title: How Hand Osteoarthritis, Comorbidity, and Pain Interact to Determine Functional Limitation in Older People: Observations From the European Project on OSteoArthritis Study.
abstract: To examine the role of comorbidity and pain in the associations of hand osteoarthritis (OA) with self-reported and performance-based physical function in a general population of elderly persons.
  
  
  
  We studied data from 2,942 participants ages 65-85 years in the European Project on OSteoArthritis, a collaborative observational study of 6 European cohorts (from Germany, Italy, The Netherlands, Spain, Sweden, and the UK). Outcome measures included self-reported physical function of the hands measured by the AUStralian/CANadian Osteoarthritis Hand Index (AUSCAN) for hand OA physical function subscale and performance-based grip strength measured using a strain gauge dynamometer.
  
  
  
  Comorbidity was not a confounder in the association of hand OA with self-reported and performance-based functional limitations, while the role of pain as a mediator was confirmed. Anxiety, depression, stroke, and osteoporosis were associated with AUSCAN scores reflecting more impairment. Depression and osteoporosis were associated with less grip strength.
  
  
  
  Although comorbidity was decidedly and independently associated with hand functional limitation, it had no effect on the relationship of hand OA with physical function. Hand OA was found to be associated with both self-reported and performance-based physical function impairment; the association was found to be partially mediated by pain, which reduced its impact.
authors.affiliation: National Research Council, Neuroscience Institute, Padua, Italy. paola.siviero@in.cnr.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Siviero
authors.affiliation: National Research Council, Neuroscience Institute, and University of Padova, Padua, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Zambon
authors.affiliation: National Research Council, Neuroscience Institute, Padua, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Limongi
authors.affiliation: Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Castell
authors.affiliation: University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Dorly J H
authors.initials: DJ
authors.lastname: Deeg
authors.affiliation: University of Ulm, Ulm, Germany.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Denkinger
authors.affiliation: University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Dennison
authors.affiliation: University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Edwards
authors.affiliation: National Research Council, Neuroscience Institute, Padua, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Gesmundo
authors.affiliation: Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Otero
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Pedersen
authors.affiliation: University of Ulm, Ulm, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Peter
authors.affiliation: University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Rocio
authors.initials: R
authors.lastname: Queipo
authors.affiliation: VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Timmermans
authors.affiliation: VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Natasja M
authors.initials: NM
authors.lastname: van Schoor
authors.affiliation: National Research Council, Neuroscience Institute, Padua, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Maggi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology; D018771:Arthralgia / Q000503:physiopathology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D050823:Hand Joints / Q000503:physiopathology*; D018737:Hand Strength; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D053581:Muscle Strength Dynamometer; D009426:Netherlands / Q000453:epidemiology; D010003:Osteoarthritis / Q000453:epidemiology / Q000503:physiopathology*; D010024:Osteoporosis / Q000453:epidemiology; D010147:Pain Measurement; D057566:Self Report; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology