Fear, Falls Unrelated to Pain Level, Catastrophizing in Knee Osteoarthritis

Older woman who has fallen on the floor
Weak elderly woman with walking stick waiting for help after breathlessness attack .Elderly woman fell on the floor.
Researchers investigated whether pain intensity and catastrophizing were associated with fear of falls and number of falls in older adult patients with osteoarthritis.

Pain intensity and catastrophizing did not correlate with fear of falling or number of falls in older adult patients with unilateral knee osteoarthritis (OA), according to study findings published in Journal of Manipulative and Physiological Therapeutics.

Researchers conducted a cross-sectional study in São Paulo, Brazil, from March 2019 to November 2019 to evaluate the relationship between pain intensity and catastrophizing with fear of falling and number of falls in 100 patients aged 60 to 80 years with unilateral knee OA. Of these 100 patients, 90 were women and 82 obtained a diagnosis of right knee OA.

Pain intensity was measured during a 7-day period using the Numerical Rating Pain Scale (NRPS) from 0 to 10. The Pain-Related Self-Statement Scale (PRSS) rated pain catastrophizing. The Falls Efficacy Scale (FES) measured fear of falling. Lastly, the researchers asked study patients about the number of falls in the past 5 years.

An average of 1.06 falls (SD=1.36) occurred, and 59% of the patients reported no fall history in the past 5 years. Pain intensity on the NRPS and pain catastrophizing on the PRSS did not correlate with fear of falling on the FES (P =.743 and P =.223, respectively) or number of falls within 5 years (P =.096 and P =.405, respectively).

A limitation of the study includes the fact that pain intensity at rest may not equate to pain intensity impairing functional activities, which may affect study findings. Other limitations include a lack of analysis of time since knee OA diagnosis, the single center nature of the study, and the low catastrophizing pain values which limit generalizability to all patients with knee osteoarthritis.

The study authors conclude, “According to the results obtained in the present study, we can speculate that pain catastrophizing does not impact the fear of falling, nor does it increase the number of falls in individuals with knee OA.”


Fidelis-de-Paula-Gomes CA, Dibai-Filho AV, Ferreira CSB, et al. Correlation among pain intensity, catastrophizing, and falls in older individuals with unilateral knee osteoarthritis: A cross-sectional study. J Manipulative Physiol Ther. 2022;45(3):196-201. doi:10.1016/j.jmpt.2022.06.004