Avoidance of Activities in Early Symptomatic Knee Osteoarthritis: Results from the CHECK Cohort
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ORIGINAL ARTICLE
Avoidance of Activities in Early Symptomatic Knee Osteoarthritis: Results from the CHECK Cohort Jasmijn F. M. Holla, MSc & Marike van der Leeden, PT, PhD & Dirk L. Knol, PhD & Wilfred F. H. Peter, PT & Leo D. Roorda, MD, PhD & Willem F. Lems, MD, PhD & Janet Wesseling, PT, MSc & Martijn P. M. Steultjens, PhD & Joost Dekker, PhD
Published online: 13 March 2012 # The Society of Behavioral Medicine 2012
Abstract Background Pain-related avoidance of activities is hypothesized to lead to lower muscle strength and thereby activity limitations. Negative affect (e.g., low vitality, depression) is thought to strengthen the tendency to avoid activities. Purpose The aim of this study was to assess the validity of this “avoidance model” in patients with early symptomatic knee osteoarthritis (OA). Methods Cross-sectional data (n 0151) were used. The associations between pain, negative affect, avoidance, muscle strength, and activity limitations were modeled using structural equation modeling. Results Pain and negative affect were associated with lower muscle strength via avoidance (mediation by avoidance). Avoidance was associated with activity limitations via lower muscle strength (mediation by muscle strength). J. F. M. Holla (*) : M. van der Leeden : W. F. H. Peter : L. D. Roorda : J. Dekker Amsterdam Rehabilitation Research Center | Reade, P.O. Box 58271, 1040 HG Amsterdam, The Netherlands e-mail: [email protected] M. van der Leeden : J. Dekker Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands M. van der Leeden : J. Dekker EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands D. L. Knol Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
There were also direct associations between pain, negative affect, avoidance, muscle strength, and activity limitations. Conclusions The results support the validity of the avoidance model, which explains the associations between pain, negative affect, avoidance, muscle strength, and activity limitations in patients with early symptomatic knee OA. Keywords Knee osteoarthritis . Avoidance model . Activity limitations . Muscle strength . Pain . Depression
Introduction Activity limitation (e.g., difficulties in walking, stair climbing) is one of the primary health complaints in osteoarthritis (OA) patients [1]. One of the factors that W. F. Lems Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands W. F. Lems Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands J. Wesseling Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands M. P. M. Steultjens Institute for Applied Health Research and School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK J. Dekker Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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ann. behav. med. (2012) 44:33–42
may influence the degr
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