Association of Pain Catastrophizing With Static Balance, Mobility, or Functional Capacity in Patients With Knee Osteoarthritis: A Blind Cross-sectional Study

Pain catastrophizing in rheumatic diseases: prevalence, origin, and implications

Pain is a crucial factor in rheumatic disorders, and reducing it is a primary goal of successful treatment. Adaptive pain-coping strategies can enhance this improvement, but maladaptive approaches such as pain catastrophizing may worsen overall patient well-being. This narrative review aims to provide a concise overview of the existing knowledge on pain catastrophizing in the most prevalent specific rheumatic disorders. The objective of this study was to improve understanding of this phenomenon and its implications, as well as to pinpoint potential directions for future research. We conducted searches in the MEDLINE/PubMed, SCOPUS, and DOAJ bibliography databases to identify articles related to pain catastrophizing in rheumatoid arthritis, psoriatic arthritis, axial spondylarthritis, systemic sclerosis, systemic lupus erythematosus, Sjögren's syndrome, juvenile idiopathic arthritis, and osteoarthritis (non-surgical treatment). Data extraction was performed on November 1, 2023. The investigators screened the identified articles to determine their relevance and whether they met the inclusion criteria. Following a bibliography search, which was further expanded by screening of citations and references, we included 156 records in the current review. The full-text analysis centred on pain catastrophizing, encompassing its prevalence, pathogenesis, and impact. The review established the role of catastrophizing in amplifying pain and diminishing various aspects of general well-being. Also, potential treatment approaches were discussed and summarised across the examined disorders. Pain catastrophizing is as a significant factor in rheumatic disorders. Its impact warrants further exploration through prospective controlled trials to enhance global patient outcomes.

Sensor-based systems for the measurement of Functional Reach Test results: a systematic review

The measurement of Functional Reach Test (FRT) is a widely used assessment tool in various fields, including physical therapy, rehabilitation, and geriatrics. This test evaluates a person's balance, mobility, and functional ability to reach forward while maintaining stability. Recently, there has been a growing interest in utilizing sensor-based systems to objectively and accurately measure FRT results. This systematic review was performed in various scientific databases or publishers, including PubMed Central, IEEE Explore, Elsevier, Springer, the Multidisciplinary Digital Publishing Institute (MDPI), and the Association for Computing Machinery (ACM), and considered studies published between January 2017 and October 2022, related to methods for the automation of the measurement of the Functional Reach Test variables and results with sensors. Camera-based devices and motion-based sensors are used for Functional Reach Tests, with statistical models extracting meaningful information. Sensor-based systems offer several advantages over traditional manual measurement techniques, as they can provide objective and precise measurements of the reach distance, quantify postural sway, and capture additional parameters related to the movement.

Correlation Among Pain Intensity, Catastrophizing, and Falls in Older Individuals With Unilateral Knee Osteoarthritis: A Cross-Sectional Study

OBJECTIVE

The purpose of this study was to investigate whether pain intensity and catastrophizing are associated with fear of falls and the number of falls in older persons with knee osteoarthritis (OA).

METHODS

A cross-sectional study was conducted involving 100 volunteers (male and female participants), 60 to 80 years old, with a diagnosis of knee OA. Patients were recruited from a physical therapy clinic in the city of São Paulo, Brazil, from March 2019 to November 2019. The following measures were used for the evaluations: Numerical Rating Pain Scale (NRPS), Pain-Related Self-Statement Scale (PRSS), and Falls Efficacy Scale. In statistical analysis, histograms were created to determine the distribution of data. Spearman's correlation coefficients (r_s) were then calculated to determine the strength of the associations among the variables. The receiver operating characteristic curve was used to identify the accuracy of PRSS and NRPS in differentiating participants with a history of falls from those without.

RESULTS

No significant correlation was found among the pain intensity, pain catastrophizing, fear of falling, and number of falls (r_s value ranging from -0.033 to -0.167; P value ranging from .096-.743). The accuracy of PRSS and NRPS in differentiating participants with falls from those without was insufficient, with area under the curve values of 0.46 and 0.42, respectively.

CONCLUSION

Pain catastrophizing and intensity were not significantly associated with fear of falling and numbers of falls in older individuals with unilateral knee OA.

Construct validity and reliability of the 2-minute step test in patients with knee osteoarthritis

Objective

To validate and evaluate the intra- and inter-rater reliability of the 2-min step test (2MST) in measuring the functional performance of patients with knee pain associated with osteoarthritis (OA).

Methods

Forty-one patients with knee OA was included. Two examiners assessed the patients at two times with interval between the test and retest from 7 to 14 days. All executions of 2MST were recorded in real time by the examiners and were also recorded by video. The intraclass correlation coefficient (ICC) and 95% confidence interval (CI), standard error of measurement (SEM) and minimum detectable difference (MDD) were used to determine reliability. In the construct validity, we correlate the score of the 2MST with the other instruments used in the study: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Numerical Pain Scale (NPS), Pain-Related Catastrophizing Thoughts Scale (PCTS) and Chronic Pain Self-Efficacy Scale (PSEQ). The agreement between the face-to-face assessment and the evaluation based on the video record was assessed using the Bland-Altman methodology in the 4 moments of the 2MST.

Results

2MST presented excellent intra- (ICC = 0.94, SEM = 4.47, MDD = 12.40) and inter-rater reliability (ICC = 0.97, SEM = 3.07, MDD = 8.52). The agreement was acceptable between face-to-face assessments and the analyzes performed on video. All instruments showed a statistically significant correlation with 2MST, except the PCTS. A correlation magnitude above 0.50 was found between the 2MST and pain and function domains of the WOMAC, and a correlation magnitude between 0.30 and 0.50 with the joint stiffness domain of the WOMAC, NRPS and PSEQ.

Conclusion

2MST proved to be valid for assessing functional capacity in patients with knee OA, with excellent reliability.

Structural validity of the Brazilian version of the Western Ontario and McMaster Universities Osteoarthritis Index among patients with knee osteoarthritis

BACKGROUND

The original structure of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been contested in several languages.

OBJECTIVE

To assess the structural validity of the Brazilian version of WOMAC among patients with knee osteoarthritis.

DESIGN AND SETTING

Structural validity study conducted at physiotherapy clinics and primary healthcare units.

METHODS

The study included males and females aged 40 to 80 years who were all native Brazilian Portuguese speakers, with knee pain in the previous six months and a diagnosis of knee osteoarthritis. We used exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) with implementation of a polychoric matrix and the robust diagonally weighted least squares (RDWLS) extraction method. The adequacy of the model was assessed using the following fit indices: root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), standardized root mean square residual (SRMR) and chi-square/degree of freedom (DF).

RESULTS

203 patients with knee osteoarthritis were included. The model proposed in this study with two factors, i.e. "pain" (items 1, 2, 3 and 4) and "physical function" (items 10, 11, 16, 17, 18, 19, 21 and 22), showed adequate fit indices in CFA: chi-square/DF = 1.30; CFI = 0.976; TLI = 0.970; RMSEA = 0.039; and SRMR = 0.070. The factorial loads ranged from 0.68 to 0.76 for the "pain" domain and 0.44 to 0.62 for the "physical function" domain.

CONCLUSION

The Brazilian version of WOMAC with two domains, i.e. "pain" (four items) and "physical function" (eight items), presents the best structure.

Association between pain catastrophizing, physical function and pain at first visit in the outpatient knee clinic

BACKGROUND

Pain catastrophizing has been associated with pain severity and disability in patients with knee osteoarthritis (OA). However, the literature is not consistent and other studies have failed to find this association. We examined the preoperative association between pain catastrophizing and physical function and pain, as well as the correlation between radiographic OA and physical symptoms and knee arthroplasty (KA).

METHODS

This study was a cross-sectional study of all patients referred to the orthopaedic outpatient Knee Clinic from March to October 2013 with clinical symptoms of knee OA. Prior to clinical examination, the patients completed EuroQol-5D (EQ-5D), The Short Form-36 (SF-36 (PF)), The Oxford Knee Score (OKS) and The Pain Catastrophizing Scale (PCS). The severity of radiographic OA was graded with the Kellgren-Lawrence Scale (KLS).

RESULTS

Of the 325 patients, 158 (48.6%) patients received a knee arthroplasty, 130 (40%) were treated conservatively, and 37 (11.4%) were scheduled for a knee arthroscopy. Mean age was 64.3 (SD 11.1) years and 53.9% were females. We found a strong correlation between PCS and OKS (r = -0.60, P = 0.000). Furthermore, the regression analysis showed statistically significant associations between PCS and both physical function and pain. We found no correlation between radiographic OA and physical function or pain.

CONCLUSIONS

Our results reveal that PCS is an important psychological factor when dealing with patients with OA. Furthermore, our results confirm the importance of a combined evaluation of symptoms, clinical examination, and radiographs when deciding on the right treatment for individual knee patients.