Physiological Impact of Different Types of Osteoarthritis Education.

age, sex, gender, education, marital status, race, height, and weight

Quantitative sensory testing in the form of mechanical temporal summation will be conducted to assess central nervous system sensitivity. We will use a 512mN weighted probe applied at the volar wrist opposite to the index knee (or least painful knee). It will be applied once and participants will be asked to rate their pain between 0 and 100.(16,17) Then, the same stimulus is applied 10 times at the rate of 1 per second and they are asked again to rate their pain. TS is defined as being present when, compared with the initial trial, the participant reports increased pain following the second trial.(16) This method has been used in many patient populations(18) including people with knee OA.(19)

Participants will be seated 63-65cm away from the display, which is the optimal distance determined by Tobii. Participants will be asked to fixate and follow with their gaze a red circle moving on the screen. The Tobii X2-60 Eye Tracker is an unobtrusive eye tracker for detailed research of natural eye gaze behavior. It is a standalone remote device (no contact with the participant) that is attached to the display. The tracker uses infrared diodes or LEDs to generate reflection patterns on the corneas of the participants' eyes. These reflection patterns, together with other visual data about the participants, are collected by the device's image sensors (at 60 Hz, or data points per second), and allows it to accurately calculate the participants' gaze point with high temporal and spatial precision. Its large head movement box allows the subject to move during recording while maintaining accuracy and precision.

Reciprocal of the measure of how much resistance the skin of an organism in a state of rest or basal activity offers to passage of an electrical current. For each participant only 2 electrodes are required at either of the locations indicated in the graphic. We will only be using locations 1-4 or 9-10 depending on which provides the best signal to noise ratio for each experimental task after pilot testing. Used with EL507 disposable snap electrodes that are designed for electrodermal activity studies and are pre-gelled with isotonic gel. The latex-free electrodes conform and adhere well to the body. The conductive gel used is medically approved BIOPAC non-irritating, isotonic Gel 101. It has the following components: Cetyl Alcohol #697313, Glycerol Monostearate, Lanolin, USP Anhydrous, Dimenthicon Silicone TBF9-1000, Water, purified USP Sodium Chloride, Sodium Lauryl Sulfate, Sorbitol, 70 USP, Methylparaben, Propylparaben, Quaternium-15

ECG data will be collected with participants in a seated position to minimize potential parasympathetic saturation. Participants will be instructed to maintain regular sleep, avoid alcohol, and physical exercise within 24 hours of the visit. Participants will also empty their bladders before the session. Data acquisition will be performed using BIOPAC MP160 equipment. Participants will be instructed to remain motionless and silence throughout this period. Lead II will be chosen for data recording due to its anticipated higher R peak compared to leads I and III. Electrode placement will involve connecting the positive terminal to the lower left rib, the negative terminal to the right clavicle and grounding to the lower right rib. Heart Rate Variability (HRV) will be assessed using the Acqknowledge software, which is attached to the BioPac system (MP160, USA).

To monitor respiration, a strain gauge respiration belt (BIOPAC SS5LB; BIOPAC Systems Inc., Coletta, CA, USA) will be positioned at the midpoint between the navel and xiphoid process. The acquired respiration rate data from the belt will be transmitted to the acquisition system and analyzed using AcqKnowledge software version 5.0.

A small training task will be utilized to familiarize the participants with the experimental procedure, get them comfortable with the lab environment and to establish a baseline for each participant. Participants will be given instructions for the task, the outcome of this task will have no effect on the study findings.

The Self-Efficacy for Managing Chronic Disease 6-item scale (SEMCD-6) will be used to measure self-efficacy for chronic pain sufferers, with higher reported scores indicating higher self-efficacy.(21) Items are measured on a 0-10 scale with higher scores indicating higher self-efficacy. The SEMCD-6 has reported to have high internal consistency (Chronbach alpha of 0.88), sensitive to change, with significant correlations with other health outcomes.(22)

The anxiety sub-scale of the Hospital Anxiety and Depression Scale (HADS) will be used to assess anxiety.(23) The HADS consists of 7 questions to measure anxiety with higher scores representing increased severity in anxiety symptoms. Each item is rated on a 4-point scale (ranging from 0 = no not at all, to 3 = yes definitely), for a total score ranging from 0-21. Two items are reverse scored (ranging from 3 = no not at all, to 0 = yes definitely). It is a brief and reliable measure of emotional distress in general in chronic populations including chronic pain and rheumatology.(24) Average sensitivity and specificity is ≥ 0.80.(24)

The Brief Fear of Movement Scale for Osteoarthritis (BFMSO) will be used to assess activity avoidance of participants due to pain-related fear of movement.(25) The BFMSO has 6 items that are derived from the Tampa Scale for Kinesiophobia (TSK) and uses a 4-point Likert scale with higher values indicating higher levels of kinesiophobia.(25) The BFMSO has adequate convergent validity with measures of pain (β=.30 to .41), physical functioning (β=.44 to .48), and psychological functioning (β=.36 to .37).(25)

The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a knee-specific instrument, used to assess self-reported opinions about patients' knee and associated problems, while evaluating short-term and long-term consequences of knee injury. There are 42 items in 5 scored sub scales, of which two will be used: 1) pain, and 2) function in daily living (ADL). Scores range from 0-100 with zero representing extreme knee problems and 100 representing no knee problems.(26) KOOS has adequate internal consistency (0.70-0.95) and construct validity in adults with knee OA.(27) Multiple studies have determined convergent and divergent construct validity with comparison to several instruments including the subscales of SF-36 and the Lysholm knee scoring scale.(28)

Electronic health literacy was defined initially as "the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem" (p.2)(29). One of the measures of electronic health literacy is eHEALS. It comprises 8 items and respondents rate each item on a 5-point Likert Scale spanning from 1 (strongly disagree) to 5 (strongly agree). The higher value in each item represents a greater perception of eHealth literacy (30). eHEALS has adequate internal consistency (α = .94) and validity in adults with knee OA(31).

The Osteoarthritis Conceptualization Questionnaire (OACQ) aims to explore individuals' perspectives on osteoarthritis and physical activity through a set of statements. Respondents are instructed to express their agreement or disagreement on a scale ranging from "Strongly Disagree=1" to "Strongly Agree=5." The questionnaire is divided into four sections: Influence of Variables, Physiology, Expectations, and Conceptual Change. Each section involves specific items, and some require reverse scoring. The OACQ demonstrates good test-retest reliability (ICC(3,1)= 0.89). Measures of convergent validity revealed a moderate correlation with other related scales.

The Intention to Exercise scale involves three key questions: "I am committed to engage in physical activity over the next 2 weeks"; "I am motivated to engage in physical activity over the next 2 weeks" and "I am determined to engage in physical activity over the next 2 weeks"(32) . Participants are asked to rate their agreement on a 7-point Likert scale, ranging from "very strongly disagree" to "very strongly agree," This scale offers an understanding of participants' intentions and attitudes towards incorporating physical activity into their lives(33).

The surgery intention scale aimed to assess individuals' inclination toward knee joint replacement surgery. The responses, ranging from 'Yes,' 'No,' to 'Unsure,' provide valuable data on immediate surgery acceptance. This scale offers a comprehensive understanding of participants' attitudes and intentions regarding this specific surgical intervention (6).

The self-administered comorbidity questionnaire (SCQ) is a highly effective tool for evaluating comorbid conditions in both clinical and health services research. The SCQ is brief, easy to understand, and can be completed by individuals without a medical background. It allows patients to indicate the severity of each comorbid condition and how it affects their daily functioning. The questionnaire includes 12 specific medical problems and 3 optional conditions. The SCQ shows modest correlations with a commonly used medical record-based comorbidity tool and with future health status and utilization.

Satisfaction with information quality aims to capture respondents' views regarding the overall quality of information on a website using a 7-point Likert scale. Participants are prompted to assess their satisfaction levels across four dimensions: "Very dissatisfied" to "Very satisfied" (IQ1), "Very displeased" to "Very pleased" (IQ2), "Frustrated" to "Contented" (IQ3), and "Disappointed" to "Delighted" (IQ4). This comprehensive approach enables an understanding of users' perspectives on the quality of information available. This questionnaire demonstrated Adequate reliability. (Cronbach alpha>0.97)