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22-06-2014 | Rheumatology | Article

Pain predicts physical activity avoidance in early knee OA


Meeting abstract

medwireNews: Patients with early symptomatic osteoarthritis (OA) of the knee avoid performing normal daily physical activities because they are experiencing pain, findings of a large, longitudinal study suggest.

Low vitality was also associated with a greater chance of patients avoiding physical activities, such as walking and stair climbing, in the multicentre CHECK (Cohort Hip & Cohort Knee) study.

“The results support the validity of the avoidance model in persons with early symptomatic knee OA,” said study author Jasmijn Holla, from the Amsterdam Rehabilitation Research Center in Reade, the Netherlands.

This model assumes that pain and psychological distress lead to the avoidance of activities and that this, in turn, can lead to muscle weakness and subsequent activity limitation.

In the study by Holla and colleagues, the course of pain-related avoidance of activities was fairly stable over time and was significantly associated with a subsequent increase in activity limitations at both 2 and 5 years’ follow up.

The researchers examined predictors and outcome of avoidance activities in 828 participants aged between 45 and 65 years.

Knee pain in the past week was assessed using a 10-point numerical rating scale, where zero indicated no pain. Vitality was assessed via the Short-Form (SF)-36 subscale, activity avoidance was assessed by the resting subscale of the Pain Coping Inventory, and activity limitations were assessed using the physical function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index.

Results showed that greater knee pain and lower vitality were associated with higher levels of avoidance of activities, Holla reported at the recent annual meeting of the European League Against Rheumatism in Paris, France. Furthermore, in longitudinal analyses, pain and vitality predicted a subsequent increase in avoidance of activities.

Cross-sectional analyses confirmed that greater knee pain and lower vitality were associated with a higher level of avoidance of activities and greater subsequent limitations in the ability to perform activities, she added.

“We found that the course of pain-related avoidance of activities was fairly stable over time”, Holla said.

“It seems that when a patient has adopted a certain avoidance behaviour that it is likely that this behaviour persists,” she added, concluding: “Therefore it can be recommended to monitor and target avoidance of activities not only at the inception of symptoms but also at the various stages of knee OA.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014

By Sara Freeman, medwireNews Reporter

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