Pain Catastrophizing, Kinesiophobia and Exercise Adherence in Patients After Total Knee Arthroplasty: The Mediating Role of Exercise Self-Efficacy

Abstract

Purpose

To examine whether exercise self-efficacy mediates the contributions of pain catastrophizing and kinesiophobia to exercise adherence in patients after total knee arthroplasty.

Patients and Methods

A cross-sectional study design was conducted. A total 211 post-total knee arthroplasty patients were recruited from three orthopedics units of a tertiary hospital in China. Participants were invited to complete questionnaires on pain catastrophizing, kinesiophobia, exercise self-efficacy, and exercise adherence. Mplus 8.3 software was used to construct mediation models.

Results

Pain catastrophizing and kinesiophobia were negatively correlated with exercise adherence (r = −0.509, r = −0.605, p < 0.001 respectively), while exercise self-efficacy were positively associated with exercise adherence (r = 0.799, p < 0.001). The results found exercise self-efficacy mediated the correlations of pain catastrophizing and kinesiophobia with exercise adherence after adjusting for demographic and clinical covariates. Pain catastrophizing indirectly affected patients’ exercise adherence through its effect on exercise efficacy (indirect effect: −0.412), while Kinesiophobia is directly associated with exercise adherence and also indirectly through exercise self-efficacy (direct effect: −0.184, indirect effect: −0.415).

Conclusion

Patients after total knee arthroplasty who have high levels of psychological distress (pain catastrophizing and kinesiophobia) are vulnerable to be non-adherent to exercise behaviors. Exercise self-efficacy explains the effects of pain catastrophizing and kinesiophobia on exercise adherence and may be a key target for measures to improve exercise behaviors in patients after total knee arthroplasty.

Keywords:

• pain catastrophizing
• kinesiophobia
• self-efficacy
• exercise
• adherence
• total knee arthroplasty

Abbreviations

OA, Osteoarthritis; TKA, Total Knee Arthroplasty; HCPs, Healthcare Professionals; PCS-CV, The Chinese Version of the Pain Catastrophizing Scale; WHO, World Health Organization; TSK-CV, The Chinese version of the Tampa Scale for Kinesiophobia; SER, The Self-efficacy for Rehabilitation Outcome Scale; SD, Standard Deviation; CFI, Comparative Fit Index; TLI, Tucker Lewis index; RMSEA, Root Mean Square Error of Approximation; CI, Confidence Interval; CMB, Common Method Bias.

Data Sharing Statement

The data used to support the conclusions in this study can be obtained from the corresponding authors upon reasonable request.

Ethics Statement

The study was approved by the Medical Institutional Review Board of Baoding No.1 Central Hospital (Approval Number: [2022]068). All procedures performed in studies involving human participants were in accordance with the ethical standards and with the Helsinki Declaration. Informed consent was obtained from all individual participants included in the study.

Informed Consent

Informed consent was obtained from all individual adult participants included in the study.

Acknowledgments

We acknowledge the contributions of the patients who participated in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that there is no conflict of interest in this work.

Additional information

Funding

This study was supported by the Science and Technology Program of Baoding (grant number: 2341ZF092).