The relationship between pain-related psychological factors and balance performance in individuals with knee osteoarthritis: A systematic review

Background and purpose Balance impairments have been well documented in individuals with knee osteoarthritis (KOA). Despite the growing body of evidence addressing the clinical relevance of pain‑related psychological factors in individuals with KOA, the association between these factors and balance performance remains unclear. Therefore, this study aimed to systematically synthesize and critically appraise the available evidence regarding the associations between pain‑related psychological factors and balance performance in individuals with KOA.Methods Case-control, cross-sectional, or cohort study designs were included in this review study. PubMed, Scopus, Web of Science, Embase, Google Scholar, and ResearchGate were searched from their inception to 18 May 2026. The selected search terms were associated with pain-related psychological factors (e.g. pain self-efficacy (PSE), kinesiophobia, pain catastrophizing (PC), and fear-avoidance beliefs (FAB)), KOA, and balance performance.Results All 13 included studies exhibited a low risk of bias in the selection and outcome domains; regarding comparability, 4 studies demonstrated a low risk of bias, while 9 showed a high risk of bias according to the adapted Newcastle–Ottawa scale. The results revealed weak and non-significant correlations for kinesiophobia in the majority of the studies (62.5%). For PC, among three studies assessing the effects of PC on balance performance, two studies found a significant negative correlation between PC and balance performance. Regarding the PSE and FAB, evidence was limited to only two studies for each component with inconsistent results.Conclusion PC may be associated with poorer balance performance in individuals with KOA. However, the available evidence remains limited and inconsistent. Findings regarding the other pain related psychological factors were inconsistent, potentially reflecting variations in the assessment tools used to measure painrelated psychological factors and balance performance across studies. Further studies are warranted to investigate the impacts of positive and negative pain related psychological factors on balance performance in individuals with KOA.