Comparison between pain intensity, functionality, central sensitization, and self-efficacy in individuals with unilateral or bilateral knee osteoarthritis: a cross-sectional study

Oliveira, Leonardo Antônio Santos de; Pontes-Silva, André; Damasceno, Karen Larissa Brito; Apahaza, Gabriel Henrique Santin; Oliveira, Adriano Rodrigues de; Dibai-Filho, Almir Vieira; Avila, Mariana Arias; Fidelis-de-Paula-Gomes, Cid André

doi:10.1590/1806-9282.20220170

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 68 (8) • Aug 2022 • https://doi.org/10.1590/1806-9282.20220170 copy

Comparison between pain intensity, functionality, central sensitization, and self-efficacy in individuals with unilateral or bilateral knee osteoarthritis: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to compare pain intensity, stiffness, functionality, central sensitization, and self-efficacy, between individuals with bilateral knee osteoarthritis and unilateral knee osteoarthritis.

METHODS:

We included sedentary participants with knee osteoarthritis. The diagnosis was defined by a specialist, in which there was a complaint of pain and/or altered function in the lower limbs (duration ≥3 months); morning stiffness; pain intensity ≥3; Kellgren-Lawrence 2–3° associated with X-ray; persistence of symptoms >3 months. We used the following tools: Western Ontario and McMaster Universities Arthritis Index, Numerical Pain Scale, Central Sensitization Inventory, and Pain Self-Efficacy Questionnaire. Intergroup comparisons were performed using the t-test.

RESULTS:

The sample consisted of 118 adult individuals, divided into two groups: bilateral knee osteoarthritis (n=59) and unilateral knee osteoarthritis (n=59). We observed a significant difference (p<0.05) and a large effect size (d≥0.8), in the comparisons between: stature, body mass index, physical function, central sensitization, and self-efficacy.

CONCLUSION:

Individuals with bilateral knee osteoarthritis have higher levels of central sensitization, impaired functionality, and a lower level of self-efficacy.

KEYWORDS:
Osteoarthritis; Chronic pain; Musculoskeletal diseases; Central nervous system sensitization; Chronic disease; Exercise

		B-KO (n=59)	U-KO (n=59)	t value	p-value
Sex (Female, %)^a a Values presented in absolute numbers (percentage), χ2 test.		56 (94.9)	51 (86.4)		0.11
Body mass (kg)^b b Values presented as average (standard deviation).		72.16 (5.05)	70.28 (4.26)	2.18	0.03^* * Significant difference (t-test of independent samples, p-value<0.05).
Stature (m)^b b Values presented as average (standard deviation).		1.63 (0.07)	1.68 (0.05)	−3.87	<0.01^* * Significant difference (t-test of independent samples, p-value<0.05).
BMI (kg/m²2 Marullo M, Vitale JA, Stucovitz E, Romagnoli S. Simultaneous bilateral unicompartmental knee replacement improves gait parameters in patients with bilateral knee osteoarthritis. Knee. 2019;26(6):1413-20. https://doi.org/10.1016/j.knee.2019.08.014 https://doi.org/10.1016/j.knee.2019.08.0... )^b b Values presented as average (standard deviation).		27.06 (2.88)	24.94 (2.17)	4.51	<0.01^* * Significant difference (t-test of independent samples, p-value<0.05).
Age (years)^b b Values presented as average (standard deviation).		65.54 (3.97)	68.25 (4.48)	−3.47	<0.01^* * Significant difference (t-test of independent samples, p-value<0.05).
WOMAC (score)^b b Values presented as average (standard deviation).
	Pain (0–20)	15.27 (2.36)	15.10 (1.43)	0.47	0.63
	Stiffness (0–8)	6.13 (1.23)	5.93 (0.86)	1.03	0.30
	Physical function (0–68)	51.81 (4.37)	48.25 (3.58)	4.83	<0.01^* * Significant difference (t-test of independent samples, p-value<0.05).
	NPS (0–10)^b b Values presented as average (standard deviation).	5.57 (0.96)	5.52 (1.15)	0.26	0.79
	CSI (0–100)^b b Values presented as average (standard deviation).	29.71 (3.07)	22.42 (2.71)	13.64	<0.01^* * Significant difference (t-test of independent samples, p-value<0.05).
	PSEQ (0–60)^b b Values presented as average (standard deviation).	21.96 (2.58)	28.16 (2.49)	−13.20	<0.01^* * Significant difference (t-test of independent samples, p-value<0.05).

Variables		Group	Mean	SD	MD	95%CI	d
Body mass (kg)		B-KO	72.16	5.05	1.88	0.17 to 3.58^* * Significant difference (t-test of independent samples, p-value<0.05).	−0.40
Body mass (kg)		U-KO	70.28	4.26
Stature (m)		B-KO	1.63	0.07	−0.44	−0.06 to −0.02^* * Significant difference (t-test of independent samples, p-value<0.05).	0.82^# # Moderate effect size (Cohen's d≥0.5).
Stature (m)		U-KO	1.68	0.05
BMI (kg/m²2 Marullo M, Vitale JA, Stucovitz E, Romagnoli S. Simultaneous bilateral unicompartmental knee replacement improves gait parameters in patients with bilateral knee osteoarthritis. Knee. 2019;26(6):1413-20. https://doi.org/10.1016/j.knee.2019.08.014 https://doi.org/10.1016/j.knee.2019.08.0... )		B-KO	27.06	2.88	2.12	1.19 to 3.06^* * Significant difference (t-test of independent samples, p-value<0.05).	−0.83^# # Moderate effect size (Cohen's d≥0.5).
		U-KO	24.94	2.17
Age (years)		B-KO	65.54	3.97	−2.71	−4.25 to −1.16^* * Significant difference (t-test of independent samples, p-value<0.05).	0.64^# # Moderate effect size (Cohen's d≥0.5).
Age (years)		U-KO	68.25	4.48
WOMAC (score)
	Pain (0–20)	B-KO	15.27	2.36	0.16	−0.54 to 0.88	−0.08
	Pain (0–20)	U-KO	15.10	1.43
	Stiffness (0–8)	B-KO	6.13	1.23	0.20	−0.18 to 0.59	−0.18
	Stiffness (0–8)	U-KO	5.93	0.86
	Physical function (0–68)	B-KO	51.81	4.37	3.55	2.10 to 5.01^* * Significant difference (t-test of independent samples, p-value<0.05).	−0.89^# # Moderate effect size (Cohen's d≥0.5).
	Physical function (0–68)	U-KO	48.25	3.58
	NPS (0–10)	B-KO	5.57	0.96	0.05	−0.33 to 0.43	−0.04
	NPS (0–10)	U-KO	5.52	1.15
	CSI (0–100)	B-KO	29.71	3.07	7.28	6.23 to 8.34^* * Significant difference (t-test of independent samples, p-value<0.05).	−2.51^# # Moderate effect size (Cohen's d≥0.5).
	CSI (0–100)	U-KO	22.42	2.71
PSEQ (0–68)		B-KO	21.96	2.58	−6.20	−7.13 to −5.27^* * Significant difference (t-test of independent samples, p-value<0.05).	2.44^# # Moderate effect size (Cohen's d≥0.5).
PSEQ (0–68)		U-KO	28.16	2.49

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[1] *Corresponding author: contato.andrepsilva@gmail.com