Association of knee joint position sense error with kinesiophobia, body awareness, balance confidence, and central sensitization-related symptoms in knee osteoarthritis: A cross-sectional study

Knee osteoarthritis is frequently accompanied by impaired proprioception, but whether proprioceptive error is independently related to psychosocial and functional status remains unclear. This cross-sectional study examined the unadjusted and adjusted associations between knee joint position sense (JPS) error and kinesiophobia, body awareness, balance confidence, and central sensitization-related symptom burden in 50 patients with knee osteoarthritis recruited from a single outpatient clinic between January and June 2026. JPS was quantified as the absolute angular error at 30° and 60° of knee flexion using a smartphone-based digital inclinometer application. Kinesiophobia, body awareness, balance confidence, and central sensitization-related symptoms were assessed with the Tampa Scale for Kinesiophobia, the Body Awareness Questionnaire, the Activities-specific Balance Confidence Scale, and the Central Sensitization Inventory Part A, respectively. Associations were examined using Spearman's rank correlation coefficient, with Holm–Bonferroni correction applied to control for multiple comparisons, alongside rank-based partial correlations adjusted for age, sex, activity-related pain, and body mass index. Participants had a mean age of 64.38±7.77 years, and 76% were women. In unadjusted analyses, the absolute angular error at 30° (AAE30) correlated moderately with kinesiophobia (rs=0.56, 95% CI 0.33–0.72, pHolm0.05). After adjustment for age, sex, activity-related pain, and body mass index, none of these associations remained statistically significant (partial rs range -0.16 to 0.26, all pHolm>0.05). These findings suggest that the raw associations between proprioceptive error and psychosocial measures in knee osteoarthritis may partly reflect shared confounding rather than an independent relationship. Given the cross-sectional design and limited sample size, these findings should be regarded as hypothesis-generating: proprioceptive assessment alone may be insufficient to capture kinesiophobia- or balance-related outcomes, and multicomponent management addressing pain, body weight, and fear-avoidance beliefs alongside proprioceptive training warrants evaluation in adequately powered, longitudinal studies.