Psychological Factors Associated with Functional Disability in Patients with Hip and Knee Osteoarthritis

López-Bravo, Marı́a; Zamarrón-Cassinello, María Dolores; Muñoz-Plata, Rosa; Cuenca‐Martínez, Ferrán; Ramos-Toro, Mónica

doi:10.1080/08964289.2020.1813682

Cited by 20 publications

(38 citation statements)

References 37 publications

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“…This idea is consistent with research which has demonstrated that psychosocial factors can mediate the association between hyperalgesia and knee pain [64]. Characteristics such as pain catastrophising [65], kinesiophobia (fear of movement) [25], helplessness [66], reduced self-efficacy [67], anxiety [26] and depression [26] have all been shown to be associated with knee OA pain and are likely to play a role in shaping the pain experience. Therefore, we integrated the idea of a relationship between central modulation, the pain experience and emotional responses to pain.…”

Section: Central Modulation Of the Pain Experiencesupporting

confidence: 84%

A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

Preece

Brookes

Williams

et al. 2021

BMC Musculoskelet Disord

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Background Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist. Methods Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists. Results The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from postural compensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention. Conclusion We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes. Trial registration ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered).

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Section: Central Modulation Of the Pain Experiencesupporting

confidence: 84%

A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

Preece

Brookes

Williams

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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“…Values over 27 points on the measuring instrument used are considered high scores. 34 However, if these results are compared against the normative values described 35 for populations with chronic musculoskeletal pain, it would only be higher than the values described by patients with osteoarthritis. The correlation of kinesiophobia values with pain intensity observed in our results are in line with an association of a high degree of kinesiophobia with high levels of pain intensity.…”

Section: Discussionmentioning

confidence: 93%

“…in adult patients with haemophilic elbow arthropathy. Values over 27 points on the measuring instrument used are considered high scores 34 . However, if these results are compared against the normative values described 35 for populations with chronic musculoskeletal pain, it would only be higher than the values described by patients with osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

The relationship between chronic pain and psychosocial aspects in patients with haemophilic arthropathy. A cross‐sectional study

et al. 2021

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Background Pain is a major characteristic in haemophilic arthropathy. Identifying the psychosocial variables affected by pain can help when addressing these patients. Aim To assess the relationship between perceived intensity of chronic pain and joint damage, kinesiophobia, catastrophism, anxiety and perceived quality of life in adult patients with haemophilic arthropathy. Methods Multicentre cross‐sectional descriptive study. Seventy‐seven adult patients with haemophilic arthropathy were recruited. The usual and maximum pain intensity (Visual Analog Scale), joint status (Haemophilia Joint Health Score), Kinesiophobia (Tampa Scale of Kinesiophobia), catastrophism (Pain catastrophizing scale), anxiety (State‐Trait Anxiety inventory) and perceived quality of life (36‐Item Short Form Health Survey) were evaluated. The correlation between usual and maximum pain intensity with quantitative variables was obtained with Spearman`s correlation test. Kruskal‐Wallis one‐way ANOVA analysed differences in perceived pain according to the severity and type of treatment, and development of inhibitors. Results The usual intensity of perceived pain correlated positively with catastrophism, kinesiophobia, and state and trait anxiety. The same results were obtained when analysing the maximum perception of pain. We found an inverse correlation between the physical component of perceived quality of life and usual and maximum pain intensity perceived by patients. Conclusion Psychosocial factors affect the painful experience of patients with haemophilic arthropathy. Pain intensity affects the quality of life of these patients.

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“…Cross-sectional studies have shown links between a range of psychosocial factors and knee OA related pain. Characteristics such as pain catastrophising [77], kinesiophobia (fear of movement) [24], helplessness [78], self-e cacy [79], anxiety [25] and depression [25] have all been shown to be associated with clinical pain. It is possible that these factors may lead to avoidance of activity [80,81] with associated physical deconditioning and this may explain, to some degree, the observation that psychosocial factors are also associated with impairments in physical function [26].…”

Section: Theoretical Componentsmentioning

confidence: 99%

Tension Release Therapy: The Development of a New Integrated Behavioural Intervention for Knee Osteoarthritis

Preece

Brookes

Williams

et al. 2021

Preprint

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Background: Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, the magnitude of clinical effect is considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While many exercise-based approaches incorporate an educational/coping component alongside muscle strengthening, there has been no previous attempt to integrate psychological techniques with muscle retraining. Building on these ideas, the aim of this study was to create a new integrated behavioural intervention for knee osteoarthritis, suitable for delivery by a physiotherapist.Methods: Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to knee muscle co-contraction. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with users.Results: The underlying framework incorporated ideas related to central sensitisation to pain, maladaptive motor responses to pain and also focused on the idea that increased knee muscle co-contraction could result from changes in postural tone. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to enable patients to visualise muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a full prototype version of the intervention. Conclusion: We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle patterns and beliefs associated with pain. Preliminary feedback and clinical indications are positive, and this motivates future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to a muscle strengthening programme. Trial Registration: ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered)

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Psychological Factors Associated with Functional Disability in Patients with Hip and Knee Osteoarthritis

Cited by 20 publications

References 37 publications

A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

The relationship between chronic pain and psychosocial aspects in patients with haemophilic arthropathy. A cross‐sectional study

Tension Release Therapy: The Development of a New Integrated Behavioural Intervention for Knee Osteoarthritis

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