Knee osteoarthritis (OA) is a common cause of joint pain and stiffness. And although physical activity is known to relieve symptoms, only one in 10 people exercise regularly.
Understanding what contributes to patient inactivity is the goal of a world-first study from the University of South Australia. Here, researchers have found that people with knee OA subconsciously believe that activity can be dangerous for their condition, despite medical advice telling them otherwise.
The study found that of those surveyed, 69% of people with knee pain had stronger implicit (unconscious) beliefs that exercise was dangerous than the average person without pain.
It’s an interesting finding that not only highlights the conflicting nature of pain and exercise, but also that what people say and what they think, deep down, may be completely different things.
Principal investigator and SAHMRI-based UniSA PhD candidate Brian Pulling says the research provides valuable information for clinicians treating people with knee OA.
“Research shows that physical activity is good for people with knee OA, but most people with this condition do not move enough to maintain overall or joint health,” Pulling says.
“To understand why people with OA might not be active, research studies often use questionnaires to assess fear of moving. But unfortunately, questionnaires are limited: what we feel deep down (and how our system naturally reacts to it). something that is threatening) may be different than what we reported and we still know that many people avoid exercise, so we wanted to know why.
To assess this, the researchers developed a tool that can detect and assess people’s implicit beliefs about exercise; that is, if they unconsciously think that the activity is dangerous for their condition.
“We found that even among those who said they were not afraid of exercise, they had unconscious beliefs that movement was dangerous,” Pulling says.
“Our research shows that people have complicated beliefs about exercise and will sometimes say one thing if asked directly, but have a completely different implicit belief.
“People are not aware that what they say does not match what they choose for the new task; they are not misrepresenting their beliefs.
“This research suggests that to fully understand how someone feels about an activity, we need to go beyond simply asking directly, because their implicit beliefs can sometimes be a better predictor of actual behavior than what people report. That’s where our tool It is useful”.
The online implicit association test presents a series of words and images that a participant must quickly associate with safety or danger. The tool intentionally promotes instant responses to avoid deliberation and other influencing factors (such as responding how they think they should respond).
Associate Professor Tasha Stanton says the new tool has the potential to identify a group of people who may have difficulty increasing their activity levels and exercising.
“What people say and what they do are often two different things,” says Associate Professor Stanton.
“Having access to more accurate and insightful information will help healthcare professionals better support their patients in engaging in activities and exercises. It may also open up opportunities for education about pain science, exposure-based therapy or “cognitive functional therapy…things that normally wouldn’t be considered for someone who said they weren’t afraid to exercise.”
The researchers are now looking to see if implicit beliefs are directly associated with behavior and are asking people to complete the Implicit Association Test (it takes seven minutes). At the end of the test, participants receive their results compared to the rest of the population.
To take the test, click here: https://unisasurveys.qualtrics.com/jfe/form/SV_0OZKUqzBNtiKGF0