The impact of social participation on activities of daily living in older adults with knee osteoarthritis: the chain mediating effects of sleep quality and multidimensional frailty

Abstract

Introduction: This study aimed to investigate the associations among social participation, sleep quality, multidimensional frailty, and activities of daily living (ADL) in older adults with knee osteoarthritis (KOA), and to further evaluate whether sleep quality and frailty jointly mediate these relationships. Methods: A cross-sectional study was conducted among 288 older adults with KOA recruited via convenience sampling. Validated scales were used to assess social participation, sleep quality, multidimensional frailty, and ADL. Statistical analyses were performed using SPSS 26.0 and the PROCESS 4.1 macro, including descriptive statistics, correlation analyses, and mediation modeling. Results: Social participation was significantly associated with sleep quality, multidimensional frailty, and ADL (all p < 0.001). Sleep quality was significantly associated with frailty and ADL, and frailty was also associated with ADL. Mediation analysis indicated that sleep quality and frailty each partially mediated the association between social participation and ADL, and jointly formed a significant chain mediation pathway. The combined indirect effect was 0.315, accounting for 42.51% of the total effect. Discussion: Social participation was significantly associated with ADL in older adults with KOA, both directly and indirectly through sleep quality and multidimensional frailty. These findings suggest that enhancing social engagement and addressing sleep and frailty issues may be important for maintaining functional independence in this population. Future longitudinal and interventional studies are needed to validate these findings and inform targeted strategies for improving daily functioning among older adults with KOA.