Relationships of fear, anxiety, and depression with physical function in patients with knee osteoarthritis

Arch Phys Med Rehabil. 2009 Nov;90(11):1866-73. doi: 10.1016/j.apmr.2009.06.012.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety / psychology*
  • Cross-Sectional Studies
  • Depression / psychology*
  • Disability Evaluation
  • Fear*
  • Female
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / physiopathology*
  • Osteoarthritis, Knee / psychology*
  • Psychiatric Status Rating Scales