Depressive symptoms and physical activity mediate the adverse effect of pain on functional independence in patients with arthritis: Evidence from the Canadian Longitudinal Study on Aging
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Objective
Arthritis is a chronic condition affecting hundreds of millions of people worldwide, often leading to pain and functional limitations. This study aimed to investigate the direct and indirect effects of pain on functional independence in individuals with arthritis. Depressive symptoms and physical activity were examined as potential mediators of this relationship.
Methods
A total of 6972 participants with arthritis (4930 with osteoarthritis and 694 with rheumatoid arthritis) were included from the Canadian Longitudinal Study on Aging. Multiple linear regression models, generalized linear models, and bootstrapping were used to assess the relationships between baseline pain, depressive symptoms, physical activity, and functional status at follow-up.
Results
Baseline pain was positively associated with depressive symptoms (b = 0.356 [95% CI: 0.310 to 0.402]) and negatively associated with physical activity (b = −0.083 [95% CI: −0.125 to −0.042]). Functional status at follow-up was significantly predicted by baseline pain (OR = 1.834 [95% CI: 1.306 to 2.610]), depressive symptoms (OR = 1.431 [95% CI: 1.205 to 1.709]), and physical activity (OR = 0.550 [95% CI: 0.440 to 0.683]). Mediation analysis showed that 30.4% of the effect of pain on functional status was mediated by the total indirect effect, with contributions from depressive symptoms (19.8%), physical activity (8.9%), and the serial mediation pathway (1.7%).
Conclusions
Pain at baseline was associated with a higher likelihood of functional dependence in basic and instrumental activities of daily living after a mean follow-up period of 6.3 years, with depressive symptoms and lower physical activity acting as partial mediators. These findings highlight the importance of managing pain, mental health, and physical activity in patients with arthritis to maintain functional independence.
Impact
These findings support the importance for intervention to target both mental health and exercise to mitigate functional decline resulting from the long-term effects of pain in patients with arthritis.
