Determinants of depression and anxiety with knee Pain and activity limitations in knee osteoarthritis patients

Abstract

Background: Knee osteoarthritis (KOA) is a common degenerative joint disease causing pain, stiffness, and functional limitations, which often co-occur with psychological distress such as depression and anxiety. Objectives: This study aimed to explore the relationships between pain intensity, psychological factors, and activity limitations in KOA patients. at the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh. Methodology: A cross-sectional study was conducted with 102 KOA patients aged 40–75 years at the Centre for the Rehabilitation of the Paralysed (CRP), Dhaka. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS) in various positions (sitting, standing, walking, stair climbing). Depression and anxiety were measured by the PHQ-9 and GAD-7 scales, respectively. Functional limitations were evaluated using the WOMAC index. Data were analyzed using chi-square tests to examine associations. Results: Mild depression and anxiety were prevalent (74.5% and 52%, respectively). Moderate to severe pain, particularly during stair climbing (92.2%) and walking (68.6%) among most of them. Depression was significantly associated with pain during sitting (p < 0.001) and standing (p = 0.025), while anxiety correlated with pain during standing only (p = 0.012). Both depression (p < 0.001) and anxiety (p < 0.001) were linked to greater KOA severity as measured by WOMAC scores. Sociodemographic factors showed limited association with depression, but age (p = 0.019), occupation (p = 0.029), and comorbidities (p < 0.001) were related to anxiety. Dominant limb involvement was associated with higher general pain intensity (p = 0.045). Discussion: These findings demonstrate that knee osteoarthritis patients experience high pain during weight-bearing activities, with depression and anxiety significantly linked to pain and disease severity. Psychological distress and dominant limb involvement influence symptoms, underscoring the need for integrated mental and physical care. Key words: Knee osteoarthritis, Pain intensity, Depression, Anxiety, Activity limitations, Functional impairments.