ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2193

The Frequency of and Patient Characteristics Associated with Fear of Movement in Adults with Symptomatic Knee Osteoarthritis

Alex Gunn1, Todd A. Schwartz2, Leigh F. Callahan3, Yvonne M. Golightly4, Adam P. Goode5, Carla Hill1, Kim Huffman6, Maura D. Iversen7, Ami Pathak8, Shannon Taylor9 and Kelli Allen10, 1University of North Carolina at Chapel Hill, Chapel Hill, NC, 2School of Nursing, University of North Carolina, Chapel Hill, NC, 3Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, 4Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 5O, Duke University, Durham, NC, 6Rheumatology, Duke University Medical Center, Durham, NC, 7Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, 8Comprehensive Physical Therapy, Chapel Hill, NC, 9Durham VA Medical Center, Durham, NC, 10University of North Carolina at Chapel Hill and Durham VA Medical Center, Chapel Hill, NC

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Tuesday, November 15, 2016

Title: Epidemiology and Public Health - ARHP Poster

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Fear of movement is associated with increased pain, decreased physical function, decreased activity, and negative psychological symptoms. Little is known about fear of movement in the context of osteoarthritis.  This study examined the frequency of and factors associated with fear of movement among patients with symptomatic knee osteoarthritis (sxKOA), using the new Brief Fear of Movement (BFOM) measure.

Methods: This cross-sectional study is a secondary analysis of data from a randomized exercise trial among patients with sxKOA. Participants (n=350) were recruited from an academic medical center, the community, and an ongoing cohort study. Participants (mean age = 65.3 ± 10.9; 71.7% female; 26.3% nonwhite) had sxKOA based on a physician diagnosis and/or a prior radiograph. The BFOM scale contains 6 items using a 4-point scale ranging from “strongly agree” to “strongly disagree.”  We examined relationships of BFOM with: age, sex, race (white vs. nonwhite), education (bachelor’s degree or higher vs. up to a bachelor’s degree), Knee Injury and Osteoarthritis Outcome Score (KOOS) pain and activities of daily living (ADL) subscales, knee symptom duration, depressive symptoms (PHQ-8), falls in the prior 12 months, history of knee injury, family history of knee problems, self-efficacy for exercise (SEE), and unilateral balance test.  We created a 3-level ordinal variable, which grouped participants based on agreement (“agree” or “strongly agree’) with 0, 1-2, or 3+ items on the BFOM scale. General linear models with trend tests were used to compare participant characteristics across the 3 BFOM categories.  A proportional odds logistic regression model with backward selection was used to examine multivariable associations of participant characteristics with the ordinal BFOM variable. 

Results: The majority of participants (76%) agreed with at least 1 item on the BFOM scale, and 36% endorsed 3+ items, suggesting high fear of movement. In bivariate analyses, the following were significantly associated (p<0.05) with the ordinal BFOM variable: age, KOOS pain, KOOS ADL, PHQ-8, and SEE (Table). In the multivariable model (for which the proportional odds assumption was met), the following remained after backward selection:  age (odds ratio (OR) = 0.74 per 10-point increase, 95% confidence interval (CI) = 0.60 – 0.97), KOOS ADL (OR = 0.66 per 10-point increase, 95% CI = 0.54 – 0.90), PHQ-8 (OR = 1.11, 95%CI = 1.04 – 1.20), and SEE (OR = 0.99, 95%CI = 0.97 – 1.00).

Conclusion: Among patients with sxKOA, there was a high frequency of fear of movement, which can negatively impact physical activity, an important component of osteoarthritis management. Psychological variables were significantly associated with BFOM, suggesting that behavioral and psychological interventions may decrease fear of movement and improve clinical outcomes in individuals with sxKOA.

Table. Bivariate Associations of Participant Characteristics with Fear of Movement, N=350.
      Agree with none (n=81, 23.1%) Agree with 1 to 2 (n=142, 40.6%) Agree with 3 to 6 (n=127, 36.3%) Trend p-value
Age (mean years ± SD) 68.7 ± 8.0 65.1 ± 11.6 63.3 ± 11.8 <0.01
Female (%) 72.8 69.0 74.0 0.64
Nonwhite (%) 21.5 23.7 32.5 0.15
Bachelor’s degree or post graduate work (%) 66.7 61.3 52.8 0.12
KOOS Pain (mean ± SD) 67.2 ± 16.9 64.1 ± 16.6 56.2 ± 18.7 <0.01
KOOS ADL (mean ± SD) 73.7 ± 8.1 68.7± 17.3 60.3 ± 19.9 <0.01
Symptom Duration (mean years ± SD) 13.4 ± 10.9 13.8± 12.4 12.1±11.3 0.49
PHQ-8  (mean ± SD) 2.1 ± 2.2 3.1 ± 3.4 5.6 ± 5.1 <0.01
≥1 fall in the previous 12 months (%) 33.3 32.4 36.5 0.77
History of knee injury (%) 45.7 50.0 52.8 0.61
Family history of knee problems (%) 75.4 79.1 79.8 0.77
SEE (mean ± SD) 61.9 ± 8.3 58.1 ± 18.7 50.8 ± 22.0 <0.01
Unilateral balance test (mean seconds ± SD) 7.48 ± 3.39 7.26 ± 3.61 7.12 ± 3.59 0.78

 

Disclosure: A. Gunn, None; T. A. Schwartz, None; L. F. Callahan, None; Y. M. Golightly, None; A. P. Goode, None; C. Hill, None; K. Huffman, None; M. D. Iversen, None; A. Pathak, None; S. Taylor, None; K. Allen, None.

To cite this abstract in AMA style:

Gunn A, Schwartz TA, Callahan LF, Golightly YM, Goode AP, Hill C, Huffman K, Iversen MD, Pathak A, Taylor S, Allen K. The Frequency of and Patient Characteristics Associated with Fear of Movement in Adults with Symptomatic Knee Osteoarthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-frequency-of-and-patient-characteristics-associated-with-fear-of-movement-in-adults-with-symptomatic-knee-osteoarthritis/. Accessed .

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