title: Reasons why multimorbidity increases the risk of participation restriction in older adults with lower extremity osteoarthritis: a prospective cohort study in primary care.
abstract: OBJECTIVE
  To determine why multimorbidity causes participation restriction in adults ages ≥50 years who consult primary care with lower extremity osteoarthritis (OA).
  
  
  METHODS
  This was a population-based prospective cohort study of 1,053 consulters for lower extremity OA who were free of participation restriction at baseline. Path analysis was used to test proposed mechanisms by examining for mediation of the association between multimorbidity at baseline, defined by self-report and consultation data separately, and incident participation restriction at 3 years by lower extremity pain severity, obesity, locomotor disability, and depression.
  
  
  RESULTS
  Multimorbidity was associated with incident participation restriction (adjusted odds ratio [OR] 2.83, 95% confidence interval [95% CI] 2.03-3.94 for multimorbidity [self-report]; OR 1.59, 95% CI 1.15-2.21 for multimorbidity [consultation data]). The extent of mediation of the association of baseline multimorbidity, defined by self-report, and incident participation restriction was greater for severe lower extremity pain than obesity (standardized beta coefficients for indirect effect 0.032 [SE 0.015] and 0.020 [SE 0.019], respectively). The addition of depression and locomotor disability increased the amount of mediation (0.115 [SE 0.028]) and reduced the proportion explained by severe lower extremity pain (0.014 [SE 0.015]) and obesity (0.006 [SE 0.010]). Locomotor disability was the strongest mediator.
  
  
  CONCLUSIONS
  The additional impact on participation in social and domestic life that multimorbidity places on individuals with lower extremity OA appears to be mediated through further restriction of locomotor disability, as well as through depression. The results suggest that the effect of multimorbidity on the daily lives of people with lower extremity OA will be ameliorated by active management of depression and locomotor disability.
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK. r.wilkie@keele.ac.uk
authors.forename: Ross
authors.initials: R
authors.lastname: Wilkie
authors.forename: Milisa
authors.initials: M
authors.lastname: Blagojevic-Bucknall
authors.forename: Kelvin P
authors.initials: KP
authors.lastname: Jordan
authors.forename: Rosie
authors.initials: R
authors.lastname: Lacey
authors.forename: John
authors.initials: J
authors.lastname: McBeth
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D019468:Disease Management; D004739:England; D005260:Female; D005534:Foot Diseases / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009765:Obesity / Q000453:epidemiology; D010003:Osteoarthritis / Q000453:epidemiology*; D015207:Osteoarthritis, Hip / Q000453:epidemiology*; D020370:Osteoarthritis, Knee / Q000453:epidemiology*; D010146:Pain / Q000453:epidemiology; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D058992:Social Participation