Bayrak Gökhan, Alkan Halil
Physiotherapy and Rehabilitation Department of the Faculty of Health Sciences, Muş Alparslan University, Muş (City), Muş, 49250, Türkiye.
BMC Musculoskelet Disord. 2025 Feb 25;26(1):196. doi: 10.1186/s12891-025-08450-0.
Pain is pivotal in managing knee osteoarthritis (KOA), necessitating tailored rehabilitative strategies. The biopsychosocial framework suggests that a multifaceted approach is crucial for understanding and managing pain in KOA patients. This study explored the factors that influence pain intensity through biological and psychosocial determinants from a biopsychological perspective in KOA patients.
This cross-sectional study included 150 KOA patients with Kellgren-Lawrence (K/L) grades 2-4. Patients were classified into three groups based on their Visual Analogue Scale scores: mild (n = 79), moderate (n = 40), and severe pain intensity (n = 31). The biological determinants included the body mass index, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for knee function, the 30-second sit-to-stand (30STS) test for functional strength, and the Timed-Up and Go (TUG) test for mobility. Psychological determinants comprised the Depression Anxiety Stress Scale-21 (DASS-21) for emotional well-being, the Tampa Scale for Kinesiophobia (TSK) for kinesiophobia, and the Activities-Specific Balance Confidence (ABC) scale for balance confidence. Social determinants included educational attainment and the Short Form-36 (SF-36) for health-related quality of life.
Significant differences in biopsychosocial determinants were identified among the various pain intensity groups. Biological factors, including WOMAC scores, TUG, and 30STS tests; psychological factors, such as depression and anxiety (DASS-21) and kinesiophobia (TSK); and social factors, including mean years of education and all SF-36 subscales, were significantly worse in the severe pain group (p < 0.05). However, balance confidence did not differ between groups (p = 0.060). Patients in the severe pain group exhibited poorer outcomes across biological, psychological, and social domains, whereas the moderate pain group displayed worse biological and social outcomes when compared to the mild pain group (p < 0.05).
This study emphasizes the significance of a biopsychosocial framework in managing pain in KOA patients. Worsened biological factors like knee function, mobility, and functional strength, alongside psychological issues such as depression and anxiety, influence pain intensity. Social determinants, including lower educational attainment and quality of life, highlight the need for patient-centered care. Future research should include diverse populations and longitudinal data to improve interventions and guide global health policies for integrating the biopsychosocial perspective for KOA management.
疼痛在膝关节骨关节炎（KOA）的管理中至关重要，需要量身定制康复策略。生物心理社会框架表明，多方面的方法对于理解和管理KOA患者的疼痛至关重要。本研究从生物心理学角度探讨了通过生物和心理社会决定因素影响KOA患者疼痛强度的因素。
这项横断面研究纳入了150名Kellgren-Lawrence（K/L）分级为2-4级的KOA患者。根据视觉模拟量表评分将患者分为三组：轻度疼痛组（n = 79）、中度疼痛组（n = 40）和重度疼痛组（n = 31）。生物决定因素包括体重指数、用于评估膝关节功能的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、用于评估功能力量的30秒坐立试验（30STS）以及用于评估活动能力的计时起立行走试验（TUG）。心理决定因素包括用于评估情绪健康的抑郁、焦虑、压力量表-21（DASS-21）、用于评估运动恐惧的坦帕运动恐惧量表（TSK）以及用于评估平衡信心的特定活动平衡信心量表（ABC）。社会决定因素包括教育程度以及用于评估与健康相关生活质量的简明健康状况调查问卷（SF-36）。
在不同疼痛强度组之间发现了生物心理社会决定因素的显著差异。生物因素，包括WOMAC评分、TUG和30STS试验；心理因素，如抑郁和焦虑（DASS-21）以及运动恐惧（TSK）；以及社会因素，包括平均受教育年限和所有SF-36子量表，在重度疼痛组中显著更差（p < 0.05）。然而，各组之间的平衡信心没有差异（p = 0.060）。重度疼痛组患者在生物、心理和社会领域的结果较差，而中度疼痛组与轻度疼痛组相比，在生物和社会方面的结果更差（p < 0.05）。
本研究强调了生物心理社会框架在管理KOA患者疼痛中的重要性。膝关节功能、活动能力和功能力量等生物因素的恶化，以及抑郁和焦虑等心理问题，都会影响疼痛强度。社会决定因素，包括较低的教育程度和生活质量，凸显了以患者为中心的护理的必要性。未来的研究应纳入不同人群和纵向数据，以改进干预措施并指导全球卫生政策，将生物心理社会视角纳入KOA管理。
