Overcoming Pain and Kinesiophobia: Unlocking the Path to Better Knee Osteoarthritis Rehabilitation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Treatment Rehabilitative Protocol
2.3. Outcome Measures
2.4. Timelines
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
KOA | knee osteoarthritis |
QMR | quantum molecular resonance |
BPS | biopsychosocial |
VAS | visual analogue scale |
KOOS | knee injury and osteoarthritis outcome scale |
TSK | Tampa scale of kinesiophobia |
CLPMs | cross-lagged panel models |
References
- Engel, G.L. The need for a new medical model: A challenge for biomedicine. Science 1977, 196, 129–136. [Google Scholar] [CrossRef] [PubMed]
- Adler, R.H. Engel’s biopsychosocial model is still relevant today. J. Psychosom. Res. 2009, 67, 607–611. [Google Scholar] [CrossRef]
- Lehman, B.J.; David, D.M.; Gruber, J.A. Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Soc. Personal. Psychol. Compass 2017, 11, e12328. [Google Scholar] [CrossRef]
- Appels, A.; Mulder, P.A. Excess fatigue as precursor of myocardial infarction. Eur. Heart J. 1988, 9, 758–764. [Google Scholar] [CrossRef]
- Stern, S.I.; Dhanda, R.; Hazuda, H.P. Hopelessness predicts mortality in older Mexican and European Americans. Psychosom. Med. 2001, 63, 344–351. [Google Scholar] [CrossRef]
- Bolton, D.; Gillett, G. The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments; Springer Nature: Cham, Switzerland, 2019; p. 149. [Google Scholar] [CrossRef]
- Bolton, D. The epistemology of randomized, controlled trials and application in psychiatry. Philos. Psychiatry Psychol. 2008, 15, 159–165. [Google Scholar] [CrossRef]
- van Dijk, H.; Köke, A.J.; Elbers, S.; Mollema, J.; Smeets, R.J.; Wittink, H. Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators—A Scoping Review. Int. J. Environ. Res. Public Health 2023, 20, 1634. [Google Scholar] [CrossRef]
- Moseley, G.L.; Butler, D.S. Fifteen years of explaining pain: The past, present, and future. J. Pain 2015, 16, 807–813. [Google Scholar] [CrossRef]
- Cross, M.; Smith, E.; Hoy, D.; Nolte, S.; Ackerman, I.; Fransen, M.; March, L. The global burden of hip and knee osteoarthritis: Estimates from the global burden of disease 2010 study. Ann. Rheum. Dis. 2014, 73, 1323–1330. [Google Scholar] [CrossRef]
- Hunter, D.J.; Schofield, D.; Callander, E. The individual and socioeconomic impact of osteoarthritis. Nat. Rev. Rheumatol. 2014, 10, 437–441. [Google Scholar] [CrossRef]
- Larsson, C.; Hansson, E.E.; Sundquist, K.; Jakobsson, U. Kinesiophobia and its relation to pain characteristics and cognitive affec tive variables in older adults with chronic pain. BMC Geriatr. 2016, 16, 128. [Google Scholar] [CrossRef] [PubMed]
- Dekker, J.; Tola, P.; Aufdemkampe, G.; Winckers, M. Negative affect, pain and disability in osteoarthritis patients: The mediating role of muscle weakness. Behav. Res. Ther. 1993, 31, 203–206. [Google Scholar] [CrossRef] [PubMed]
- Miller, T.W.; Kraus, R.F. An overview of chronic pain. Hosp. Community Psychiatry 1990, 41, 433–440. [Google Scholar] [CrossRef]
- Lundberg, M.; Larsson, M.E.H.; Ostlund, H.; Styf, J. Kinesiophobia among patients with musculoskeletal pain in primary healthcare. J. Rehabil. Med. 2006, 38, 37–43. [Google Scholar] [CrossRef]
- Vlaeyen, J.W.; Crombez, G.; Linton, S.J. The fear-avoidance model of pain. Pain 2016, 157, 1588–1589. [Google Scholar] [CrossRef]
- Palmas, G.; Palma, D.; Palmas, L. Good Life with Arthritis from Denmark (GLA:D®) as a treatment for kinesiophobia in a patient with knee osteoarthritis. G. Ital. Ortop. Traumatol. 2023, 49, 178–185. [Google Scholar] [CrossRef]
- Unver, B.; Ertekin, Ö.; Karatosun, V. Pain, fear of falling and stair climbing ability in patients with knee osteoarthritis before and after knee replacement: 6 month follow-up study. J. Back Musculoskelet. Rehabil. 2014, 27, 77–84. [Google Scholar] [CrossRef]
- Pells, J.J.; Shelby, R.A.; Keefe, F.J.; Dixon, K.E.; Blumenthal, J.A.; LaCaille, L.; Kraus, V.B. Arthritis self-efficacy and self-efficacy for resisting eating: Relationships to pain, disability, and eating behavior in overweight and obese individuals with osteoarthritic knee pain. Pain 2008, 136, 340–347. [Google Scholar] [CrossRef]
- Deveza, L.A.; Hunter, D.J. Pain relief for an osteoarthritic knee in the elderly: A practical guide. Drugs Aging 2016, 33, 11–20. [Google Scholar] [CrossRef]
- Vervullens, S.; Breugelmans, L.; Beckers, L.; Van Kuijk, S.M.; Van Hooff, M.; Winkens, B.; Smeets, R.J. Clinical prediction model for interdisciplinary biopsychosocial rehabilitation in osteoarthritis patients. Eur. J. Phys. Rehabil. Med. 2023, 59, 84. [Google Scholar] [CrossRef]
- Des Jarlais, D.C.; Lyles, C.; Crepaz, N.; TREND Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. Am. J. Public Health 2004, 94, 361–366. [Google Scholar] [CrossRef] [PubMed]
- Paolucci, T.; Pino, V.; Elsallabi, O.; Gallorini, M.; Pozzato, G.; Pozzato, A.; Lanuti, P.; Reis, V.M.; Pesce, M.; Pantalone, A.; et al. Quantum Molecular Resonance Inhibits NLRP3 Inflammasome/Nitrosative Stress and Promotes M1 to M2 Macrophage Polarization: Potential Therapeutic Effect in Osteoarthritis Model In Vitro. Antioxidants 2023, 12, 1358. [Google Scholar] [CrossRef] [PubMed]
- Paolucci, T.; Tommasi, M.; Pozzato, G.; Pozzato, A.; Pezzi, L.; Zuccarini, M.; Di Lanzo, A.; Palumbo, R.; Porto, D.; Messeri, R.; et al. Management and Rehabilitative Treatment in Osteoarthritis with a Novel Physical Therapy Approach: A Randomized Control Study. Diagnostics 2024, 14, 1200. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Thong, I.S.K.; Jensen, M.P.; Mirò, J.; Tan, G. The validity of pain intensity measures: What do the NRS, VAS, VRS, and FPS-R measure? Scand. J. Pain 2018, 18, 99–107. [Google Scholar] [CrossRef]
- Kelly, A.M. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg. Med. J. 2001, 18, 205–207. [Google Scholar] [CrossRef]
- Monticone, M.; Ferrante, S.; Salvaderi, S.; Rocca, B.; Totti, V.; Foti, C.; Roi, G. Development of the Italian version of the knee injury and osteoarthritis outcome score for patients with knee injuries: Cross-cultural adaptation, dimensionality, reliability, and validity. Osteoarthr. Cartil. 2012, 20, 330–335. [Google Scholar] [CrossRef]
- Neblett, R.; Hartzell, M.M.; Mayer, T.G.; Bradford, E.M.; Gatchel, R.J. Establishing clinically meaningful severity levels for the Tampa Scale for Kinesiophobia (TSK-13). Eur. J. Pain 2016, 20, 701–710. [Google Scholar] [CrossRef] [PubMed]
- Monticone, M.; Giorgi, I.; Baiardi, P.; Barbieri, M.; Rocca, B.; Bonezzi, C. Development of the Italian version of the Tampa Scale of Kinesiophobia (TSK-I): Cross-cultural adaptation, factor analysis, reliability, and validity. Spine 2010, 35, 1241–1246. [Google Scholar] [CrossRef] [PubMed]
- Kearney, M.W. Cross Lagged Panel Analysis. In The SAGE Encyclopedia of Communication Research Methods; Allen, M.R., Ed.; Sage: Thousand Oaks, CA, USA, 2016; ISBN 978-1-48333-8143-5. [Google Scholar]
- JASP, version 0.18.1, Computer Software. JASP Team: Amsterdam, The Netherlands, 2023.
- Penny, K.I.; Purves, A.M.; Smith, B.H.; Chambers, W.A.; Smith, W.C. Relationship between the chronic pain grade and measures of physical, social and psychological well-being. Pain 1999, 79, 275–279. [Google Scholar] [CrossRef]
- Nagyova, I.; Stewart, R.E.; Macejova, Z.; van Dijk, J.P.; van den Heuvel, W.J. The impact of pain on psychological well-being in rheumatoid arthritis: The mediating effects of self-esteem and adjustment to disease. Patient Educ. Couns. 2005, 58, 55–62. [Google Scholar] [CrossRef]
- Selçuk, M.; Karakoyun, A. Is There a Relationship Between Kinesiophobia and Physical Activity Level in Patients with Knee Osteoarthritis? Pain Med. 2020, 21, 3458–3469. [Google Scholar] [CrossRef] [PubMed]
Measure | Time Phases | Mean | SD |
---|---|---|---|
VAS | T0 | 5.272 | 1.636 |
T1 | 3.005 | 2.007 | |
T2 | 2.260 | 1.853 | |
KOOS | T0 | 64.850 | 12.495 |
T1 | 75.800 | 15.020 | |
T2 | 83.425 | 11.914 | |
TSK | T0 | 64.700 | 13.384 |
T1 | 53.900 | 13.810 | |
T2 | 51.550 | 16.000 |
Model | Predictor | Outcome | Coefficient Estimate | SE | z-Value | p(z) | AIC | BIC | χ2 | Model Comparison | χ2 Difference | df | p(χ2) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
M1 | VAS-T0 | TSK-T1 | 1.144 | 0.997 | 1.148 | 0.251 | 1378.5 | 1417.3 | 4.653 | ||||
TSK-T0 | VAS-T1 | 0.047 | 0.018 | 2.624 | 0.009 | ||||||||
VAS-T1 | TSK-T2 | 1.936 | 0.948 | 2.041 | 0.041 | ||||||||
TSK-T1 | VAS-T2 | −0.012 | 0.017 | −0.728 | 0.466 | ||||||||
M2 | VAS-T0 | TSK-T1 | 0.049 | 0.018 | 2.739 | 0.006 | 1377.7 | 1414.8 | 5.842 | M2 vs. M1 | 1.189 | 1 | 0.276 |
TSK-T0 | VAS-T1 | 0.049 | 0.018 | 2.739 | 0.006 | ||||||||
VAS-T1 | TSK-T2 | 1.936 | 0.934 | 2.073 | 0.038 | ||||||||
TSK-T1 | VAS-T2 | −0.012 | 0.016 | −0.753 | 0.452 | ||||||||
M3 | VAS-T0 | TSK-T1 | 1.144 | 0.997 | 1.148 | 0.251 | 1380.5 | 1417.6 | 8.649 | M3 vs. M1 | 3.996 | 1 | 0.046 |
TSK-T0 | VAS-T1 | 0.047 | 0.018 | 2.624 | 0.009 | ||||||||
VAS-T1 | TSK-T2 | −0.008 | 0.017 | −0.470 | 0.638 | ||||||||
TSK-T1 | VAS-T2 | −0.008 | 0.017 | −0.470 | 0.638 | ||||||||
M4 | VAS-T0 | TSK-T1 | 0.049 | 0.018 | 2.739 | 0.006 | 1379.7 | 1415.1 | 9.838 | M4 vs. M1 | 5.184 | 2 | 0.075 |
TSK-T0 | VAS-T1 | 0.049 | 0.018 | 2.739 | 0.006 | ||||||||
VAS-T1 | TSK-T2 | −0.008 | 0.016 | −0.485 | 0.627 | ||||||||
TSK-T1 | VAS-T2 | −0.008 | 0.016 | −0.485 | 0.627 |
Model | Predictor | Outcome | Coefficient Estimate | SE | z-Value | p(z) | AIC | BIC | χ2 | Model Comparison | χ2 Difference | df | p(χ2) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
M1 | VAS-T0 | KOOS-T1 | −2.179 | 1.063 | −2.050 | 0.040 | 1311.8 | 1350.7 | 6.436 | ||||
KOOS-T0 | VAS-T1 | −0.030 | 0.021 | −1.419 | 0.156 | ||||||||
VAS-T1 | KOOS-T2 | −1.264 | 0.636 | −1.987 | 0.047 | ||||||||
KOOS-T1 | VAS-T2 | 0.022 | 0.018 | 1.266 | 0.205 | ||||||||
M2 | VAS-T0 | KOOS-T1 | −0.040 | 0.021 | −1.909 | 0.056 | 1313.7 | 1350.8 | 10.295 | M2 vs. M1 | 3.859 | 1 | 0.049 |
KOOS-T0 | VAS-T1 | −0.040 | 0.021 | −1.909 | 0.056 | ||||||||
VAS-T1 | KOOS-T2 | −1.264 | 0.637 | −1.984 | 0.047 | ||||||||
KOOS-T1 | VAS-T2 | 0.022 | 0.017 | 1.330 | 0.184 | ||||||||
M3 | VAS-T0 | KOOS-T1 | −2.179 | 1.063 | −2.050 | 0.040 | 1313.7 | 1350.8 | 10.262 | M3 vs. M1 | 3.826 | 1 | 0.050 |
KOOS-T0 | VAS-T1 | −0.030 | 0.021 | −1.419 | 0.156 | ||||||||
VAS-T1 | KOOS-T2 | 0.010 | 0.017 | 0.605 | 0.545 | ||||||||
KOOS-T1 | VAS-T2 | 0.010 | 0.017 | 0.605 | 0.545 | ||||||||
M4 | VAS-T0 | KOOS-T1 | −0.040 | 0.021 | −1.909 | 0.056 | 1315.5 | 1351 | 14.121 | M4 vs. M1 | 7.685 | 2 | 0.021 |
KOOS-T0 | VAS-T1 | −0.040 | 0.021 | −1.909 | 0.056 | ||||||||
VAS-T1 | KOOS-T2 | 0.010 | 0.016 | 0.630 | 0.529 | ||||||||
KOOS-T1 | VAS-T2 | 0.010 | 0.016 | 0.630 | 0.529 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Pantalone, A.; Paolucci, T.; Pesce, M.; Palumbo, R.; Pozzato, A.; Cichelli, A.; Santilli, G.; Zuccarini, M.; Patruno, A.; Tommasi, M. Overcoming Pain and Kinesiophobia: Unlocking the Path to Better Knee Osteoarthritis Rehabilitation. Biomedicines 2025, 13, 1361. https://doi.org/10.3390/biomedicines13061361
Pantalone A, Paolucci T, Pesce M, Palumbo R, Pozzato A, Cichelli A, Santilli G, Zuccarini M, Patruno A, Tommasi M. Overcoming Pain and Kinesiophobia: Unlocking the Path to Better Knee Osteoarthritis Rehabilitation. Biomedicines. 2025; 13(6):1361. https://doi.org/10.3390/biomedicines13061361
Chicago/Turabian StylePantalone, Andrea, Teresa Paolucci, Mirko Pesce, Rocco Palumbo, Alessandro Pozzato, Alice Cichelli, Gabriele Santilli, Mariachiara Zuccarini, Antonia Patruno, and Marco Tommasi. 2025. "Overcoming Pain and Kinesiophobia: Unlocking the Path to Better Knee Osteoarthritis Rehabilitation" Biomedicines 13, no. 6: 1361. https://doi.org/10.3390/biomedicines13061361
APA StylePantalone, A., Paolucci, T., Pesce, M., Palumbo, R., Pozzato, A., Cichelli, A., Santilli, G., Zuccarini, M., Patruno, A., & Tommasi, M. (2025). Overcoming Pain and Kinesiophobia: Unlocking the Path to Better Knee Osteoarthritis Rehabilitation. Biomedicines, 13(6), 1361. https://doi.org/10.3390/biomedicines13061361