Kinesiophobia and alexithymia in knee osteoarthritis: association with radiological severity
Aysel Cinar Sayhan1, Fethi Isnac2, İsmail Gunes Gokmen3
1Department of Physical Medicine and Rehabilitation, Bilecik Seyh Edebali University, Bilecik, Turkey.
Background:
Pain and disability in knee osteoarthritis (KO) are influenced by both structural and psychosocial factors. However, the roles of kinesiophobia and alexithymia in KO remain poorly understood.
Objective:
To investigate the relationships among kinesiophobia, alexithymia, and radiographic severity in patients with KO.
Methods:
In this cross-sectional study, 109 adults with clinically and radiographically confirmed KO were recruited from two tertiary care centers. Demographic and clinical data were also collected. Pain intensity at rest and during movement was measured using the Visual Analog Scale (VAS), kinesiophobia with the Tampa Scale of Kinesiophobia (TSK), and alexithymia with the Toronto Alexithymia Scale (TAS). Radiographic severity was graded according to the Kellgren-Lawrence (KL) classification. Correlation and logistic regression analyses were conducted.
Results:
Kinesiophobia increased significantly with higher KL grade (r = 0.341, p < 0.001), whereas total alexithymia scores were not directly associated with radiographic severity. However, scores on the TAS subscale for difficulty identifying feelings (TAS-DIF) increased with higher KL stages (r = 0.300, p = 0.002). Kinesiophobia was further related to greater movement-evoked pain (r = 0.206, p = 0.035), higher body mass index (r = 0.317, p < 0.001), and lower education levels (r = -0.300, p = 0.002), while alexithymia was associated with movement-related evoked pain (r = 0.247, p = 0.011), lower educational attainment (r = -0.224, p = 0.021), comorbidity (r = -0.279, p = 0.004), and female sex (r = -0.201, p = 0.039). No variable independently predicted alexithymia in logistic regression analysis.
Conclusion:
Higher radiological severity and greater movement-evoked pain are linked to increased fear of movement, whereas alexithymia appears less dependent on structural degeneration and more related to individual psychological factors. These results emphasize the interconnection between physical and psychosocial components in KOA and support a multidisciplinary, biopsychosocial approach that incorporates emotional assessment and fear-reduction strategies into routine management.
