Association Between Pain Catastrophising and Functional Limitation in Patients With Knee Osteoarthritis: A cross-sectional study in a Tunisian rehabilitation setting

Abstract

Objectives: Knee osteoarthritis (KOA) is a common reason for consultation in rehabilitation settings, responsible for pain and restricted autonomy. This study aimed to determine the association between catastrophising and functional limitation in patients followed for KOA in physical medicine and rehabilitation. Methods: This cross-sectional analytical study was conducted from June to August 2025 at the Department of Physical Medicine and Functional Rehabilitation in Taher Sfar University Hospital, Mahdia, Tunisia. Demographic data, the history of KOA as well as the radiographic stage of Kellgren and Lawrence were collected from patients with KOA. Functional impairment was assessed by the Lequesne knee index and catastrophising was assessed by the Pain Catastrophizing Scale (PCS) questionnaire in its Arabic translated and validated version. Results: A total of 90 patients were included with a mean age of 58.76 ± 9.09 years. Most were women (88.9%) and obesity was present in 44.4% of patients. KOA was bilateral in 73.3% of cases. The mean on 100 of the VAS pain at rest was 29.18 ± 19.69 and at walk 57.14 ± 15.81. The mean Lequesne score in the population was 11.33 ± 3.53 and that of the PCS was 23.91 ± 11.28. Significant factors associated with a high level of catastrophizing were the level of education (P = 0.040), obesity (P = 0.007), the radiological stage (P = 0.048) and the Lequesne index (P = 0.019). The mean Hospital Anxiety and Depression Scale (HADS)-depression score was 7.75 ± 2.84 in the low catastrophising group versus 11.04 ± 2.24 in the high catastrophizing group (P <0.001). The mean HADS-anxiety score was 8.20 ± 3.97 versus 12.32 ± 3.83, respectively (P <0.001). Conclusion: These findings demonstrated an association between catastrophising and functional limitation in KOA. Evaluating pain catastrophisation during the follow-up of these patients, may guide and personalise therapeutic strategies, such as cognitive-behavioural approaches, pain management and rehabilitation according to each patient's needs.