Negative attitudes/beliefs surrounding osteoarthritis, pain, and activity contribute to reduced physical activity in people with knee osteoarthritis (KOA). These attitudes/beliefs are assessed using self-report questionnaires, relying on information one is consciously aware of and willing to disclose. Automatic (ie, implicit) assessment of attitudes does not rely on conscious reflection and may identify features unique from self-report. We developed an implicit association test that explored associations between images of a person moving/twisting their knee (activity) or sitting/standing (rest), and perceived threat (safe vs dangerous). We hypothesised that people with KOA would have greater implicit threat-activity associations (vs pain-free and non-knee pain controls), with implicit attitudes only weakly correlating with self-reported measures (pain knowledge, osteoarthritis/pain/activity beliefs, fear of movement). Participants (n = 558) completed an online survey: 223 had painful KOA (n = 157 female, 64.5 ± 8.9 years); 207 were pain free (n = 157 female, 49.3 ± 15.3 years); and 99 had non-KOA lower limb pain (n = 74 female, 47.5 ± 15.04 years). An implicit association between "danger" and "activity" was present in those with and without limb pain (KOA: 0.36, 95% CI 0.28-0.44; pain free: 0.13, 95% CI 0.04-0.22; non-KOA lower limb pain 0.11, 95% CI -0.03 to 0.24) but was significantly greater in the KOA group than in the pain free (P < 0.001) and non-KOA lower limb pain (P = 0.004) groups. Correlations between implicit and self-reported measures were nonsignificant or weak (rho = -0.29 to 0.19, P < 0.001 to P = 0.767). People with painful KOA hold heightened implicit threat-activity associations, capturing information unique to that from self-report questionnaires. Evaluating links between implicit threat-activity associations and real-world behaviour, including physical activity levels, is warranted.

中文翻译：

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患有疼痛性膝骨关节炎的人对活动持有消极的内隐态度。

围绕骨关节炎、疼痛和活动的消极态度/信念会导致膝骨关节炎 (KOA) 患者的体力活动减少。这些态度/信念是通过自我报告问卷进行评估的，依赖于人们有意识地了解并愿意披露的信息。自动（即隐式）态度评估不依赖于有意识的反思，并且可以从自我报告中识别出独特的特征。我们开发了一种隐式关联测试，探索一个人移动/扭转膝盖（活动）或坐着/站立（休息）的图像与感知威胁（安全与危险）之间的关联。我们假设患有 KOA 的人会有更大的隐性威胁活动关联（与无痛和非膝盖疼痛控制相比），隐性态度仅与自我报告的测量（疼痛知识、骨关节炎/疼痛/活动信念、恐惧）微弱相关。的运动）。参与者 (n = 558) 完成了一项在线调查：223 人患有疼痛性 KOA（n = 157 名女性，64.5 ± 8.9 岁）； 207 名患者无疼痛（n = 157 名女性，49.3 ± 15.3 岁）； 99 名患有非 KOA 下肢疼痛（n = 74 名女性，47.5 ± 15.04 岁）。在有或没有肢体疼痛的患者中，“危险”和“活动”之间存在隐含关联（KOA：0.36，95% CI 0.28-0.44；无痛：0.13，95% CI 0.04-0.22；非 KOA 下肢疼痛0.11，95% CI -0.03 至 0.24），但 KOA 组显着高于无痛组（P < 0.001）和非 KOA 下肢疼痛组（P = 0.004）。隐性测量和自我报告测量之间的相关性不显着或较弱（rho = -0.29 至 0.19，P < 0.001 至 P = 0.767）。患有痛苦的 KOA 的人持有高度的隐性威胁活动关联，从自我报告问卷中获取独特的信息。有必要评估隐性威胁活动关联与现实世界行为（包括身体活动水平）之间的联系。