Kinesiophobia in chronic musculoskeletal pain

NewsBot · Apr 13, 2019

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Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review
Alejandro Luque-Suarez et al
Br J Sports Med 2019;53:554-559.

Objective (1) To explore the level of association between kinesiophobia and pain, disability and quality of life in people with chronic musculoskeletal pain (CMP) detected via cross-sectional analysis and (2) to analyse the prognostic value of kinesiophobia on pain, disability and quality of life in this population detected via longitudinal analyses.

Design A systematic review of the literature including an appraisal of the risk of bias using the adapted Newcastle Ottawa Scale. A synthesis of the evidence was carried out.

Data sources An electronic search of PubMed, AMED, CINAHL, PsycINFO, PubPsych and grey literature was undertaken from inception to July 2017.

Eligibility criteria for selecting studies Observational studies exploring the role of kinesiophobia (measured with the Tampa Scale for Kinesiophobia) on pain, disability and quality of life in people with CMP.

Results Sixty-three articles (mostly cross-sectional) (total sample=10 726) were included. We found strong evidence for an association between a greater degree of kinesiophobia and greater levels of pain intensity and disability and moderate evidence between a greater degree of kinesiophobia and higher levels of pain severity and low quality of life. A greater degree of kinesiophobia predicts the progression of disability overtime, with moderate evidence. A greater degree of kinesiophobia also predicts greater levels of pain severity and low levels of quality of life at 6 months, but with limited evidence. Kinesiophobia does not predict changes in pain intensity.

Summary/conclusions The results of this review encourage clinicians to consider kinesiophobia in their preliminary assessment. More longitudinal studies are needed, as most of the included studies were cross-sectional in nature.
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Admin2 · Apr 13, 2019

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NewsBot · Jan 25, 2020

Kinesiophobia and Pain Intensity Are Increased by a Greater Hallux Valgus Deformity Degree- Kinesiophobia and Pain Intensity in Hallux Valgus.
Palomo-López P et al
Int J Environ Res Public Health. 2020 Jan 18;17(2)

BACKGROUND:
Hallux valgus (HV) has been previously associated with psychological disorders. Thus, the purposes of this study were to associate kinesiophobia and pain intensity with HV deformity degrees, as well as predict kinesiophobia and pain intensity based on HV deformity and demographic features.

METHODS:
A cross-sectional study was carried out recruiting 100 subjects, who were divided into HV deformity degrees, such as I-no HV (n = 25), II-mild (n = 25), III-moderate (n = 25), and IV-severe (n = 25) HV. Kinesiophobia total and domains (activity avoidance and harm) scores and levels were self-reported by the Tampa Scale of Kinesiophobia (TSK-11). Pain intensity was self-reported by the numeric rating scale (NRS).

RESULTS:
Statistically significant differences (p < 0.01; η2 = 0.132-0.850) were shown for between-groups comparison of kinesiophobia total and domain scores (activity avoidance and harm) and levels, as well as pain intensity among HV deformity degrees. Post hoc comparisons showed statistically significant differences with a large effect size (p < 0.05; d = 0.85-4.41), showing higher kinesiophobia symptoms and levels and pain intensity associated with greater HV deformity degrees, especially for III-moderate and/or IV-severe HV deformity degrees versus I-no HV and/or II-mild deformity degrees. Both statistically significant prediction models (p < 0.05) for kinesiophobia (R2 = 0.300) and pain intensity (R2 = 0.815) were predicted by greater HV deformity degree and age.

CONCLUSIONS:
Greater kinesiophobia symptoms and levels and pain were associated with higher HV deformity degrees, especially severe and/or moderate HV with respect to no and/or mild HV. The kinesiophobia and pain intensity were predicted by greater HV deformity degree and age.
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NewsBot · Feb 2, 2020

Fear Avoidance Beliefs and Kinesiophobia Are Presented in Athletes who Suffer from Gastrocnemius Chronic Myofascial Pain
Marta San-Antolín, MSc, PSYCH, David Rodríguez-Sanz, PhD, MSc, PT, DP, Davinia Vicente-Campos, PhD, MSc, PT, Patricia Palomo-López, PhD, MSc, DP, Carlos Romero-Morales, PhD, MSc, PT, María Benito-de-Pedro, PhD, MSc, PT, DP, Daniel López-López, PhD, MSc, DP, César Calvo-Lobo, PhD, MSc, PT
Pain Medicine, pnz362, https://doi.org/10.1093/pm/pnz362
Published: 31 January 2020

Objective
To compare and predict kinesiophobia and fear avoidance beliefs between athletes with gastrocnemius myofascial pain syndrome (MPS) and healthy athletes.

Design
Case–control.

Setting
Outpatient clinic.

Subjects
Fifty athletes were divided into athletes with chronic gastrocnemius MPS (N = 25) and healthy athletes (N = 25).

Methods
Kinesiophobia symptoms total and domain scores (harm and activity avoidance) and levels were determined by the Tampa Scale of Kinesiophobia (TSK-11). Fear avoidance beliefs total and domain scores (physical and working activities) were measured by the Fear Avoidance Beliefs Questionnaire (FABQ).

Results
Significant differences (P < 0.05) with a large effect size (d = 0.81–4.22) were found between both groups, with greater kinesiophobia symptom scores for the TSK-11 activity avoidance domain and total scores, and greater fear avoidance beliefs scores for the FABQ physical and working activities domains and total scores of athletes with gastrocnemius MPS with respect to healthy athletes. TSK-11 total score showed a prediction model (R2 = 0.256) based on the FABQ total score. The FABQ total score showed a prediction model (R2 = 0.741) based on gastrocnemius MPS presence (R2 = 0.665), levels of kinesiophobia (R2 = 0.052), and height (R2 = 0.025).

Conclusions
Greater kinesiophobia levels, greater total and activity avoidance domain scores (but not for the harm domain), and greater fear avoidance beliefs total and domain scores (work and physical activity) were shown for athletes with gastrocnemius MPS vs healthy athletes. Higher kinesiophobia symptoms were predicted by greater fear avoidance beliefs in athletes. Greater fear avoidance beliefs were predicted by the presence of gastrocnemius MPS, higher levels of kinesiophobia, and lower height in athletes.
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NewsBot · Oct 4, 2020

Comparison of the lower extremity function of patients with foot problems according to the level of kinesiophobia
Sulenur Yildiz et al
Somatosensory & Motor Research : 30 Sep 2020

The presence of kinesiophobia was identified in patients with foot problems. There was no finding of foot functionality according to the level of kinesiophobia in lower extremity problems. The aim of this study was to compare the lower extremity functional status in foot problems with a low or high level of kinesiophobia.

Materials and methods
Evaluated herein were 37 patients with foot problems (plantar fasciitis, hallux valgus, flat foot). Physical and demographic characteristics were recorded. Patients were divided into two groups based on if they had a high or low level of kinesiophobia using the Tampa kinesiophobia scale. Ankle plantar flexor and knee flexor muscles tightness were recorded. The foot posture was evaluated using the Foot Posture Index. Foot-related pain was measured using the Visual Analog Scale Foot & Ankle. The Foot Function Index and the American Orthopaedics Foot and Ankle Foundation Ankle-Hindfoot Scale and Hallux Metatarsophalangeal–Interphalangeal Scale were used to assess the foot function. The general functional status of the lower extremities was evaluated using the Lower Extremity Functional Scale.

Results
Foot function was better in patients with a low level of kinesiophobia (p < 0.05). Pain was higher in patients with high level of kinesiophobia than in patients with a low level of kinesiophobia (p < 0.05). There was no difference between the groups in terms of foot posture index and muscle tightness (p > 0.05). The general lower extremity function was more negatively affected in patients with a high level of kinesiophobia (p < 0.05).

Conclusions
Patients with a high level of kinesiophobia presented with more functional problems in the foot and whole lower extremity; hence, function-based rehabilitation and pain coping strategies should be a crucial part of the rehabilitation program at the earliest opportunity.
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NewsBot · Jul 27, 2021

The Impact of the Degree of Kinesiophobia on Recovery in Patients with Achilles Tendinopathy
Nabeel Hamdan Alghamdi, PT, MSc, Ryan T Pohlig, PhD, Mari Lundberg, PT, PhD, Karin Grävare Silbernagel, PT, ATC, PhD
Physical Therapy, 21 July 2021

Objective
Kinesiophobia has been proposed to influence recovery in patients with Achilles tendinopathy. However, whether there are differences in outcomes in patients with different levels of kinesiophobia is unknown. The purpose of this study was to compare the characteristics of patients at baseline and recovery over time in patients with Achilles tendinopathy and various levels of kinesiophobia.

Methods
This study was a secondary analysis of a prospective observational cohort study of 59 patients with Achilles tendinopathy. The patients were divided into 3 groups on the basis of scores on the Tampa Scale for Kinesiophobia (TSK) (those with low TSK scores [≤33] [low TSK group], those with medium TSK scores [34–41] [medium TSK group], and those with high TSK scores [≥42] [high TSK group]). All patients were evaluated with self-reported outcomes, clinical evaluation, tendon morphology, viscoelastic property measurements, and a calf muscle endurance test at baseline, 6 months, and 12 months. No treatment was provided throughout the study period.

Results
There were 16 patients (8 women) in the low TSK group (age = 51.9 [SD = 15.3] years, body mass index [BMI] = 24.3 [22.3–25.4]), 28 patients (13 women) in the medium TSK group (age = 52.7 [SD = 15.2] years, BMI = 26.4 [22.5–30.8]), and 15 patients (8 women) in the high TSK group (age = 61.1 [SD = 11.1] years, BMI = 28.1 [25.2–33.6]). Among the groups at baseline, the high TSK group had significantly greater BMI and symptom severity and lower quality of life. All groups showed significant improvement over time for all outcomes except tendon viscoelastic properties and tendon thickening when there was an adjustment for baseline BMI. The high and medium TSK groups saw decreases in kinesiophobia at 6 months, but there was no change for the low TSK group.

Conclusion
Despite the high TSK group having the highest BMI and the worse symptom severity and quality of life at baseline, members of this group showed improvements in all of the outcome domains similar to those of the other groups over 12 months.

Impact
Evaluating the degree of kinesiophobia in patients with Achilles tendinopathy might be of benefit for understanding how they are affected by the injury. However, the degree of kinesiophobia at baseline does not seem to affect recovery; this finding could be due to the patients receiving education about the injury and expectations of recovery.
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NewsBot · Oct 24, 2021

Effects of kinesiophobia and pain on performance and willingness to perform jumping tests in Achilles tendinopathy: A cross-sectional study
Haraldur B.Sigurdsson et al
Physical Therapy in Sport; Volume 50, July 2021, Pages 139-144

Highlights
•Kinesiophobia is not related to jump height.
•Pain is correlated with decreased jump height.
•Kinesiophobia does not affect successful completion of performance tests.
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Objectives
Fear of movement may be a source of systemic bias in studies reporting functional deficits in patients with Achilles tendinopathy. The purpose of this study was to assess the effects of kinesiophobia on completion rate and performance on tests evaluating lower extremity function, while controlling for self-reported pain.

Design
Cross-sectional study;

Setting
Tendon research laboratory.

Participants
Ninety-four participants with Achilles tendinopathy.

Main outcome measures
Completion (yes/no) and performance (cm) on the counter-movement jump, hopping, and drop counter-movement jump.

Results
The models fit the data (R^2 = 0.81, both models). TSK score did not predict completion (beta = −0.01, 95% CI = −0.13 – 0.09, P = 0.74) but pain did (beta = −0.36, 95% CI = −0.53 to −0.19, P < 0.0001). TSK score did not predict performance (beta = −0.06, 95% CI = −0.14 – 0.003, P = 0.07), but pain did (beta = −0.15, 95% CI = −0.22 to −0.07, P < 0.0001).

Conclusions
Kinesiophobia did not affect the physical performance tests in patients with Achilles tendinopathy. Measures of physical performance should be interpreted alongside self-reported pain.
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NewsBot · Apr 6, 2022

Kinesiophobia Severity Categories and Clinically Meaningful Symptom Change in Persons With Achilles Tendinopathy in a Cross-Sectional Study: Implications for Assessment and Willingness to Exercise
Ruth L Chimenti et al
Front Pain Res (Lausanne). 2021 Sep 1

Objectives: (1) Validate thresholds for minimal, low, moderate, and high fear of movement on the 11-item Tampa Scale of Kinesiophobia (TSK-11), and (2) Establish a patient-driven minimal clinically important difference (MCID) for Achilles tendinopathy (AT) symptoms of pain with heel raises and tendon stiffness. Methods: Four hundred and forty-two adults with chronic AT responded to an online survey, including psychosocial questionnaires and symptom-related questions (severity and willingness to complete heel raises and hops). Kinesiophobia subgroups (Minimal ≤ 22, Low 23-28, Moderate 29-35, High ≥ 36 scores on the TSK-11), pain MCID subgroups (10-, 20-, 30-, >30-points on a 0- to 100-point scale), and stiffness MCID subgroups (5, 10, 20, >20 min) were described as median [interquartile range] and compared using non-parametric statistics. Results: Subgroups with higher kinesiophobia reported were less likely to complete three heel raises (Minimal = 93%, Low = 74%, Moderate = 58%, High = 24%). Higher kinesiophobia was associated with higher expected pain (Minimal = 20.0 [9.3-40.0], Low = 43.0 [20.0-60.0], Moderate = 50.0 [24.0-64.0], High = 60.5 [41.3-71.0]) yet not with movement-evoked pain (Minimal = 25.0 [5.0-43.0], Low = 31.0 [18.0-59.0], Moderate = 35.0 [20.0-60.0], High = 43.0 [24.0-65.3]). The most common pain MCID was 10 points (39% of respondents). Half of respondents considered a 5-min (35% of sample) or 10-min (16%) decrease in morning stiffness as clinically meaningful. Conclusions: Convergent validity of TSK-11 thresholds was supported by association with pain catastrophizing, severity of expected pain with movement, and willingness to complete tendon loading exercises. Most participants indicated that reducing their pain severity to the mild range would be clinically meaningful.
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NewsBot · Jan 17, 2023

Relationship between Kinesiophobia, Foot Pain and Foot Function, and Disease Activity in Patients with Rheumatoid Arthritis: A Cross-Sectional Study
Andres Reinoso-Cobo et al
Medicina 2023, 59(1), 147;

The main objective of the present study was to determine the relationship between kinesiophobia and pain (general and foot pain), foot function, and disease activity in patients with rheumatoid arthritis (RA). A total of 124 interviews were carried out with participants with RA. Participants were recruited from the Hospital Universitario Virgen de las Nieves de Granada in Spain. Interviews took place in January 2021. Participants completed the following questionnaires during an appointment with their rheumatologist: Foot Function Index (FFI), Tampa Scale for Kinesiophobia (TSK-11), and the Visual Analogue Scale Pain foot (VAS Pain). Furthermore, the Simplified Disease Activity Index (SDAI) was used to measure disease activity. Of the 124 participants, 73% were women, and their mean age was 59.44 years (SD 11.26 years). In the statistical analysis, positive linear correlations (p < 0.001) were obtained between the variables TSK-11 and VAS (related to general pain or foot pain) and FFI (in its three subscales). Additionally, a negative correlation between the TSK-11 and the educational background was shown. This study provided information about the relationship between foot function and pain with different levels of kinesiophobia in patients with RA. Additionally, the educational background of the patient was considered a predictor of whether or not a patient suffered from kinesiophobia.
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NewsBot · Feb 28, 2023

Kinesiophobia, self-reported ankle function, and sex are associated with perceived ankle instability in college club sports athletes with chronic ankle instability
Kentaro Watanabe, Yuta Koshino, Daiki Kawahara, Moeko Akimoto, Masumi Mishina, Kosumi Nakagawa, Tomoya Ishida, Satoshi Kasahara, Mina Samukawa, Harukazu Tohyama
Physical Therapy in Sport; 26 February 2023

Objective
To investigate the association between sex, self-reported ankle function, pain intensity, kinesiophobia, and perceived ankle instability in athletes with chronic ankle instability (CAI).

Design
Cross-Sectional Study.

Setting
University.

Participants
College club sports athletes with CAI (n = 42).

Main outcome measures
Relationships with the Cumberland Ankle Instability Tool (CAIT) score and the Tampa Scale for Kinesiophobia-11 (TSK-11), the Foot and Ankle Ability Measure (FAAM), sex (0: male, 1: female), and ankle pain intensity by numeral rating scale were explored with multiple regression analysis.

Results
The regression model explained 50.3% of the variance of the CAIT score (P < 0.001), and the TSK-11 score (B = −0.382, P = 0.002), the FAAM sports subscale score (B = 0.122, P = 0.038), and sex (B = −2.646, P = 0.031) were significant independent variables for the CAIT score (P < 0.001), while pain intensity was not significant (B = −0.182, P = 0.504). These results indicated that higher TSK-11 score, lower FAAM sports subscale score, and being female were related to lower CAIT score.

Conclusions
Kinesiophobia related to perceived instability along with self-reported function and sex in athletes with CAI. Clinicians should assess the psychological aspects of athletes with CAI.
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NewsBot · Aug 10, 2023

Kinesiophobia contributes to worse functional and patient-reported outcome measures in Achilles tendinopathy: a systematic review
Prushoth Vivekanantha et al
Knee Surg Sports Traumatol Arthrosc. 2023 Aug 8

Purpose: To assess the effect of kinesiophobia or fear of reinjury on patient-reported outcome measures and physical performance measures in patients with chronic Achilles tendinopathy (AT).

Methods: Three databases were systematically screened for studies from inception to May 22nd, 2023 for literature investigating the impact of kinesiophobia on PROMs or physical performance metrics in AT. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, pain, level of activity, self-reported injury severity, quality of life, single-leg hop performance, and heel-raise performance were recorded. Data was presented primarily in a narrative summary fashion. The MINORS score was used for all studies to perform a quality assessment of included studies.

Results: Six studies comprising 705 patients were included in this review. Variations of the Tampa Scale of Kinesiophobia (TSK-11 or TSK-17) were used in all studies. TSK scores were strongly correlated with the Pain Catastrophizing Score (PCS) and Visual Analogue Scale (VAS) scores and were correlated with decreased Victorian Institute of Sports Assessment Achilles (VISA-A) and Foot and Ankle Outcome Scores Quality of Life (FAOS-QoL) subscale scores. Kinesiophobia was associated with heel raise completion with conflicting evidence on correlations with hop test performance.

Conclusion: Increased kinesiophobia scores (> 35 points), measured by TSK are associated with worse PROMs, including increased pain, decreased quality of life, increased self-reported severity, and is also associated with poorer physical performance measures in patients with AT.
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NewsBot · Nov 1, 2023

The effects of kinesiophobia on postural control with chronic ankle instability
Seunguk Han, Minsub Oh, Hyunwook Lee, Jon Tyson Hopkins
Gait & Posture 18 October 2023

Background
Patients with chronic ankle instability (CAI) often experience injury-related fear following ankle injuries, a condition known as kinesiophobia. Little research has investigated the impact of kinesiophobia in patients with CAI.

Research question
How does kinesiophobia impact the static and dynamic balance of individuals with CAI?

Methods
Fifty patients with CAI were divided into 2 subgroups based on their responses to the Tampa Scale of Kinesiophobia: 25 with kinesiophobia (CAI-K) and 25 without kinesiophobia (CAI-N). These groups were compared to 20 control participants. All participants performed a single-leg balance test with eyes open (EO) and eyes closed (EC). They also performed the Y-balance test (YBT) with EO. Romberg ratios were calculated as EC/EO and used for statistical analysis.

Results
No differences in static balance with EO and EC were found among three groups. However, the CAI-K group displayed a higher Romberg ratio in the mediolateral direction during static balance than both CAI-N and control groups. Additionally, both CAI-K and CAI-N groups displayed higher Romberg ratio in the anterior–posterior than controls. During YBT, the CAI-K group showed reduced reach distance in the anterior direction than CAI-N and control groups.

Significance
The CAI-K group relies more on visual feedback during static balance in the mediolateral direction than CAI-N and control groups. Furthermore, the CAI-K group displayed less anterior reach distance during YBT compared to the CAI-N and control groups. Clinicians should consider both psychological and physical factors when designing rehabilitation programs
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NewsBot · Jan 1, 2024

Exploring athlete pain and pain assessment experiences and priorities; A three-part qualitative series of athlete and physiotherapist interactions. Part One. 'Through their eyes' - Athlete & physiotherapist pain experiences and perspectives.
Ciaran Purcell et al
Source

Abstract Objectives: To explore upper and lower limb athlete pain experiences and perceptions and facilitate dialogue and shared understanding between athletes and sports physiotherapists. Design; Qualitative Research using a hermeneutic phenomenological approach. Methods: We carried out focus groups comprising a deliberate criterion sample of athletes and physiotherapists using a constructivist perspective. We developed a topic guide using an established step-by-step approach. Using reflexive thematic analysis, we developed codes, candidate themes and finalised themes iteratively. We applied a critical friend approach to add depth to analysis. Our paper follows the consolidated criteria for reporting qualitative research (COREQ) guidelines. Results: We completed five focus groups, comprising twelve athletes (five female, seven male) and four sports physiotherapists (four male) including one successful pilot of two athletes. Four final themes (I-IV) and nine subthemes (a-i) were developed; I) Athlete Pain Lens ( a - pain is part of being an athlete, b - pain shapes the life of an athlete) II) Exploring And Navigating Pain (c- the athlete pain spectrum, d- making sense of pain) III) The Emotional Toll of Pain (e - challenging emotions, f - the impact of time) IV) Coping, Community and Communication (g - coping with Pain, h - influence of community and support network, i - communication-the broken key). Conclusion: We explored athlete pain experiences and perspectives through engaged conversations with athletes and physiotherapists. Athletes often struggle to understand and manage their pain, and it is crucial for everyone in the sports community to recognize and adjust to these challenges.
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