 6-month follow-up . Methods The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Results Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course . Pain and disability outcomes in patients with a low risk of developing long-term disability— and pain outcomes in patients with a high risk of developing long-term disability — were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course . However , disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed . Limitations A limitation of this study was that actual practice behavior was not measured . Conclusions An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or in patients with a risk of developing long-term disability . However , patients who had a risk of developing long-term disability and had higher levels of catastrophizing or depression may have shown greater reductions in disability if the attitudes and beliefs of their physical therapists changed during the course Many variables have retrospectively been associated with the presence of anterior knee pain . Very few prospect i ve data exist , however , to determine which of these variables will lead to the development of anterior knee pain . It was our purpose in this study to determine the intrinsic risk factors for the development of anterior knee pain in an athletic population over a 2-year period . Before the start of training , 282 male and female students enrolled in physical education classes  were evaluated for anthropometric variables , motor performance , general joint laxity , lower leg alignment characteristics , muscle length and strength , static and dynamic patellofemoral characteristics , and psychological parameters . During this 2-year follow-up study , 24 of the 282 students developed  patellofemoral pain . Statistical analyses revealed a significant difference between those subjects who developed patellofemoral pain and those who did not concerning quadriceps and gastrocnemius muscle flexibility , explosive strength , thumb-forearm mobility , reflex response time of the vastus medialis obliquus and vastus lateralis muscles , and the psychological parameter of seeking social support . However , only a shortened quadriceps muscle , an altered vastus medialis obliquus muscle reflex response time , a decreased explosive strength , and a hypermobile patella had a significant correlation with the incidence of patellofemoral pain . We concluded that the latter four parameters play a dominant role in the genesis of anterior knee pain and we therefore deem them to be risk factors for this syndrome OBJECTIVE To determine , in subjects with knee pain but no radiographic changes of tibiofemoral or patellofemoral compartment osteoarthritis ( OA ) , whether mean body weight , quadriceps and hamstring strength , lower extremity muscle mass , depression scores , and perceptions of their general health status differed from those of subjects with symptomatic knee OA . METHODS Subjects were 25 women and 10 men with knee pain and radiographic evidence of OA at the baseline examination , and 21 women and 16 men who had knee pain at the baseline examination but no radiographic evidence of knee OA at either baseline examination or followup evaluation performed , on average , 31 months later . These individuals were a subset of a cohort of 462 independently living elderly individuals recruited by telephone interview after r and om selection through r and om digit dialing of households in central Indiana . Data from an additional 134 subjects who had neither knee pain nor radiographic changes of OA at either the baseline or followup examination were analyzed for comparison . Lower extremity muscle strength was measured by isokinetic dynamometry , lean tissue ( i.e. , muscle ) mass in the lower extremities by dual x-ray absorptiometry , depression by Center for Epidemiology Depression ( CES-D ) scale . knee pain by Western Ontario McMaster University OA instrument , and perceived general health status by the Medical Outcome Survey Short Form-36 . RESULTS In contrast to those with symptomatic knee OA , those who had knee pain but no radiographic evidence of OA were less obese , had hamstring as well as quadriceps weakness , and had CES-D scores high enough to qualify for a diagnosis of clinical depression . CONCLUSION Among subjects with knee pain but no OA-- and among women in this subset , in particular -- knee pain may be a manifestation of depression . rather than of joint disease OBJECTIVE Depression and pain are common comorbid conditions that have reciprocal adverse effects on disability and treatment outcomes . The objective of this article is to describe a study that tests the effectiveness of a stepped-care approach using a combined medication-behavioral intervention . METHOD Stepped Care for Affective Disorders and Musculoskeletal Pain ( SCAMP ) is an NIMH-sponsored r and omized clinical trial nested within a prospect i ve cohort study . A total of 250 patients with clinical ly significant depression ( PHQ-9 scores > or = 10 ) and musculoskeletal pain of the lower back or legs ( hip or knee ) and 250 nondepressed patients with similar pain are enrolled , with baseline and serial follow-up assessment s to be conducted over 12 months . The depressed patients are r and omized to either a stepped-care intervention group or a usual-care control group . Stepped-care patients receive 12 weeks of optimized antidepressant management ( Step 1 ) followed by six sessions of a pain self-management ( PSM ) program over the next 12 weeks ( Step 2 ) , all delivered by a nurse care manager who is supervised by a physician specialist . Approximately two thirds of the care manager contacts are by telephone . RESULTS The target sample of 500 subjects has been successfully enrolled , and r and omization of the depressed patients has result ed in balanced groups of patients with moderately severe pain and depression . Mean SCL-20 depression severity in the clinical trial group is 1.9 , with most meeting DSM-IV criteria for major depression ( 76.3 % ) and the rest having dysthymia only ( 18.4 % ) or minor depression ( 5.3 % ) . Pain is about equally distributed between lower back ( 53 % ) and hip or knee ( 47 % ) . A rational algorithmic approach to antidepressant selection and dosing , as well as an overview of the PSM program , is provided . CONCLUSIONS When completed , SCAMP will test whether optimized antidepressant management improves outcomes in patients with comorbid depression and pain and whether PSM produces additional benefits . The findings will be important for both primary care and mental health clinicians confronted by the prevalent depression-pain dyad There is limited underst and ing of how comorbid health conditions affect osteoarthritis (OA)-related outcomes . This study examined associations of different comorbidity measures with baseline OA-related patient-reported outcomes ( PROs ) among patients with hip and knee OA . Data were from patients ( N = 300 , 9 % female , mean age = 61.1 ; SD = 9.2 ) enrolled in a r and omized control trial at the Durham Veterans Affairs Medical Center . Separate multivariable regression models , adjusted for demographic and clinical characteristics , examined the association of each comorbidity measure with baseline PROs : pain , physical function , depressive symptoms , fatigue , and insomnia . Comorbidity measures included the Self-Administered Comorbidity Question naire ( SACQ ) , conditions reported as activity-limiting ( SACQ-AL ) , and indicators of depression , diabetes , hypertension , and back pain . Mean ( SD ) numbers of comorbid conditions and activity-limiting conditions were 3.4 ( 1.8 ) and 1.6 ( 1.4 ) , respectively . Comorbidity scores  ( SACQ overall and SACQ-AL ) and individual comorbidity conditions were each associated with worse OA-related PROs adjusting for demographic and clinical factors . Worse SACQ overall and SACQ-AL scores were associated with worse mean scores for pain , depressive symptoms , fatigue , and insomnia ( p values < 0.01 ) . Additionally , increasing SACQ-AL scores were associated with worse mean scores for function ( p < 0.01 ) . Depression was associated with worse pain ( p = 0.03 ) , fatigue , and insomnia ( p values < 0.01 ) . Diabetes was associated with worse fatigue ( p = 0.01 ) , depressive symptoms ( p = 0.02 ) , and insomnia ( p = 0.03 ) . Back pain was associated with worse pain scores ( p = 0.02 ) . Results provide evidence that comorbidity burden , particularly activity-limiting conditions , is associated with worse OA-related PROs . Interventions for patients with OA need to address comorbid conditions and their impact on key outcomes Background Decreased pain represents a clinical ly important outcome following  arthroscopic knee surgery .  However , little is known about preoperative mood and attitudinal factors and their potential relationship with pain outcomes . Purpose This prospect i ve , longitudinal study investigated the influence of preoperative depression , stress , and optimism on pain severity and interference with functioning , controlling for relevant demographic and clinical factors 1 year postoperatively . Methods Participants ( N = 180 , mean age = 48.2 years ) completed scales assessing pain severity and interference  both preoperatively and postoperatively .  Demographics , depression , stress , optimism , and body mass index were assessed preoperatively . Physicians assessed extent of knee osteoarthritis during surgery . Results Hierarchical regression analyses controlling for relevant demographic and clinical variables revealed that optimism and stress were significant predictors of pain severity at 1 year but not pain interference . Extent of osteoarthritis predicted pain interference . Conclusions These findings support that optimism and stress are important predictors of patient-rated pain severity . They do not , however , predict the extent to which pain interferes with daily functioning Objective : To identify predictors of pain and disability in knee osteoarthritis . Design : A one-year prospect i ve analysis of determinants of pain and functioning in knee osteoarthritis . Study setting : Primary care providers in a medium-sized city . Patients : A total of 111 patients aged from 35 to 75 with clinical symptoms and radiographic grading ( Kellgren-Lawrence 2–4 ) of knee osteoarthritis who participated in a r and omized controlled trial . Main measures : The outcome measures were self-reported pain and function , which were recorded at 0 , 3 and 12 months . Disease-specific pain and functioning were assessed using the pain and function subscales of the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index . Generic physical and mental functioning were assessed using the R AND -36 subscales for function , and physical and mental component summary scores . Possible baseline predictors for these outcomes were 1 ) demographic , socioeconomic and disease-related variables , and 2 ) psychological measures of re sources , distress , fear of movement and catastrophizing . Results : Multivariate linear mixed model analyses revealed that normal mood at baseline measured with the Beck Anxiety Inventory predicted significantly better results in all measures of pain ( WOMAC P=0.02 ) and function ( WOMAC P=0.002 , R AND -36 P=0.002 ) during the one-year follow-up . Psychological re source factors ( pain self-efficacy P=0.012 , satisfaction with life P=0.002 ) predicted better function ( R AND -36 ) . Pain catastrophizing predicted higher WOMAC pain levels ( P=0.013 ) , whereas fear of movement ( kinesiophobia ) predicted poorer functioning ( WOMAC P=0.046 , R AND -36 P=0.024 ) . Conclusions : Multiple psychological factors in people with knee osteoarthritis pain are associated with the development of disability and longer term worse pain
We found a strong level of evidence for a relationship between depression and knee pain , limited evidence for no relationship between anxiety and knee pain , and minimal evidence for no relationship between poor mental health and knee pain .
Conclusions Despite the heterogeneity of the included studies , these data show that depression plays a significant role in knee pain , and that a biopsychosocial approach to the management of this condition is integral to optimising outcomes for knee pain
Background While it is recognized that psychosocial factors are important in the development and progression of musculoskeletal pain and disability , no systematic review has specifically focused on examining the relationship between psychosocial factors and knee pain .
We aim ed to systematic ally review the evidence to determine whether psychosocial factors , specifically depression , anxiety and poor mental health , are risk factors for knee pain .