Cognitive–behavioral therapy (CBT) is suggested as a first-line treatment for depressed patients with physical health conditions. Internet-based CBT (iCBT) programs provide many advantages over the conventional face-to-face modality, such as high accuracy, decreased cost, greater approachability, and convenience. iCBT can be particularly helpful for older patients suffering from Knee Osteoarthritis (OA). However, there is lack of a randomized trial that has evaluated the impact of an iCBT program for depression in knee OA patients.

O'Moore KA & colleagues conducted a randomized controlled trial to evaluate the effectiveness of an Internet-based cognitive behavioral therapy to eradicate depression among patients with knee OA & comorbid major depressive disorder(MDD).

The study was conducted in sixty-nine adults with age more than 50 years. Those patients who met the criteria for MDD & knee OA were included. The time points for data collection were 1-week post-intervention and after 3-months. The patients were divided into two groups either to a 10-week iCBT program for depression designated as treatment as usual (TAU) or to a TAU control group. The results were evaluated on the basis of primary and secondary outcomes. Factors used to evaluate primary outcomes were psychological distress and depression symptoms. Further, the secondary outcomes involved osteoarthritis pain, physical function, stiffness, physical and mental health and arthritis self-efficacy. Primary outcomes were measured through K10 and PHQ-9. On the other hand, secondary outcomes were measured by ASES, WOMAC, SF-12 PSC and MCS. Further, the status of depression was determined by blinded diagnostic interview (MINI) at intake and follow-up.

Intention-to-treat analyses determined the between-group superiority of iCBT over TAU on the primary outcomes at post-intervention and 3-month follow-up. Also, the superiority of iCBT over TAU on secondary OA-specific measures was noted at 3-month follow-up. However, about 84% iCBT participants did not meet the diagnostic criteria at 3-month follow-up.

The study outcomes are enough to confirm the effectiveness of an iCBT program for depression in patients with comorbid depression and knee OA. iCBT program not only decreased the depression but also offered increased self-effectiveness and improved pain, stiffness, and physical function at follow-up.