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Vol. 23. Issue 3.
Pages 266-272 (01 May 2019)
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Vol. 23. Issue 3.
Pages 266-272 (01 May 2019)
Original Research
DOI: 10.1016/j.bjpt.2018.08.011
Can muscle weakness and disability influence the relationship between pain catastrophizing and pain worsening in patients with knee osteoarthritis? A cross-sectional study
Ryo Tanakaa,b,
Corresponding author

Corresponding author. Current address: 1-7-1 Kagamiyama, Higashi-Hiroshima, Hiroshima 739-8521, Japan.
, Kenta Hirohamac, Junya Ozawab
a Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan
b Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan
c Department of Rehabilitation, Sakamidorii Hospital, Hiroshima, Japan

  • We studied the likely mediator between pain catastrophizing and pain worsening.

  • This relationship was mediated by disability and muscle weakness.

  • Cognitive intervention for disability and muscle strengthening may be effective for relieving pain.

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Figures (2)
Tables (3)
Table 1. The characteristics of participants.
Table 2. Summary measures.
Table 3. Result of correlation analysis.
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To verify if the relationship between pain catastrophizing and pain worsening would be mediated by muscle weakness and disability in patients with symptomatic knee osteoarthritis.


This was a cross-sectional study in a hospital out-patient setting. Convenience sampling was used with a total of 50 participants with symptomatic knee osteoarthritis. Pain and the activities of daily livings (ADL) were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale. Pain catastrophizing was assessed using the Coping Strategy Questionnaire (CSQ) subscale. Muscle strength of knee extension and 30-s chair stand test (30CST) were also assessed. Path analysis was performed to test the hypothetical model. Goodness of fit of models were assessed by using statistical parameters such as the chi-square value, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA).


The chi-square values were not significant (chi-square=0.283, p=0.594), and the indices of goodness of fit were high, implying a valid model (GFI=1.000; AGFI=0.997; CFI=1.000; RMSEA=0.000). Pain was influenced significantly by muscle strength and ADL; muscle strength was influenced significantly by ADL via 30CST; ADL was influenced by pain catastrophizing.


The relationship between pain catastrophizing with pain worsening are mediated by muscle weakness and disability.

Knee osteoarthritis
Fear-avoidance model
Pain catastrophizing
Muscle weakness


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