A new integrated behavioural intervention for knee osteoarthritis: development and pilot study

Stephen J Preece, Nathan Brookes, Anita E Williams, Richard K Jones, Chelsea Starbuck, Anthony Jones, Nicola E Walsh, Stephen J Preece, Nathan Brookes, Anita E Williams, Richard K Jones, Chelsea Starbuck, Anthony Jones, Nicola E Walsh

Abstract

Background: Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist.

Methods: Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists.

Results: The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from postural compensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to "create a new normal" and to be "in control of their own treatment." Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention.

Conclusion: We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes.

Trial registration: ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered).

Keywords: Behaviour change; Biomechanical; Biopsychosocial; Co-contraction; EMG; Intervention; Knee osteoarthritis; Pain.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schematic diagram to show the stages of intervention development
Fig. 2
Fig. 2
(a, b) A passively stiff hip flexor (illustrated as a rope) prevents the pelvis returning to a neutral position in standing. (c) Biomechanical compensation for a passively stiff hip flexor, consisting of a flexed hip, knee and ankle and an increased lumbar lordosis. Note there is still a slight flexion of the trunk. A full animation of this pattern can be viewed at: www.cogmustherapy.com/BMC_example_1
Fig. 3
Fig. 3
Medial hamstring EMG during walking in people with knee OA (blue), in healthy people (green) and in healthy people after instruction to increase trunk flexion by 5° (red). Note how the muscle pattern in the healthy people changes dramatically, becoming similar to the OA pattern, with increased trunk flexion. MVIC refers to maximal voluntary isometric contraction
Fig. 4
Fig. 4
Postural framework to explain elevated knee muscle activation from increased passive stiffness of hip/trunk muscles
Fig. 5
Fig. 5
Integrated behavioural framework
Fig. 6
Fig. 6
The avoidance model in knee osteoarthritis (adapted from [87])

References

    1. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646–656.
    1. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1323–1330. doi: 10.1136/annrheumdis-2013-204763.
    1. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60(2):91–97. doi: 10.1136/ard.60.2.91.
    1. King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res. 2013;138(2):185–193.
    1. Osteoarthritis: care and management (2014). Clinical guideline [CG177]. National Institute for Clinical Excellence.
    1. Bennell KL, Ahamed Y, Jull G, Bryant C, Hunt MA, Forbes AB, Kasza J, Akram M, Metcalf B, Harris A, Egerton T, Kenardy JA, Nicholas MK, Keefe FJ. Physical therapist-delivered pain coping skills training and exercise for knee osteoarthritis: randomized controlled trial. Arthritis Care Res. 2016;68(5):590–602. doi: 10.1002/acr.22744.
    1. Hurley MV, Walsh NE, Mitchell H, Nicholas J, Patel A. Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial. Arthritis Care Res. 2012;64(2):238–247. doi: 10.1002/acr.20642.
    1. Osteoarthritis: care and management [CG177]: NICE guidelines. 2014.
    1. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1. 10.1002/14651858.CD004376.pub3.
    1. Goh SL, Persson MSM, Stocks J, Hou Y, Lin J, Hall MC, Doherty M, Zhang W. Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: a systematic review and meta-analysis. Ann Phys Rehabil Med. 2019;62(5):356–365. doi: 10.1016/j.rehab.2019.04.006.
    1. Hurley MV, Walsh NE, Mitchell HL, Pimm TJ, Patel A, Williamson E, Jones RH, Dieppe PA, Reeves BC. Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: a cluster randomized trial. Arthritis Rheum. 2007;57(7):1211–1219. doi: 10.1002/art.22995.
    1. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–1359. doi: 10.1249/MSS.0b013e318213fefb.
    1. Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum. 2001;45(4):384–391. doi: 10.1002/1529-0131(200108)45:4<384::AID-ART352>;2-0.
    1. Bennell KL, Dobson F, Hinman RS. Exercise in osteoarthritis: moving from prescription to adherence. Best Pract Res Clin Rheumatol. 2014;28(1):93–117. doi: 10.1016/j.berh.2014.01.009.
    1. Lyytinen T, Liikavainio T, Bragge T, Hakkarainen M, Karjalainen PA, Arokoski JPA. Postural control and thigh muscle activity in men with knee osteoarthritis. J Electromyogr Kinesiol. 2010;20(6):1066–1074. doi: 10.1016/j.jelekin.2010.05.005.
    1. Childs JD, Sparto PJ, Fitzgerald GK, Bizzini M, Irrgang JJ. Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2004;19(1):44–49. doi: 10.1016/j.clinbiomech.2003.08.007.
    1. Hubley-Kozey CL, Deluzio KJ, Landry SC, McNutt JS, Stanish WD. Neuromuscular alterations during walking in persons with moderate knee osteoarthritis. J Electromyogr Kinesiol. 2006;16(4):365–378. doi: 10.1016/j.jelekin.2005.07.014.
    1. Hortobagyi T, Westerkamp L, Beam S, Moody J, Garry J, Holbert D, DeVita P. Altered hamstring-quadriceps muscle balance in patients with knee osteoarthritis. Clin Biomech. 2005;20(1):97–104. doi: 10.1016/j.clinbiomech.2004.08.004.
    1. Winby CR, Gerus P, Kirk TB, Lloyd DG. Correlation between EMG-based co-activation measures and medial and lateral compartment loads of the knee during gait. Clin Biomech. 2013;28(9):1014–1019. doi: 10.1016/j.clinbiomech.2013.09.006.
    1. Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait. Clin Biomech. 2009;24(10):833–841. doi: 10.1016/j.clinbiomech.2009.08.005.
    1. Brandon SCE, Miller RH, Thelen DG, Deluzio KJ. Selective lateral muscle activation in moderate medial knee osteoarthritis subjects does not unload medial knee condyle. J Biomech. 2014;47(6):1409–1415. doi: 10.1016/j.jbiomech.2014.01.038.
    1. Hodges PW, van den Hoorn W, Wrigley TV, Hinman RS, Bowles K-A, Cicuttini F, Wang Y, Bennell K. Increased duration of co-contraction of medial knee muscles is associated with greater progression of knee osteoarthritis. Man Ther. 2016;21:151–158. doi: 10.1016/j.math.2015.07.004.
    1. Hatfield GL, Costello KE, Astephen Wilson JL, Stanish WD, Hubley-Kozey CL. Baseline gait muscle activation patterns differ for osteoarthritis patients who undergo total knee arthroplasty 5–8 years later from those who do not. Arthritis Care Res. 2020;73:549–558. doi: 10.1002/acr.24143.
    1. Preece SJ, Jones RK, Brown CA, Cacciatore TW, Jones AK. Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskelet Disord. 2016;17(1):372. doi: 10.1186/s12891-016-1209-2.
    1. Odole A, Ekediegwu E, Ekechukwu END, Uchenwoke C. Correlates and predictors of pain intensity and physical function among individuals with chronic knee osteoarthritis in Nigeria. Musculoskelet Sci Pract. 2019;39:150–156. doi: 10.1016/j.msksp.2018.11.014.
    1. Sharma A, Kudesia P, Shi Q, Gandhi R. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open Access Rheumatol. 2016;8:103–113. doi: 10.2147/OARRR.S93516.
    1. Scopaz KA, Piva SR, Wisniewski S, Fitzgerald GK. Relationships of fear, anxiety, and depression with physical function in patients with knee osteoarthritis. Arch Phys Med Rehabil. 2009;90(11):1866–1873. doi: 10.1016/j.apmr.2009.06.012.
    1. Silva Guerrero AV, Maujean A, Campbell L, Sterling M. A systematic review and meta-analysis of the effectiveness of psychological interventions delivered by physiotherapists on pain, disability and psychological outcomes in musculoskeletal pain conditions. Clin J Pain. 2018;34(9):838–857. doi: 10.1097/AJP.0000000000000601.
    1. Denneny D, Frijdal A, Bianchi-Berthouze N, Greenwood J, McLoughlin R, Petersen K, Singh A, Williams ACC. The application of psychologically informed practice: observations of experienced physiotherapists working with people with chronic pain. Physiotherapy. 2020;106:163–73. 10.1016/j.physio.2019.01.014.
    1. O'Sullivan PB, Caneiro JP, O'Keeffe M, Smith A, Dankaerts W, Fersum K, O'Sullivan K. Cognitive functional therapy: an integrated behavioral approach for the targeted Management of Disabling low Back Pain. Phys Ther. 2018;98(5):408–423. doi: 10.1093/ptj/pzy022.
    1. Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075–2094. doi: 10.1007/s00586-010-1502-y.
    1. Veenhof C, Köke AJ, Dekker J, Oostendorp RA, Bijlsma JW, van Tulder MW, van den Ende CH. Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and/or knee: a randomized clinical trial. Arthritis Rheum. 2006;55(6):925–934. doi: 10.1002/art.22341.
    1. Hurley M, Dickson K, Hallett R, Grant R, Hauari H, Walsh N, et al. Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: amixedmethods review. Cochrane Database Syst Rev. 2018;4. 10.1002/14651858.CD004376.pub3.
    1. Duncan E, O'Cathain A, Rousseau N, Croot L, Sworn K, Turner KM, Yardley L, Hoddinott P. Guidance for reporting intervention development studies in health research (GUIDED): an evidence-based consensus study. BMJ Open. 2020;10(4):e033516. doi: 10.1136/bmjopen-2019-033516.
    1. Altman R, Alarcon G, Appelroth D. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the knee. Arthritis Rheum. 1986;29(8):1039–1049. doi: 10.1002/art.1780290816.
    1. O'Cathain A, Croot L, Duncan E, Rousseau N, Sworn K, Turner KM, Yardley L, Hoddinott P. Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open. 2019;9(8):e029954. doi: 10.1136/bmjopen-2019-029954.
    1. Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Fernández ME. Planning health promotion programs: an intervention mapping approach. 3. San Franciso: Jossey-Bass; 2011.
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):42. doi: 10.1186/1748-5908-6-42.
    1. Behaviour change: individual approaches: Public health guideline [PH49]: NICE guidelines. 2014.
    1. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88. doi: 10.1186/s12913-017-2031-8.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Turcot K, Sagawa Y, Jr, Hoffmeyer P, Suvà D, Armand S. Multi-joint postural behavior in patients with knee osteoarthritis. Knee. 2015;22(6):517–521. doi: 10.1016/j.knee.2014.09.001.
    1. Yasuda T, Togawa D, Hasegawa T, Yamato Y, Kobayashi S, Yoshida G, Banno T, Arima H, Oe S, Hoshino H, Koyama H, Hanada M, Imada T, Matsuyama Y. Relationship between knee osteoarthritis and Spinopelvic sagittal alignment in volunteers over 50 years of age. Asian Spine J. 2020;14(4):495–501. doi: 10.31616/asj.2018.0266.
    1. Wang WJ, Liu F, Zhu YW, Sun MH, Qiu Y, Weng WJ. Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: a radiographic study. Bone Joint Res. 2016;5(5):198–205. doi: 10.1302/2046-3758.55.2000538.
    1. Tauchi R, Imagama S, Muramoto A, Tsuboi M, Ishiguro N, Hasegawa Y. Influence of spinal imbalance on knee osteoarthritis in community-living elderly adults. Nagoya J Med Sci. 2015;77(3):329–337.
    1. Janda V, Jull G. Muscles and motor control in low back pain: assessment and management. Physical Therapy of the Low Back. T Twomey, Churchill livingstone New York. 1987:p253–78.
    1. Kendall F, McCreary E, Provance P, Rodgers M, Romani W: Testing and function with posture and pain: Lippincoll Williams & Wilkins; 2005.
    1. Preece SJ, Alghamdi W. Inter-individual variation in hip flexor length may explain differences in trunk flexion during walking in people with knee osteoarthritis. Osteoarthr Cartil. 2020;28:S244–S245. doi: 10.1016/j.joca.2020.02.392.
    1. Preece SJ, Tan YF, Alghamdi TD, Frances A: Comparison of pelvic tilt before and after hip flexor stretching in healthy adults Journal of Manipulative and Physiological Therapeutics (accepted) 2020.
    1. Preece SJ, Alghamdi W. The effect of increasing trunk flexion during normal walking. Gait & Posture. 2021;83:250–255. doi: 10.1016/j.gaitpost.2020.10.021.
    1. Alghamdi W, Preece SJ. How does normal variability in trunk flexion affect lower limb muscle activity during walking? Hum Mov Sci. 2020;72:102630. doi: 10.1016/j.humov.2020.102630.
    1. Preece SJ, Algarni AS, Jones RK. Trunk flexion during walking in people with knee osteoarthritis. Gait Posture. 2019;72:202–205. doi: 10.1016/j.gaitpost.2019.06.012.
    1. Preece SJ, Alghamdi W, Jones R. Could increased trunk flexion underlie alterations in knee muscle activity in people with knee OA? Osteoarthr Cartil. 2019;27:S116–S117. doi: 10.1016/j.joca.2019.02.172.
    1. Csapo R, Maganaris CN, Seynnes OR, Narici MV. On muscle, tendon and high heels. J Exp Biol. 2010;213(Pt 15):2582–2588. doi: 10.1242/jeb.044271.
    1. Wisdom KM, Delp SL, Kuhl E. Use it or lose it: multiscale skeletal muscle adaptation to mechanical stimuli. Biomech Model Mechanobiol. 2015;14(2):195–215. doi: 10.1007/s10237-014-0607-3.
    1. Boukabache A, Preece SJ, Brookes N. Prolonged sitting and physical inactivity are associated with limited hip extension: a cross-sectional study. Musculoskelet Sci Pract. 2021;51:102282. doi: 10.1016/j.msksp.2020.102282.
    1. Heneghan NR, Baker G, Thomas K, Falla D, Rushton A. What is the effect of prolonged sitting and physical activity on thoracic spine mobility? An observational study of young adults in a UK university setting. BMJ Open. 2018;8(5):e019371. doi: 10.1136/bmjopen-2017-019371.
    1. Mier A, Brophy C, Estenne M, Moxham J, Green M, De Troyer A. Action of abdominal muscles on rib cage in humans. J Appl Physiol (Bethesda, Md : 1985) 1985;58(5):1438–1443. doi: 10.1152/jappl.1985.58.5.1438.
    1. Lluch E, Torres R, Nijs J, Van Oosterwijck J. Evidence for central sensitization in patients with osteoarthritis pain: a systematic literature review. Eur J Pain (London, England) 2014;18(10):1367–1375. doi: 10.1002/j.1532-2149.2014.499.x.
    1. Finan PH, Buenaver LF, Bounds SC, Hussain S, Park RJ, Haque UJ, Campbell CM, Haythornthwaite JA, Edwards RR, Smith MT. Discordance between pain and radiographic severity in knee osteoarthritis: findings from quantitative sensory testing of central sensitization. Arthritis Rheum. 2013;65(2):363–372. doi: 10.1002/art.34646.
    1. Girbes EL, Nijs J, Torres-Cueco R, Cubas CL. Pain treatment for patients with osteoarthritis and central sensitization. Phys Ther. 2013;93(6):842–851. doi: 10.2522/ptj.20120253.
    1. Martindale JC, Wilson AW, Reeve AJ, Chessell IP, Headley PM. Chronic secondary hypersensitivity of dorsal horn neurones following inflammation of the knee joint. Pain. 2007;133(1–3):79–86. doi: 10.1016/j.pain.2007.03.006.
    1. Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, Schubiner H, Keefe FJ. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol. 2011;67(9):942–968. doi: 10.1002/jclp.20816.
    1. Mason KJ, O'Neill TW, Lunt M, Jones AKP, McBeth J. Psychosocial factors partially mediate the relationship between mechanical hyperalgesia and self-reported pain. Scand J Pain. 2018;18(1):59–69. doi: 10.1515/sjpain-2017-0109.
    1. Lopez-Bravo MD, Zamarron-Cassinello MD, Touche RL, Munoz-Plata R, Cuenca-Martinez F, Ramos-Toro M. Psychological factors associated with functional disability in patients with hip and knee osteoarthritis. Behav Med. 2020:1–11. 10.1080/08964289.2020.1813682.
    1. Creamer P, Lethbridge-Cejku M, Hochberg MC. Determinants of pain severity in knee osteoarthritis: effect of demographic and psychosocial variables using 3 pain measures. J Rheumatol. 1999;26(8):1785–1792.
    1. Degerstedt Å, Alinaghizadeh H, Thorstensson CA, Olsson CB. High self-efficacy – a predictor of reduced pain and higher levels of physical activity among patients with osteoarthritis: an observational study. BMC Musculoskelet Disord. 2020;21(1):380. doi: 10.1186/s12891-020-03407-x.
    1. Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152(3):S90–S98. doi: 10.1016/j.pain.2010.10.020.
    1. Hodges PW, Tsao H, Sims K. Gain of postural responses increases in response to real and anticipated pain. Exp Brain Res. 2015;233(9):2745–2752. doi: 10.1007/s00221-015-4347-0.
    1. Butera KA, Fox EJ, George SZ. Toward a transformed understanding: from pain and movement to pain with movement. Phys Ther. 2016;96(10):1503–1507. doi: 10.2522/ptj.20160211.
    1. Lewek MD, Ramsey DK, Snyder-Mackler L, Rudolph KS. Knee stabilization in patients with medial compartment knee osteoarthritis. Arthritis Rheum. 2005;52(9):2845–2853. doi: 10.1002/art.21237.
    1. Sritharan P, Lin YC, Richardson SE, Crossley KM, Birmingham TB, Pandy MG. Musculoskeletal loading in the symptomatic and asymptomatic knees of middle-aged osteoarthritis patients. J Orthop Res. 2016;35:321–330. doi: 10.1002/jor.23264.
    1. Geisser ME, Haig AJ, Wallbom AS, Wiggert EA. Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain. Clin J Pain. 2004;20(2):61–69. doi: 10.1097/00002508-200403000-00001.
    1. Pakzad M, Fung J, Preuss R. Pain catastrophizing and trunk muscle activation during walking in patients with chronic low back pain. Gait Posture. 2016;49:73–77. doi: 10.1016/j.gaitpost.2016.06.025.
    1. Stefanik JJ, Frey-Law L, Segal NA, Niu J, Lewis CE, Nevitt MC, Neogi T. The Relation of Peripheral and Central Sensitization to Muscle Co-contraction: The MOST Study. Osteoarthritis Cartil. 2020;28(9):1214–1219. doi: 10.1016/j.joca.2020.06.002.
    1. Andriacchi TP, Mündermann A, Smith RL, Alexander EJ, Dyrby CO, Koo S. A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng. 2004;32(3):447–457. doi: 10.1023/B:ABME.0000017541.82498.37.
    1. Andriacchi TP, Mundermann A. The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rheumatol. 2006;18(5):514–518. doi: 10.1097/01.bor.0000240365.16842.4e.
    1. Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. J Neuroeng Rehabil. 2013;10(1):60. doi: 10.1186/1743-0003-10-60.
    1. Kok G, Gottlieb NH, Peters GJ, Mullen PD, Parcel GS, Ruiter RA, Fernández ME, Markham C, Bartholomew LK. A taxonomy of behaviour change methods: an intervention mapping approach. Health Psychol Rev. 2016;10(3):297–312. doi: 10.1080/17437199.2015.1077155.
    1. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92(12):2041–2056. doi: 10.1016/j.apmr.2011.07.198.
    1. De Troyer A. Mechanical role of the abdominal muscles in relation to posture. Respir Physiol. 1983;53(3):341–353. doi: 10.1016/0034-5687(83)90124-X.
    1. Ivanenko Y, Gurfinkel VS. Human Postural Control. Front Neurosci. 2018;12:171. doi: 10.3389/fnins.2018.00171.
    1. Jeannerod M. Mental imagery in the motor context. Neuropsychologia. 1995;33(11):1419–1432. doi: 10.1016/0028-3932(95)00073-C.
    1. Rutherford DJ, Hubley-Kozey CL, Stanish WD, Dunbar MJ. Neuromuscular alterations exist with knee osteoarthritis presence and severity despite walking velocity similarities. Clin Biomech. 2011;26(4):377–383. doi: 10.1016/j.clinbiomech.2010.11.018.
    1. Huang H, Wolf SL, He J. Recent developments in biofeedback for neuromotor rehabilitation. J Neuroeng Rehabil. 2006;3(1):11. doi: 10.1186/1743-0003-3-11.
    1. van der Esch M, Holla JF, van der Leeden M, Knol DL, Lems WF, Roorda LD, Dekker J. Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study. Arch Phys Med Rehabil. 2014;95(10):1962–1968. doi: 10.1016/j.apmr.2014.06.007.
    1. Holla JFM, Sanchez-Ramirez DC, Van Der Leeden M, Ket JCF, Roorda LD, Lems WF, Steultjens MPM, Dekker J. The avoidance model in knee and hip osteoarthritis: a systematic review of the evidence. J Behav Med. 2014;37(6):1226–1241. doi: 10.1007/s10865-014-9571-8.
    1. Beckwée D, Vaes P, Cnudde M, Swinnen E, Bautmans I. Osteoarthritis of the knee: why does exercise work? A qualitative study of the literature. Ageing Res Rev. 2013;12(1):226–236. doi: 10.1016/j.arr.2012.09.005.
    1. Richards RE, van den Noort JC, van der Esch M, Booij MJ, Harlaar J. Effect of real-time biofeedback on peak knee adduction moment in patients with medial knee osteoarthritis: Is direct feedback effective? Clin Biomech (Bristol, Avon) 2018;57:150–158. doi: 10.1016/j.clinbiomech.2017.07.004.
    1. Booij MJ, Richards R, Harlaar J, van den Noort JC. Effect of walking with a modified gait on activation patterns of the knee spanning muscles in people with medial knee osteoarthritis. Knee. 2020;27(1):198–206. doi: 10.1016/j.knee.2019.10.006.
    1. O'Neill TW, Felson DT. Mechanisms of osteoarthritis (OA) pain. Curr Osteop Rep. 2018;16(5):611–616. doi: 10.1007/s11914-018-0477-1.
    1. Anandacoomarasamy A, Caterson I, Sambrook P, Fransen M, March L. The impact of obesity on the musculoskeletal system. Int J Obes (2005) 2008;32(2):211–222. doi: 10.1038/sj.ijo.0803715.
    1. Gerhart JI, Burns JW, Post KM, Smith DA, Porter LS, Burgess HJ, Schuster E, Buvanendran A, Fras AM, Keefe FJ. Relationships between sleep quality and pain-related factors for people with chronic low Back pain: tests of reciprocal and time of day effects. Ann Behav Med. 2017;51(3):365–375. doi: 10.1007/s12160-016-9860-2.
    1. McCracken LM. Social context and acceptance of chronic pain: the role of solicitous and punishing responses. Pain. 2005;113(1–2):155–159. doi: 10.1016/j.pain.2004.10.004.
    1. Suri P, Morgenroth DC, Kwoh CK, Bean JF, Kalichman L, Hunter DJ. Low Back pain and other musculoskeletal pain comorbidities in individuals with symptomatic osteoarthritis of the knee: data from the osteoarthritis initiative. Arthritis Care Res. 2010;62(12):1715–1723. doi: 10.1002/acr.20324.

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