Association of kinesiophobia with pain, disability and functional limitation in adults with knee osteoarthritis: A systematic review and meta-analysis

•Kinesiophobia correlates moderately with disability in knee osteoarthritis (OA) patients (r = 0.516).•Fair correlations were found between kinesiophobia and pain (r = 0.362) and functional limitation (r = 0.270) in knee OA.•Comprehensive meta-analysis reveals significant associations between kinesiophobia and knee OA symptoms.•Despite high heterogeneity, the certain of evidence is low to moderate. Knee osteoarthritis (KOA) is a prevalent degenerative joint disease associated with pain, disability, and functional limitations. Kinesiophobia, the fear of movement, has been linked to disability and pain in KOA patients. This study aimed to analyze the relationship between kinesiophobia and symptoms of KOA. A comprehensive literature search was conducted in four electronic databases (PubMed/Medline, Web of Science, Scopus and Science Direct) with the following inclusion criteria: 1) recruited participants with diagnostic of knee osteoarthritis; 2) measures of pain, disability and/or functional limitation through questionnaires or physical tests; 3) articles exploring the correlation between kinesiophobia, and pain, disability, and/or functional limitation as principal or secondary outcome; 4) primary data studies (observational and experimental). A total of 17 studies involving 1,574 participants (mean age 61.04 ± 5.79 years) were included in the corresponding meta-analyses. Results showed a moderate correlation between kinesiophobia and disability (r = 0.519; p-value=0.004), and fair correlations of kinesiophobia with pain (r = 0.362; p-value