Internet cognitive behaviour therapy for depression in older adults with knee osteoarthritis: A randomized controlled trial

Objective To determine the efficacy of an internet-based cognitive behavioural therapy (iCBT) program for depression in older adults with osteoarthritis of the knee and comorbid major depressive disorder (MDD). We conducted a RCT in sixty-nine adults (≥ 50 years) meeting criteria for MDD and osteoarthritis of the knee with 1-week post intervention (week 11) and 3-month follow-up (week 24) end points. Patients were allocated to either a 10-week iCBT program for depression added to treatment as usual (TAU) or to a TAU control group. Primary outcomes were depression symptoms (PHQ-9) and psychological distress (K-10). Secondary outcomes included arthritis self-efficacy (ASES), osteoarthritis pain, stiffness, physical function (WOMAC), and physical and mental health (SF-12 PSC and MCS). Depression status was assessed by blinded diagnostic interview (MINI) at intake and follow-up. Results Intention-to-treat analyses indicated between-group superiority of iCBT over TAU on the primary outcomes (PHQ-9; Hedges g=1.01, 95%CI= .47-1.54; K-10; Hedges g=.75, 95%CI=.23-1.28) at post intervention and 3-month follow-up (PHQ9; Hedges g=.90, 95%CI= .36-1.44 and K-10; Hedges g=.94, 95%CI=.41-1.48), and on secondary OA-specific measures (ASES; Hedges g=-.81, 95%CI= -.29 to -1.33; WOMAC; Hedges g's=.56-.65 95%CIs=.04-1.18) at 3-month follow-up. The majority of iCBT participants (84%) no longer met diagnostic criteria at 3-month follow-up. Conclusions Results support the efficacy of an iCBT program (requiring no face-to-face contact) for depression in individuals with comorbid depression and osteoarthritis of the knee. Importantly, the benefits of the program extended beyond reduced depressive symptoms and distress, to increased self-efficacy and improved pain, stiffness and physical function at follow-up. This article is protected by copyright. All rights reserved.