Lee Soyoung, Kim Ehyun, Cha Baekdong, Ferre Claudio L, Yücel Meryem, Kumar Deepak
Department of Physical Therapy, Boston University, Boston, MA 02215, USA.
Department of Occupational Therapy, Boston University, Boston, MA 02215, USA.
Osteoarthr Cartil Open. 2025 Apr 24;7(3):100615. doi: 10.1016/j.ocarto.2025.100615. eCollection 2025 Sep.
For people with knee osteoarthritis (OA), step-up is one of the most physically demanding and pain-evoking daily movements. Given the significant role of the prefrontal cortex (PFC) in executive function and pain modulation, our objectives were (1) to assess PFC activation during walking and step-up in people with knee OA and (2) to examine the association of pain and psychological outcomes with changes in PFC activation from walking to step-up.
This cross-sectional study included 44 individuals with symptomatic knee OA. Participants completed Knee Injury and Osteoarthritis Outcome Score (KOOS), Pain, Enjoyment of Life, and General Activity (PEG) scale, Patient Health Questionnaire (PHQ-8) for mood, 3-item Pain Catastrophizing Scale (PCS), and Fear-Avoidance Beliefs Questionnaire (FABQ). Oxygenated hemoglobin concentration changes (HbO) in the bilateral PFC were assessed using functional Near-Infrared Spectroscopy. HbO were compared between tasks using repeated measures ANCOVA. Multiple linear regression models tested the association between clinical outcomes and changes in HbO from walking to step-up while adjusting for confounders.
HbO during step-up was higher compared to walking, with moderate effect size ( = 0.3-0.5). Greater pain catastrophizing (R = 0.10) was correlated with smaller changes in HbO from walking to step-up.
People with knee OA utilized greater executive control during step-up compared to walking. Similar to stair climbing, step-up is more physically demanding and more frequently impaired than walking. Greater pain catastrophizing was related to smaller increases in PFC activation from walking to step-up, reflecting the availability of fewer executive resources to maintain task performance.
对于膝骨关节炎（OA）患者而言，上台阶是日常活动中对身体要求最高且最易引发疼痛的动作之一。鉴于前额叶皮质（PFC）在执行功能和疼痛调节中发挥的重要作用，我们的目标是：（1）评估膝OA患者在行走和上台阶过程中PFC的激活情况；（2）研究从行走至 上台阶过程中疼痛及心理指标与PFC激活变化之间的关联。
这项横断面研究纳入了44例有症状的膝OA患者。参与者完成了膝关节损伤和骨关节炎疗效评分（KOOS）、疼痛、生活乐趣和日常活动（PEG）量表、用于评估情绪的患者健康问卷（PHQ-8）、3项疼痛灾难化量表（PCS）以及恐惧回避信念问卷（FABQ）。使用功能近红外光谱技术评估双侧PFC中氧合血红蛋白浓度的变化（HbO）。采用重复测量协方差分析比较不同任务间的HbO。多元线性回归模型在调整混杂因素的同时，检验了临床指标与从行走至 上台阶过程中HbO变化之间的关联。
与行走相比，上台阶过程中的HbO更高，效应量中等（=0.3 - 0.5）。更高的疼痛灾难化程度（R = 0.10）与从行走至上台阶过程中HbO的较小变化相关。
与行走相比，膝OA患者在上台阶过程中运用了更强的执行控制。与爬楼梯类似，上台阶比行走对身体的要求更高，且更易受损。更高的疼痛灾难化程度与从行走至上台阶过程中PFC激活的较小增加相关，这反映出用于维持任务表现的执行资源较少。
