Network analysis of pain, kinesiophobia, social participation and knee function in patients after total knee arthroplasty from an ethical equity perspective
10.3969/j.issn.1006-9771.2026.03.013
- VernacularTitle:全膝关节置换术后患者疼痛、运动恐惧、社会参与与膝关节功能的关系：基于伦理公平性视角下的网络分析
- Author:
Zhiwei WANG
1
;
Lijun MENG
2
;
Yu WU
1
;
Jian LIU
1
;
Zhaojin DA
1
;
Zeping YAN
3
;
Shicai WU
2
Author Information
1. School of Nursing and Rehabilitation, University of Shandong, Ji'nan, Shandong 250012, China
2. Beijing Bo'ai Hospital, China Rehabilitation Research Centre, Beijing 100068, China
3. Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong 250021, China
- Publication Type:Journal Article
- Keywords:
total knee arthroplasty;
knee function;
pain;
kinesiophobia;
social participation;
ethical equity;
network analysis
- From:
Chinese Journal of Rehabilitation Theory and Practice
2026;32(3):364-372
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo explore the complex network relationships among pain, kinesiophobia, social participation and knee function in patients after total knee arthroplasty (TKA), and to analyze the moderating effects of different socio-structural factors on the rehabilitation network from an ethical equity perspective. MethodsA convenience sampling method was used to select 291 patients who underwent TKA in Qilu Hospital of Shandong University from May to July, 2023. Pain was assessed using Numerical Rating Scale, kinesiophobia with Chinese short version of the Tampa Scale for Kinesiophobia, social participation with Impact on Participation and Autonomy Questionnaire, and knee function with Hospital for Special Surgery Knee Score. A partial correlation network among pain, kinesiophobia, social participation and knee function was constructed using Graphical Least Absolute Shrinkage and Selection Operator. Key variables were identified through node centrality and bridge centrality analysis. Network Comparison Tests (NCT) were used to analyze network differences among subgroups based on different socio-structural characteristics. ResultsIn the network model, the nodes with the highest strength centrality were indoor participation, activity behavior and activity pain. Bridge centrality analysis indicated that activity pain, knee function, indoor participation and activity cognition were key bridge nodes. NCT revealed no significant differences in overall network structure or global strength among subgroups based on residence, education level or payment method (P > 0.05). However, significant differences in edge weights were found for specific edges such as activity cognition-activity behavior and knee function-indoor participation (P < 0.05). ConclusionThere is a network of interactions among pain, kinesiophobia, social participation and knee function in patients after TKA, with nodes such as indoor participation and activity pain playing key roles in the rehabilitation process. Although the overall rehabilitation network is similar across different socio-structural groups, variations exist in specific relational pathways among patients from rural areas, those with lower education levels, and those with out-of-pocket payment. This suggests that clinical rehabilitation interventions should focus on these core nodes and implement targeted support strategies for socio-structurally disadvantaged groups to promote rehabilitation equity.
