Kinesiophobia, proprioception, and functional status after total knee arthroplasty: the mediating role of deep...

Kinesiophobia is known to adversely affect functional recovery following total knee arthroplasty (TKA); however, its relationship with the proprioceptive system has not yet been sufficiently elucidated. The aim of this study was to examine the associations between kinesiophobia and pain, functional performance, lower limb functional performance, and proprioception following TKA, and to evaluate the potential mediating role of proprioception in the effect of kinesiophobia on functional outcomes.

This cross-sectional observational study included a total of 40 patients (37 female, 3 male; mean age: 66.0 ± 7.48 years) who had undergone TKA for knee osteoarthritis and were at least 3 months post-surgery. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). Pain was evaluated with the Visual Analogue Scale (VAS), functional status with the WOMAC Osteoarthritis Index, and lower limb functional performance with the Five Times Sit-to-Stand Test (FTSST). Proprioception was analyzed through joint position error (JPE) measured at 30° and 60° of knee flexion using a digital goniometer. Statistical analyses included correlation analysis, Steiger's t-test, hierarchical regression, and mediation analysis.

Significant positive correlations were found between TSK scores and WOMAC (ρ = 0.559, p < 0.001), FTSST (ρ = 0.491, p = 0.001), and JPE at 60 degrees (ρ = 0.482, p = 0.002). No significant association was observed with JPE at 30 degrees (ρ = 0.215, p = 0.183), though the correlation at 60 degrees was significantly stronger (p = 0.046). Hierarchical regression identified FTSST, movement pain, and JPE at 60 degrees as the primary predictors of functional status. Mediation analysis demonstrated that JPE at 60 degrees exerted a significant indirect effect on the relationship between kinesiophobia and functional status (B = 0.453, 95% CI [0.130, 0.994]).

In patients post-TKA, kinesiophobia is associated with pain, lower limb functional performance, and increased joint position error, particularly at 60° of flexion. Mediation analysis indicated that joint position error at 60° statistically mediated the association between kinesiophobia and functional limitation, suggesting fear of movement relates to functional outcomes partly through proprioceptive accuracy. Integrating proprioceptive training targeting deep flexion angles and cognitive-behavioral strategies into rehabilitation programs may optimize functional recovery, though prospective studies are needed to confirm these exploratory findings.