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Multiple Psychological Factors Are Associated With Poorer Functioning in a Sample of Community-Dwelling Knee Osteoarthritis Patients

Sinikallio, Sanna H. PhD*; Helminen, Eeva-Eerika MD†‡; Valjakka, Anna L. Lic.Psych§; Väisänen-Rouvali, Rauni H. MSc; Arokoski, Jari P. MD, PhD¶‡

JCR: Journal of Clinical Rheumatology: August 2014 - Volume 20 - Issue 5 - p 261–267
doi: 10.1097/RHU.0000000000000123
Original Articles

Background Knee osteoarthritis (OA) is the most common type of arthritis and imposes a heavy burden on individual welfare among elderly people. There is preliminary evidence that psychological factors play a role in functional ability and pain in knee OA patients, particularly with respect to the surgery outcome. Less is known about psychological factors among community-dwelling patients with knee OA.

Objectives We aimed to determine which psychological factors are associated with pain and functional ability among community-dwelling knee OA patients using a comprehensive set of psychological questionnaires.

Methods In the cross-sectional baseline setting of a prospective, randomized controlled intervention study, 111 patients aged from 35 to 75 years with clinical symptoms and radiographic grading of knee OA were included. They completed a comprehensive set of psychological questionnaires, including measures of resources and coping, fear and catastrophizing, and distress.

Results In cross-sectional comparisons, pain self-efficacy, fear of movement, pain catastrophizing, and elevated anxiety were associated with pain and a poorer functional ability. In logistic regression analysis, independent association was seen between pain self-efficacy and poorer functioning. Knee OA patients also reported elevated levels of anxiety.

Conclusions The results reveal that both pain self-efficacy and negatively charged emotion and expectations toward pain are important factors when dealing with knee OA patients. Failure to consider these will probably contribute to prolonged disability and further pain. The results call for the routine assessment of multiple psychological factors in knee OA.

From the *Institution of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus; †Kuopio Health Centre; Departments of ‡Physical and Rehabilitation Medicine, §Psychiatry, Addiction Psychiatry Outpatient Clinic, and ║Physical and Rehabilitation Medicine, Kuopio University Hospital; and ¶Institute of Clinical Medicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.

S.H.S. and E.-E.H. contributed equally to this work.

Both S.H.S. and E.-E.H. received EVO research grants from Kuopio University Hospital. The remaining authors declare no conflict of interest.

Correspondence: Sanna H. Sinikallio, PhD, Institution of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, POB 1627, FI-70211 Kuopio, Finland. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.