This study revealed that the social support and pain score from KOA was 18.73 ± 5.65, which is higher than that of Ma et al.[44] on patients with infratemporal joint disorders. Spanish seniors also have a high level of social support[45–46]. The reason may be that the elderly have more time and energy to communicate with their friends and family after retirement, express their feelings, and get responses from others, thereby increasing their social support. Most older adults in Malaysia also perceive a higher level of social support [47]. However, in a study of Mexico, social support was found to be lower among older adults [48]. Literacy and lifestyle affect the social support of older adults in different countries. Therefore, when medical staff intervenes in clinical interventions on elderly pain patients, they should also interfere with their surrounding family members; not only should the health education of the patients be strengthened, but also the psychological care and communication skills of their family members should be strengthened. Good interaction and communication skills can make the patient feel happy and relieve the pain caused by the disease.
In this study, the self-perceived burden score of elderly KOA patients was 31.18 ± 8.70, which is at a moderate burden level, which is consistent with the research results of Ren et al. [49]. The high cost of medicine and the lack of social resources are among the factors that affect patients' self-perceived burden[50]. The reason may be that the disease brings not only the consumption of external substances to the patient but also the increasing physical and mental torture, which makes the patient suffer from an increase in self-burden during the diagnosis and treatment process. The self-perceived burden can regulate the quality of life of patients [51]. The study found that the use of Motivational Interviewing(MI) was effective in reducing patients' self-perceived burden[52]. From this point of view, medical workers should discover the patient’s negative emotions as early as possible in their work, provide timely help, unblock the patient’s thoughts, and reduce the burden of self-feeling.
TSK-11 is a concise scale with strong generalization ability and is widely used by the public. It has a similar evaluation function with TSK-17, but its accuracy is not lower than TSK-17. The survey showed that the kinesiophbia score of elderly KOA patients was 29.04 ± 7.11. The incidence of kinesiophbia was 57.89%, which was slightly higher than the survey results of Kocic et al. [53]on patients with total knee arthroplasty (21.8%), but lower than the results of the study of patients with degenerative cervical disc disease (81.5%) [54]. The prevalence of kinesiophbia in a survey of patients with ankylosing spondylitis in Turkey was 66.6% [55]. The reason may be that it may be different from the living environment at home and abroad, and the elderly are in a period of decline in life, their physical abilities are in a decline stage, and the fear of pain is transformed into a behavioral fear of activity, that is, kinesiophbia. Medical staff should pay attention to elderly patients with long-term pain, let them correctly understand the pain, positively respond to the pain, teach patients how to reduce pain, and take adequate measures to help patients reduce the occurrence of kinesiophbia.
The results of this study show that the pain social support scores of elderly KOA patients are significantly negatively correlated with the panic disorder scores(r=-0.368,p<0.01). That is, the higher the level of social support for pain, the lower the degree of panic disorder, which is consistent with the results of Luque et al. [56]. Social support and self-efficacy have a positive impact on patients and can improve health status[57]. After receiving support and encouragement from friends, elderly KOA patients can actively perform rehabilitation exercises and calmly overcome the fear of pain. The score of self-perceived burden is positively correlated with the score of kinesiophbia (r = 0.605, p < 0.01), that is, the heavier the burden of self-perceived, the higher the level of kinesiophbia, which is consistent with the results of Sun et al. [58]. When the patient's physical and mental burden is too heavy, it will further produce negative emotions and loss of confidence and motivation in life, which induces kinesiophbia. Pain social support is negatively correlated with the self-perceived burden (r=-0.297, p < 0.01), that is, the higher the satisfaction with social support, the lighter the patient’s self-perceived burden, which is consistent with the results of Hill et al. [23]. Adequate social support can enable patients to open up and communicate well with the outside world. Caregivers of the elderly are less burdened as social support increases[59]. Good feedback from relatives and friends can also help patients reduce their burden.
The hierarchical regression results showed that when SPQ and SPBS were placed in the second layer, the adjusted R216.7% was increased from 43.2–43.2%, and the degree of explanation of the regression equation for kinesiophbia increased by 26.5%. It suggests that the lower the patient's kinesiophbia level, the more social support the individual receives, and the less burden he bears, which is more conducive to later rehabilitation training.
The results of this study show that education level, marital status, understanding of the condition, and pain level are the influencing factors for the occurrence of kinesiophbia in elderly patients with KOA. The higher the education level, the lower the level of kinesiophbia, which is consistent with the research results of Cai et al. [60]. The reason may be that patients with a low level of education have insufficient understanding and cognition of knowledge about disease treatment and rehabilitation, and fear that activities will cause further physical harm. Therefore, medical staff should teach patients with lower education levels simply and clearly, so that they can better understand the importance of exercise for rehabilitation. Studies have shown that widowed patients have a higher level of panic disorder than married patients. It is possible that in life with the elderly, the primary companion is the spouse. The care and support provided by the spouse in life can reduce the patient's fear of activities and facilitate future recovery. The dynamic process of coping with agoraphobia in patients with myocardial infarction was found to include kin anxiety, and the presence of family members can lead to a different direction of disease development[61]. n clinical work, more attention should be paid to patients who lack long-term companions, and help and care should be given in life to reduce the level of kinesiophbia.
The more you understand the condition, the higher the level of panic disorder. After the patient understands his illness and physical condition, he can accurately assess his physical function, make behaviors in line with his abilities, and not excessively perform activities to aggravate the condition. It can be seen that medical staff should carry out different health education for different older people, and develop effective exercise plans for their physical conditions so that patients can recover as soon as possible. The more severe the pain, the higher the degree of kinesiophbia, which is consistent with the findings of Larsson et al. [62]. The possible reason is that the heavier the pain felt by the patient, which promotes the fear of movement and the deviation of the individual's behavioral cognition, resulting in a higher level of kinesiophbia. The study points out that pain and exercise, fear of injury are the antitheses[42]. Pain level has a strong relationship with the attendance of caregivers suffering from low back pain [63]. Therefore, medical workers should take intervention measures for patients with severe pain as soon as possible to reduce their fear of exercise, enhance their confidence in fighting pain, and improve their quality of life.
Limitations
This study only conducted a cross-sectional survey of two hospitals in Jinzhou City, Liaoning Province. The number and scope of the survey subjects have certain limitations. The survey scope can be expanded for further research in the future.