Investigation of factors affecting fear of movement in patients with knee osteoarthritis

Kinesiophobia assessed using a transculturally adapted version of the Tampa Scale of Kinesiophobia (TSK), which was developed to measure the fear of movement/re-injury of patients. The 4-point Likert scale (from strongly disagree (score = 1) to strongly agree (score = 4)) is used on the scale. A high score (maximum 68) indicates that the patient’s fear of falls and movements is excessive.

1. Pain Intensity. Knee pain severity was measured using the Visual Analog Scale (VAS) during activity and rest. The patients were asked to mark the pain levels they felt on a horizontal line of 100 mm. 0 indicated no pain and 100 indicated maximum pain, referring to intolerable pain. The point marked on the line was measured with a ruler, and the intensity of the pain felt by the persons was recorded in cm.
2. Quadriceps muscle strength measured using the Lafayette manual muscle testing system (Range: 0-300 lb [0-136.1 kg]). In order to measure the quadriceps muscle strength, the patient was asked to perform a knee extension against the dynamometer stabilized in the bed by placing perpendicularly on the tibia immediately above the malleoli, while the patient was in sitting position with the knees in a 90-degree flexion position. The value displayed in the digital dynamometer was recorded as the quadriceps muscle strength.
3. Hamstring muscle strength. While the patient was lying in the supine position, the dynamometer was placed just above the ankle joint, and the patient was asked to flex his leg. The value displayed in the digital dynamometer was recorded as the knee flexion muscle strength.
4. Range of Motion. The patient was placed in a supine position, and the normal joint motion range of the knee joint in the direction of flexion and extension was passively measured using a manual goniometer.
5. Balance assessed using the Berg Balance Scale (BBS). This test assesses the ability of individuals to maintain their balances while performing their functional activities. This balance test consists of 14 items, and each section is rated between “0”, the lowest level of function, and “4”, the highest level of function. It measures the level of dependence and/or independence when performing positions, such as standing up from a sitting position, standing with the feet together, standing in tandem stance and balancing on one leg. It also measures whether the person can switch positions. The highest score from the BBS shows the best balance. A score of 0-20 shows high, 21-40 medium and 41-64 low risk of fall.
6. Mobility. The Timed Up and Go (TUG) Test was used to measure main balance and mobility including ambulation, transfer and turning ability. The participants, while sitting on a chair, were asked to get up and walk for 3 m and then to turn and sit back down. The elapsed time was recorded.
7. Physical activity level assessed using a validated version of the International Physical Activity Questionnaire (IPAQ) short form. The questionnaire was developed by Craig et al. to determine the physical activity levels of adults. In the evaluation of all the activities in the questionnaire, it is taken as a criterion that each activity is done at least 10 minutes at a time. A score of “MET-minute/week” is obtained by multiplying the minutes, days and MET values. Physical activity levels were classified as physically inactive (<600 MET-min/week), low in physical activity (600-3000 MET-min/week) and adequate in physical activity (>3000 MET-min/week).
8. Disability. The assessment of the pain, stiffness and physical function of the individuals included in the study was made using transcultural adaptation of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). WOMAC is an OA-specific, valid and reliable measure that includes 24 questions in three sub-headings consisting of pain, stiffness and physical function. Each question was rated according to the Likert scale, by accepting 0 = None, 1 = Slight, 2 = Moderate, 3 = Very, 4 = Extremely. The score of each section was calculated within itself. A high score indicates an increase in pain and stiffness, and physical functional impairment.
9. Health-related quality of life (HRQOL). The transcultural adaptation version of the Nottingham Health Profile (NHP) was used to assess the health-related quality of life. The Nottingham Health Profile is a general quality of life questionnaire designed to measure perceived health problems and the extent to which these problems affect normal daily activities. The survey had a total of 38 questions consisting of 6 sub-sections: lack of energy (3 items), pain (8 items), emotional reaction (9 items), sleep disturbance (5 items), social isolation (5 items), and physical mobility (9 items). The questions are answered as “yes” or “no” by the participants; and the best score to be taken in the sub-sections is “0”, and the worst score is “100”.
10. Depression and anxiety. A valid and reliable version of the Hospital Anxiety and Depression Scale (HADS) was used to assess the psychological status of the patients. The scale was prepared to screen for anxiety and depression in those with physical disease. It was developed by Zigmond and Snaith to determine the risk of anxiety and depression, and to assess its level, severity and change. A 3-point Likert scale was used in this scale consisting of 14 questions. The cut-off points of the Turkish version of HADS were set to be 10 for the anxiety sub-scale and 7 for the depression sub-scale.