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Depressive symptoms and physical activity were examined as potential mediators of this relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This study was a longitudinal cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study setting included community-dwelling adults participating in the Canadian Longitudinal Study on Aging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>This study sample consisted of 6972 participants with arthritis, including 4930 with osteoarthritis and 694 with rheumatoid arthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>The exposure was the usual presence of pain or discomfort at baseline, with depressive symptoms (CESD-10) and physical activity (PASE) tested as mediators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome and Measure<\/jats:title>\n                    <jats:p>The main outcome was functional dependence in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) at follow-up, measured with a modified version of the Older Americans\u2019 Resources and Services Multidimensional Functional Assessment Questionnaire (OARS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Baseline pain was positively associated with depressive symptoms (b\u2009=\u20090.356 [95% CI\u2009=\u20090.310 to 0.402]) and negatively associated with physical activity (b\u2009=\u2009\u22120.083 [95% CI\u2009=\u2009\u22120.125 to \u22120.042]). Functional dependence at follow-up was significantly predicted by baseline pain (log OR\u2009=\u20090.607 [95% CI\u2009=\u20090.261 to 0.952]), depressive symptoms (log OR\u2009=\u20090.358 [95% CI\u2009=\u20090.184 to 0.533]), and physical activity (log OR\u2009=\u2009\u22120.598 [95% CI\u2009=\u2009\u22120.818 to \u22120.378]). Mediation analysis showed that 23.3% of the total effect of pain on functional dependence was accounted for by the indirect effect through depressive symptoms (16.2%), physical activity (6.3%), and their serial combination (0.8%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The presence of pain at baseline was associated with higher odds of functional dependence in basic and instrumental activities of daily living after a mean follow-up period of 6.3\u00a0years, with depressive symptoms and lower physical activity acting as mediators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance<\/jats:title>\n                    <jats:p>The findings highlight the need for arthritis care to extend beyond pain management by incorporating strategies that address depressive symptoms and promote physical activity to preserve functional independence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ptj\/pzaf120","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T12:05:30Z","timestamp":1759406730000},"source":"Crossref","is-referenced-by-count":5,"title":["Depressive Symptoms and Physical Activity Mediate the Adverse Effect of Pain on Functional Dependence in Patients With Arthritis: Evidence From the Canadian Longitudinal Study on Aging"],"prefix":"10.1093","volume":"105","author":[{"given":"Miriam","family":"Goubran","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, University of Ottawa , Ottawa, Ontario ,","place":["Canada"]},{"name":"Bruy\u00e8re Health Research Institute , Ottawa, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary M","family":"van Allen","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Ottawa , Ottawa, Ontario ,","place":["Canada"]},{"name":"Perley Health Centre of Excellence in Frailty-Informed Care , Ottawa, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Bilodeau","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Ottawa , Ottawa, Ontario ,","place":["Canada"]},{"name":"Bruy\u00e8re Health Research Institute , Ottawa, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9376-3071","authenticated-orcid":false,"given":"Matthieu P","family":"Boisgontier","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Ottawa , Ottawa, Ontario ,","place":["Canada"]},{"name":"Bruy\u00e8re Health Research Institute , Ottawa, Ontario ,","place":["Canada"]},{"name":"Perley Health Centre of Excellence in Frailty-Informed Care , Ottawa, Ontario ,","place":["Canada"]},{"name":"Institut du Savoir Montfort, H\u00f4pital Montfort , Ottawa, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"2025111310122218200_ref1","doi-asserted-by":"publisher","DOI":"10.1101\/2024.06.30.24309697","article-title":"Epidemiological trends of osteoarthritis at the global, regional, and national levels from 1990 to 2021 and projections to 2050","author":"Qiao","year":"2024; 2:1\u201337","journal-title":"medRxiv"},{"issue":"9","key":"2025111310122218200_ref2","doi-asserted-by":"publisher","first-page":"e508","DOI":"10.1016\/S2665-9913(23)00163-7","article-title":"GBD 2021 osteoarthritis collaborators. 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