Abstract
Purpose: This study aims to explore the role of pain, fear of movement and learned helplessness on functional knee range of motion and daily functioning in a patients awaiting total knee arthroplasty (TKA)
Methods and results: Sixty-five patients (mean age 69 years old) with osteoarthritis were assessed an average of 37 days prior to TKA. Dynamic knee angle was measured during 11 functional activities including getting up from a chair and walking up and down a slope and stairs using flexible electrogoniometry. Function was assessed using the function components of the Knee Society Score (KSS) and the Western Ontario & McMaster University Osteoarthritis Index (WOMAC). Other self-report measures included the 8 item Tampa scale for kinesiophobia to assess ‘activity avoidance’ (TSK-AA), and the 5 item Helplessness subscale of the rheumatology attitudes index.
The pain component of the WOMAC was negatively associated with the knee angle during sitting down and getting up from a low chair and stepping in and out of a bath (r=0.40–0.45), but not with the peak knee angle during ascending and descending a slope or walking speed. Higher scores of the activity avoidance and the helplessness scales however, were associated with reduced knee angles during descending a slope and a slower walking speed (r=0.31–0.38). Both psychosocial scales were also associated with function (r=0.39–0.45). Another important finding was that activity avoidance was not associated with pain.
Conclusions: Not only pain but also fear of movement and learned helplessness play a role on specific components of knee function in patients with final stage osteoarthritis of the knee. Further research into the impact of pain and psychosocial variables on functional outcome in ostearthritis is indicated.
Correspondence should be addressed to Mr Tim Wilton, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
