Association between patient-reported disease understanding assessed during rehabilitation and long-term outcomes in patients with knee osteoarthritis: a retrospective observational cohort study

Abstract

Abstract Background Patient education is a core component of conservative management for knee osteoarthritis; however, patients’ understanding of their condition may change during rehabilitation as they receive repeated explanations and gain experience applying rehabilitation strategies in daily life. This study investigated whether patient-reported disease understanding assessed during rehabilitation was associated with 1-year clinical outcomes in patients with knee osteoarthritis. Methods This retrospective observational cohort study analyzed longitudinal clinical data collected during routine care from patients with knee osteoarthritis. Patient-reported disease understanding was assessed at baseline and 3 months, and clinical outcomes were evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS). The primary outcome was improvement in the KOOS5 composite score from baseline to 1 year, calculated as the arithmetic mean of the five KOOS subscale scores. Multiple linear regression analysis was performed to explore the association between patient-reported disease understanding and 1-year improvement in the KOOS5 composite score. Results In the primary multivariable model, greater patient-reported disease understanding at 3 months was positively associated with improvement in the KOOS5 composite score at 1 year, although the association was not statistically significant (B = 5.51, 95% CI − 1.20 to 12.23, P = 0.104). Adjustment for Kellgren–Lawrence grade produced a similar coefficient (B = 5.38), whereas additional adjustment for age attenuated the association (B = 4.46). The individual KOOS subscale analyses were considered exploratory; the nominally significant association observed for the Pain subscale was not statistically significant after correction for multiple comparisons. Conclusions Patient-reported disease understanding assessed at 3 months was positively associated with 1-year improvement in the KOOS5 composite score, although the association was not statistically significant. These exploratory findings should be considered hypothesis-generating and do not establish an independent or causal relationship between patient-reported disease understanding and clinical improvement. Larger prospective studies using validated measures of patient understanding are warranted. Clinical trial number Not applicable.

The authors' abstract, as published at the source. BMC Musculoskeletal Disorders, 2026 · DOI ↗