What question did this study set out to answer?

This research aims to examine the relationships between kinesiophobia, alexithymia, and the severity of knee osteoarthritis as determined by radiographic grading.

April 5, 2026PeerJ0 citationsOpen Access

Kinesiophobia and alexithymia in knee osteoarthritis: association with radiological severity

ASAysel Cinar Sayhan FİFethi İsnaçSivas State Hospital İGİsmail Güneş GökmenEskişehir City Hospital

Key Points

This research aims to examine the relationships between kinesiophobia, alexithymia, and the severity of knee osteoarthritis as determined by radiographic grading.
Conducted a cross-sectional study with 109 adults diagnosed with knee osteoarthritis.
Used the Visual Analog Scale to measure pain, Tampa Scale of Kinesiophobia for kinesiophobia, and Toronto Alexithymia Scale for alexithymia.
Radiographic severity was assessed using the Kellgren–Lawrence classification and analyzed statistically.
Kinesiophobia positively correlates with higher radiographic severity (KL grades), with a correlation coefficient of r = 0.341.
Total alexithymia scores were not significantly related to radiographic severity; however, difficulty identifying feelings did correlate (r = 0.300).
Kinesiophobia was associated with increased movement-evoked pain and higher body mass index, whereas alexithymia related to movement-related pain and comorbidity.

Abstract

Background Pain and disability in knee osteoarthritis (KO) are influenced by both structural and psychosocial factors. However, the roles of kinesiophobia and alexithymia in KO remain poorly understood. Objective To investigate the relationships among kinesiophobia, alexithymia, and radiographic severity in patients with KO. Methods In this cross-sectional study, 109 adults with clinically and radiographically confirmed KO were recruited from two tertiary care centers. Demographic and clinical data were also collected. Pain intensity at rest and during movement was measured using the Visual Analog Scale (VAS), kinesiophobia with the Tampa Scale of Kinesiophobia (TSK), and alexithymia with the Toronto Alexithymia Scale (TAS). Radiographic severity was graded according to the Kellgren–Lawrence (KL) classification. Correlation and logistic regression analyses were conducted. Results Kinesiophobia increased significantly with higher KL grade (r = 0.341, p < 0.001), whereas total alexithymia scores were not directly associated with radiographic severity. However, scores on the TAS subscale for difficulty identifying feelings (TAS-DIF) increased with higher KL stages (r = 0.300, p = 0.002). Kinesiophobia was further related to greater movement-evoked pain (r = 0.206, p = 0.035), higher body mass index (r = 0.317, p < 0.001), and lower education levels (r = −0.300, p = 0.002), while alexithymia was associated with movement-related evoked pain (r = 0.247, p = 0.011), lower educational attainment (r = −0.224, p = 0.021), comorbidity (r = −0.279, p = 0.004), and female sex (r = −0.201, p = 0.039). No variable independently predicted alexithymia in logistic regression analysis. Conclusion Higher radiological severity and greater movement-evoked pain are linked to increased fear of movement, whereas alexithymia appears less dependent on structural degeneration and more related to individual psychological factors. These results emphasize the interconnection between physical and psychosocial components in KOA and support a multidisciplinary, biopsychosocial approach that incorporates emotional assessment and fear-reduction strategies into routine management.

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