The effects of motivational interviewing and mindfulness interventions combined with six weeks of neuromuscular exercises on pain-related neurofeedback, balance, and kinesiophobia in women with knee osteoarthritis: A randomized controlled trial

Background and aims: Chronic pain from knee osteoarthritis (KOA) induces adverse changes in the central and peripheral nervous systems, negatively impacting patients’ cognitive function and diminishing their psychological and physical well-being. This study aimed to investigate the effects of neuromuscular exercises combined with motivational interviewing and mindfulness on pain, balance, kinesiophobia, quality of life (QOL), and gait patterns in patients with KOA. Methods: Sixty patients with KOA were randomly assigned to three groups: Motivational Interviewing (n=20), Mindfulness (n=20), and a control group (n=20). All groups performed neuromuscular exercises. Outcomes were assessed before and after six weeks and included pain (primary outcome) measured by the Visual Analog Scale, QOL assessed by the SF-36, kinesiophobia evaluated using the Tampa Scale, balance measured by the Berg Balance Scale, and gait analyzed with a plantar pressure measurement device (secondary outcomes). Results: All groups showed significant improvements in pain, balance, kinesiophobia, and gait patterns after six weeks (p < 0.05). After adjusting for baseline scores, inter-group comparisons revealed that the Motivational Interviewing group experienced significantly greater improvements in pain (p = 0.0001), kinesiophobia (p = 0.02), balance (p = 0.002), and QOL (p = 0.02) compared to the Mindfulness group. Conclusion: This study indicates that integrating psychological interventions - especially motivational Interviewing - with the physical benefits of neuromuscular exercises can more effectively reduce pain severity in KOA patients.