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This study aimed to adapt and validate the Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ) for Chinese patients, thereby advancing the understanding of fear-avoidance behaviors. Adopting a cross-sectional design, data were collected for 241 subjects (78.8% women; mean age 68.0 ± 7.8 years) across various healthcare settings in Hong Kong. Exploratory factor analysis resulted in an 11-item questionnaire with three distinct subscales, covering fears and beliefs related to physicians and disease (six items), daily living activities (three items), and sports and leisure activities (two items). The overall Cronbach's α coefficient was 0.86, indicating strong internal consistency. The questionnaire exhibited favorable convergent validity. Confirmatory factor analyses confirmed a good model fit. Test-retest reliability analysis indicated a high intraclass correlation coefficient of 0.93 (95% confidence interval: 0.88, 0.96), and a Bland-Altman plot revealed a slight bias in two measurements (0.97 [0.19]) without a systematic trend. The adapted Chinese version of the KOFBeQ demonstrated robust psychometric properties in terms of validity and reliability, providing an effective tool for surveying Chinese patients with knee osteoarthritis. These findings offer valuable insights for clinicians and patients, aiding in informed decision-making and improved rehabilitation strategies.

Virtual reality (VR) has the potential to help clinical medicine manage generalized anxiety disorder (GAD). However, patients with GAD who use traditional head-mounted VR to cycle may cause them to feel motion sickness and fatigue. To solve this problem, a projection-based virtual environment (VE) system was built to provide GAD patients with a sense of immersion while they are cycling. This projection-based VE system allows patients with GAD to interact with the virtual environment and produce experiences similar to cycling in the outdoors. Sixty GAD patients met several screening criteria and were selected as participants. All participants were randomly assigned to one of the two 20-min conditions: (1) Observing watercolor paintings projected by the projector while engaged in cycling with a stationary bicycle; or (2) observing the scenes (i.e., forest or park) projected by the VE system and engaging in cycling with a stationary bicycle. Finally, this study confirmed that patients with GAD in the projection-based VE group exhibited higher alpha values and lower galvanic skin responses (GSR) after cycling than those cycling in the control group. These results showed that cycling in the projection-based VE group allowed the patient with GAD to achieve higher exercise intensity and lower perceived emotional stress.