Incidence and Risk Factors of Kinesiophobia After Total Knee Arthroplasty in Zhengzhou, China: A Cross-Sectional Study

Influencing factors of kinesiophobia among stroke patients with hemiplegia: A mixed methods study

OBJECTIVES

There is a scarcity of data regarding the effects of kinesiophobia on stroke patients with hemiplegia. Therefore, this paper aims to evaluate the level of kinesiophobia experienced by stroke patients with hemiplegia in China, examine the elements that influence it, and investigate the unique psychological experience of kinesiophobia combined with a qualitative study.

METHODS

This mixed study was conducted in two steps. Four approved scales were used to evaluate a total of 163 patients: (i) Tampa Scale of Kinesiophobia, (ii) Pain Catastrophizing Scale, (iii) Self-Efficacy for Exercise Scale, and (iv) Hospital Anxiety and Depression Scale. A multivariate linear regression model was used to evaluate the predictors of kinesiophobia in stroke patients with hemiplegia. Subsequently, semi-structured interviews with 15 stroke patients with hemiplegia were conducted using an objective sampling method, and the Colaizzi 7-step analysis process was utilized to analyze the interview data.

RESULTS

A total of 163 stroke patients with hemiplegia were included in this study, of them, 47.9% reported kinesiophobia. Multiple linear regression revealed that the influencing factors of kinesiophobia in stroke patients with hemiplegia were a history of falls, exaggeration, helplessness, anxiety, depression, and low exercise self-efficacy (P<0.05). The qualitative research focuses on two main topics: personal adoption of negative coping styles and insufficient external support.

CONCLUSION

Our study showed that the kinesiophobia in stroke patients with hemiplegia was high, with several factors influencing their kinesiophobia. Some of these factors are modifiable and should be considered when formulating kinesiophobia intervention strategies for stroke patients with hemiplegia.

Prevalence and influencing factors of kinesiophobia in older patients with primary osteoporosis: A cross-sectional survey

AIM

To explore the prevalence of kinesiophobia in older patients with primary osteoporosis and analyze its influencing factors.

METHODS

A cross-sectional survey was conducted among 221 older patients with primary osteoporosis in a general hospital in Kunming, China. Data were collected through a sociodemographic-clinical questionnaire, Tampa Scale for Kinesiophobia-11 (TSK-11), Global Pain Scale (GPS), Five Facets Mindfulness Questionnaire-Short Form (FFMQ-SF), and Hospital Anxiety and Depression Scale (HADS). SPSS 27.0 software was utilized for univariate and binary logistic regression analyses.

RESULTS

The findings revealed that the prevalence of kinesiophobia in this study was 57.01 %. Age, history of fractures, chronic obstructive pulmonary disease (COPD), lumbar disc herniation, chronic pain, mindfulness, anxiety, and depression were identified as significant influencing factors of kinesiophobia in the binary logistic regression analyses.

CONCLUSION

Healthcare professionals should be attentive to occurrence of kinesiophobia. Timely measures should be implemented to improve pain, anxiety and depression, and employ mindfulness interventions to mitigate kinesiophobia.

The longitudinal relationship between fear of movement and physical activity after cardiac hospitalization: A cross lagged panel model

BACKGROUND

Little is known about the association between fear of movement (kinesiophobia) and objectively measured physical activity (PA), the first 12 weeks after cardiac hospitalization.

PURPOSE

To assess the longitudinal association between kinesiophobia and objectively measured PA and to assess the factor structure of kinesiophobia.

METHODS

We performed a longitudinal observational study. PA was continuously measured from hospital discharge to 12 weeks using the Personal Activity Monitor. The PAM measures time spent per day in PA-intensity categories: light, moderate and heavy. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK) at four time points (hospital discharge, 3, 6 and 12 weeks). The longitudinal association between PA-intensity and kinesiophobia was studied with a random intercept cross lagged panel model (RI-CLPM). A RI-CLPM estimates effects from kinesiophobia on objectively measured PA and vice versa (cross-over effects), and autoregressive effects (e.g. kinesiophobia from one occasion to the next).

RESULTS

In total, 116 patients (83.6% male) with a median age of 65.5 were included in this study. On no occasion did we find an effect of kinesiophobia on PA and vice versa. Model fit for the original model was poor (X2: = 44.646 P<0.001). Best model fit was found for a model were kinesiophobia was modelled as a stable between factor (latent variable) and PA as autoregressive component (dynamic process) (X2 = 27.541 P<0.12).

CONCLUSION

Kinesiophobia and objectively measured PA are not associated in the first 12 weeks after hospital discharge. This study shows that kinesiophobia remained relatively stable, 12 weeks after hospital discharge, despite fluctuations in light to moderate PA-intensity.

Treatment of Concurrent Depression and Its Effect on Outcomes After Total Joint Arthroplasty: A Systematic Review of Comparative Studies

PURPOSE

There is a growing body of evidence suggesting that patients with a diagnosis of depression suffer worse outcomes after total joint arthroplasty (TJA) procedures. It is unclear whether depression treatment is a modifiable risk factor that can be targeted to improve suboptimal outcomes. We conducted a systematic review to understand the role that various interventions have on outcomes of TJA in patients with diagnosed depression (PDDs).

METHODS

PubMed, Ovid MEDLINE, Scopus, and EMBASE were searched systematically from inception until November 2022. Studies of PDDs who underwent TJA that compared any intervention/treatment of depression with a control group and reported pain, functional outcomes, depression scores, and/or revision rates after TJA were relevant for this review.

RESULTS

Ten relevant studies were included in the final systematic review, with a total of 33,501 patients included. Two studies reported lower revision rates for patients receiving selective serotonin reuptake inhibitor treatment and psychotherapy. Two studies showed no difference in functional outcomes for patients receiving pharmacologic treatment. One study reported improved functional outcomes for patients receiving cognitive behavioral therapy and another reported improved postoperative functional outcomes for patients receiving alprazolam.

CONCLUSION

Interventions targeted at PDDs may improve short-term pain and functional outcomes, and there may be an association between selective serotonin reuptake inhibitor use and implant survival. The current literature is limited and inconclusive, with important gaps in understanding regarding the optimization and treatment of this modifiable risk factor. Surgeons should consider depression treatment as a method to improve outcomes in this cohort.

Pain Catastrophizing, Kinesiophobia and Exercise Adherence in Patients After Total Knee Arthroplasty: The Mediating Role of Exercise Self-Efficacy

Purpose

To examine whether exercise self-efficacy mediates the contributions of pain catastrophizing and kinesiophobia to exercise adherence in patients after total knee arthroplasty.

Patients and Methods

A cross-sectional study design was conducted. A total 211 post-total knee arthroplasty patients were recruited from three orthopedics units of a tertiary hospital in China. Participants were invited to complete questionnaires on pain catastrophizing, kinesiophobia, exercise self-efficacy, and exercise adherence. Mplus 8.3 software was used to construct mediation models.

Results

Pain catastrophizing and kinesiophobia were negatively correlated with exercise adherence (r = -0.509, r = -0.605, p < 0.001 respectively), while exercise self-efficacy were positively associated with exercise adherence (r = 0.799, p < 0.001). The results found exercise self-efficacy mediated the correlations of pain catastrophizing and kinesiophobia with exercise adherence after adjusting for demographic and clinical covariates. Pain catastrophizing indirectly affected patients' exercise adherence through its effect on exercise efficacy (indirect effect: -0.412), while Kinesiophobia is directly associated with exercise adherence and also indirectly through exercise self-efficacy (direct effect: -0.184, indirect effect: -0.415).

Conclusion

Patients after total knee arthroplasty who have high levels of psychological distress (pain catastrophizing and kinesiophobia) are vulnerable to be non-adherent to exercise behaviors. Exercise self-efficacy explains the effects of pain catastrophizing and kinesiophobia on exercise adherence and may be a key target for measures to improve exercise behaviors in patients after total knee arthroplasty.

Occupational self-perception level effects on the development of kinesiophobia in individuals with total knee arthroplasty

Introduction

The development of kinesiophobia after Total Knee Arthroplasty (TKA) has been one of the important issues. However, the early results and the presence of kinesiophobia before surgery have not been adequately investigated. In addition, the effects of factors such as pain perception, postoperative pain level, and demographic characteristics were mentioned. However, occupational factors such as occupational expectations and occupational self-perception level have not been adequately investigated.

Methods

Each assessment tool was administered three times: once on the first day of the preoperative period and then again at the third and sixth weeks after the surgery. The assessment tools employed were the Knee Injury and Osteoarthritis Outcome Score, Tampa Scale for Kinesiophobia, Occupational Self Assessment, and Timed Up and Go test. To analyze the differences in Tampa Scale for Kinesiophobia scores, a one-way ANOVA was conducted. Subsequently, the patients were categorized into two groups based on their level of kinesiophobia: high and low. Independent sample t-tests were employed to compare continuous and normally distributed data between the two groups, while the Mann-Whitney U test was used for non-normally distributed data. The Pearson correlation coefficient was utilized to assess the relationship between continuous data, whereas the Spearman rank-order correlation was employed for non-normally distributed data.

Results

High levels of kinesiophobia were identified in individuals both prior to and following surgery. Significant differences were observed between the high and low kinesiophobia groups in terms of the mean OSA Competency (p < 0.05). However, no statistically significant differences were found between the groups in relation to the other evaluation scores during the follow-up periods. Furthermore, a negative correlation was observed between TSK score and OSA Competence results (p < 0.05).

Conclusion

Occupational self-perception levels effect the level of kinesiophobia in individuals with TKA and high rates of kinesiophobia observed before the surgery intensified after the surgery, especially in the early period. It may be necessary to focus more on factors such as individual factors, individuals' values, habits, and beliefs.

Heterogeneous trajectories of kinesiophobia and their effects on rehabilitation outcomes after total knee arthroplasty: a prospective cohort study

BACKGROUND

Kinesiophobia is one of the most common and aversive psychological phenomena among patients after total knee arthroplasty (TKA). This study aimed to identify trajectories of kinesiophobia, examine factors distinguishing these trajectories, and clarify the association between trajectories of kinesiophobia and rehabilitation outcomes.

METHODS

In this prospective cohort study, the patients who underwent TKA were recruited between December 2021 and April 2022 from three orthopedic wards of a tertiary hospital in China. Kinesiophobia was measured using the Tampa Scale for Kinesiophobia at baseline (T0), and then at 1 month (T1) and 3 months (T2) after TKA to perform latent class growth analysis. Meanwhile, rehabilitation outcomes were assessed at 3 months after TKA, using the Kessler Psychological Distress Scale, the Hospital for Special Surgery-Knee Scale, Barthel Index, and the Impact on Participation and Autonomy questionnaire.

RESULTS

The four kinesiophobia trajectories identified were as follows: low stable group (n = 120), rapid recovering group (n = 31), slow recovering group (n = 48), and stable moderate group (n = 58). Body mass index, employment status, heart disease, and pain degree significantly predicted trajectory groups (all p < 0.05). Analysis of variance revealed significant differences between the four kinesiophobia trajectories concerning all rehabilitation outcomes, except for the activities of daily living.

CONCLUSION

Distinct kinesiophobia trajectories were identified, and nurses should assess the kinesiophobia of patients after TKA in the early phase. Patients in the slow recovering group are worthy of a specific focus because of their poor recovery after undergoing TKA. As important sources of psychosocial care, nurses need to customize psychological interventions for patients after TKA depending on each kinesiophobia trajectory.

Robot-assisted rehabilitation training improves knee function and daily activity ability in older adults following total knee arthroplasty

To evaluate the effects of robot-assisted rehabilitation training on knee function and the daily activity ability of older adults following total knee arthroplasty (TKA). Eighty-eight patients who underwent TKA were randomly assigned to a robot-assisted rehabilitation or traditional therapy group. The patients in the control group were treated with traditional manual rehabilitation therapy, while the patients in the experimental group were subjected to the robot-assisted rehabilitation program. Range of motion of the knee joint, Hospital for Special Surgery Knee Rating Score, and the modified Barthel Index were assessed on the first or second day after TKA (preintervention) and the discharge day (postintervention). Additionally, the length of hospital stay and related hospitalization expenses of the two groups were collected on the discharge day. Improvements in the active range of motion (p < 0.001), passive range of motion (p = 0.001), Hospital for Special Surgery Knee Rating Score (p < 0.001), and modified Barthel Index score (p = 0.004) were significantly better in the robot-assisted rehabilitation group than in the traditional therapy group. Interestingly, the length of hospital stay in the experimental group (9 days) was shorter than that in the control group (13 days), and the total cost of hospitalization was lower (p = 0.002). The robot-assisted rehabilitation training program is an effective intervention that significantly improves the daily activity ability and knee function of older adults following TKA.

Identifying patterns of kinesiophobia trajectories among COPD patients: A longitudinal study

AIM

To determine differences in kinesiophobia levels among COPD patients at different time points 6 months after discharge；To identify potential subgroups of COPD patients who perceived different levels of kinesiophobia over time；and to evaluate differences in identified subgroups based on demographic and disease-related characteristics DESIGN: An observational longitudinal study.

METHODS

OPD patients hospitalized in respiratory department of a grade A hospital in Huzhou city from October 2021 to May 2022 were selected as the research objects. TSK scale was used to evaluate the level of kinesiophobia at discharge (T1), 1 month after discharge (T2), 4 months after discharge (T3) and 6 months after discharge (T4). The kinesiophobia level scores at different time points were compared using latent class growth modelling. ANOVA and Fisher's exact tests were used to test differences in demographic characteristics，and univariate analysis and multinomial logistic regression analysis were used to explore the influencing factors.

RESULTS

During the first 6 months after discharge, kinesiophobia levels decreased significantly in the entire sample of COPD patients. The best-fitting group-based trajectory model described three distinctive trajectories: Low kinesiophobia group (31.4% of sample); Medium kinesiophobia group (43.4% of sample)；and High kinesiophobia group (25.2% of sample). Logistic regression results showed that sex, age, course of disease, pulmonary function, education level, BMI, the level of pain, MCFS and mMRC were influencing factors of kinesiophobia trajectory in COPD patients (p < 0.05).

Surgery-related anxiety on geriatric patients undergoing total knee arthroplasty: a retrospective observational study

BACKGROUND

The prevalence of anxiety in patients undergoing total knee arthroplasty (TKA) and its association with postoperative functions are well known; however, the levels of anxiety or anxiety-related characteristics are unknown. This study aimed to investigate the prevalence of clinically significant state anxiety in geriatric patients undergoing TKA for osteoarthritis (OA) of the knee and to evaluate the anxiety-related characteristics experienced by these patients pre- and post-operatively.

METHODS

This retrospective observational study recruited patients who had undergone TKA for knee OA using general anesthesia between February 2020 and August 2021. The study participants were geriatric patients older than 65 years who had moderate or severe OA. We evaluated patient characteristics including age, sex, body mass index, smoking status, hypertension, diabetes, and cancer. We assessed their levels of anxiety status using the STAI-X which comprises 20-item scales. Clinically meaningful state anxiety was defined as a total score of 52 or higher. An independent Student's t-test was used to determine differences of STAI score between subgroups in terms of patient characteristics. And patients were asked to complete questionnaires, which assessed four areas: (1) the main cause of anxiety; (2) the most helpful factor in overcoming anxiety before surgery; (3) the most helpful factor in reducing anxiety after surgery; and (4) the most anxious moment during the entire process.

RESULTS

The mean STAI score of patients who underwent TKA was 43.0 points and 16.4% of patients experienced clinically significant state anxiety. The current smoking status affect STAI score and the proportion of patients with clinically meaningful state anxiety. The most common cause of preoperative anxiety was the surgery itself. Overall, 38% of patients reported that they experienced the greatest level of anxiety when the surgeon had recommended TKA in the outpatient clinic. The trust in the medical staff before surgery and the surgeon's explanations after surgery helped the most in reducing anxiety.

CONCLUSIONS

One in six patients before TKA experience clinically meaningful state anxiety, and about 40% of patients experience anxiety from the time they are recommended for surgery. Patients tended to overcome anxiety before TKA through trust in the medical staff, and the surgeon's explanations after surgery was found to be helpful in reducing anxiety.

The effect of pain social support on kinesiophobia in older patients with rheumatoid arthritis: The mediating role of self-perceived burden

OBJECTIVES

This study would investigate the role of self-perceived burden in mediating the relationship between pain social support and kinesiophobia.

METHODS

A convenience sampling method was used to survey 386 older patients with rheumatoid arthritis in a hospital in Liaoning Province. They were surveyed using the general demographic questionnaire, pain social support scale (SPQ), self-perceived burden scale (SPBS), and tampa scale of kinesiophobia(TSK-11).

RESULTS

Pain social support had a negative correlation with kinesiophobia(r=-0.336, p < 0.01). The self-perceived burden was positively correlated with kinesiophobia(r = 0.583, p < 0.01). The mediating effect of self-perceived burden accounted for 43.40% of the total effect.

CONCLUSIONS

The study had shown the mediating role of self-perceived burden to be beneficial in reducing kinesiophobia in older rheumatoid arthritis patients.

An investigation of the relationship between cutaneous allodynia and kinesiophobia, gastrointestinal system symptom severity, physical activity and disability in individuals with migraine

Background

To investigate the relationship between cutaneous allodynia (CA) and kinesiophobia, gastrointestinal system (GIS) symptom severity, physical activity, and disability, and to determine whether CA, pain, and disability were influencing factors for kinesiophobia, GIS symptoms, and physical activity in individuals with migraine.

Methods

The study included 144 individuals with migraine. CA, kinesiophobia, GIS symptoms, physical activity level, and migraine-related disability were evaluated with the Allodynia Symptom Checklist, the Tampa Kinesiophobia Scale (TKS), the Gastrointestinal Symptom Rating Scale (GSRS), the International Physical Activity Questionnaire-7, and the Migraine Disability Assessment Scale (MIDAS), respectively.

Results

The CA severity was only associated with TKS (r = 0.515; P < 0.001), GSRS-total (r = 0.336; P < 0.001), GSRS-abdominal pain (r = 0.323; P < 0.001), GSRS-indigestion (r = 0.257; P = 0.002), GSRS-constipation (r = 0.371; P < 0.001), and MIDAS scores (r = 0.178; P = 0.033). Attack frequency (P = 0.015), attack duration (P = 0.035) and presence of CA (P < 0.001) were risk factors for kinesiophobia. Attack frequency (P = 0.027) and presence of CA (P = 0.004) were risk factors for GIS symptoms.

Conclusions

There was a relationship between the CA and kinesiophobia, GIS symptoms, and disability. CA and attack frequency were found to be risk factors for kinesiophobia and GIS symptoms. Migraine patients with CA should be assessed in terms of kinesiophobia, GIS, and disability. Lifestyle changes such as exercise and dietary changes and/or pharmacological treatment options for CA may increase success in migraine management.

Effect of meditation music and comedy movie interventions on postoperative kinesiophobia and pain in patients undergoing total knee arthroplasty

BACKGROUND

This study aimed to investigate the effects of music and comedy movie interventions on postoperative pain and kinesiophobia in patients who underwent total knee arthroplasty.

METHODS

This randomized-controlled study was carried out with the participation of patients who underwent total knee arthroplasty. The patients were divided into three groups. To reduce surgical pain and kinesiophobia, the patients in group 1 watched a comedy movie, those in group 2 listened to music, and those in group 3 did not participate in any intervention other than the routine practices of the clinic.

RESULTS

The personal and medical characteristics of the patients in all groups were similar. The patients in all three groups were kinesiophobic, and their surgical pain levels were moderate despite pharmaceutical interventions. Groups 1 and 2 had a statistically significant decrease in kinesiophobia and pain scores after the interventions. The effects of having patients watch a comedy movie and having them listen to meditation music were not significantly different.

CONCLUSIONS

The results of the study showed that listening to meditation music or watching comedy movie scenes had significant positive effects in alleviating postoperative pain and kinesiophobia after TKA. Based on the results of this study, it is recommended that patients watch comedy movies and listen to meditation music to alleviate their postoperative pain and kinesiophobia.

TRIAL REGISTRATION

NCT, NCT05471778. The study was registered at ClinicalTrials.gov.

Factors associated with kinesiophobia in Chinese older adults patients with osteoarthritis of the knee: A cross-sectional survey

OBJECTIVES

To identify important determinants of kinesiophobia in older adults with osteoarthritis of the knee bassed on demographics, social support and pain, and self-perceived burden factors.

METHODS

A cross-sectional survey of 304 older adults patients with knee osteoarthritis from two hospitals in Jinzhou, Liaoning, China. General Demographic Questionnaire, the Social Support and Pain Scale (SPQ), the Self-Perceived Burden Scale (SPBS), and the Tampa Kinesiophobia Scale (TSK-11) were used to collect the data.

RESULTS

The results showed that the prevalence of kinesiophobia in older adults with osteoarthritis of the knee was 57.89%. Marital status, education, knowledge of the condition, pain level, SPQ, and SPBS levels were significant determinants of kinesiophobia, which together explained 43.2% of the variance.

CONCLUSIONS

The prevalence of kinesiophobia in older adults with knee osteoarthritis is very high. Health care workers should take early intervention measures to improve social support and pain and reduce the self-perceived burden, thereby promoting recovery from disease.

Status and influencing factors of patients with kinesiophobia after insertion of peripherally inserted central catheter: A cross-sectional study

This study aimed to investigate the current status and influencing factors of kinesiophobia in patients after insertion of peripherally inserted central catheter (PICC). A total of 240 patients with PICC were included. Their postinsertion status and influencing factors were investigated using the general information questionnaire, Tampa Scale of Kinesiophobia (TSK), Medical Coping Modes Questionnaire, Numerical Rating Scale, and Self-rating Anxiety Scale. The mean TSK score was 36.49 ± 4.19 points, and 89 patients (37.08%) had kinesiophobia. Multiple linear regression analysis showed that factors such as education level, age, monthly income level, catheterization history, face, pain level, anxiety, and number of needle insertions influenced postoperative kinesiophobia in patients with PICC (P < .05). The total variation in the TSK score was 71.8%. The incidence of kinesiophobia was relatively high after PICC insertion. The medical staff needs to undertake targeted intervention measures to help minimize kinesiophobia after PICC insertion, allowing patients to perform scientifically correct functional exercises and attain physical recovery.

Kinesiophobia and Fear Avoidance in Older Adults: A Scoping Review on the State of Research Activity

A scoping review was performed to examine the extent and nature of research activity on kinesiophobia and fear avoidance in older adults and summarize research findings. Four databases were searched from January 2006 to May 2021. Eleven papers were selected for inclusion, with a predominance of cross-sectional design (54.5%; n = 6). Most of the studies were associated with chronic pain (n = 9; 81.8%). Higher levels of kinesiophobia were found among frailer and older people, predominantly living in care homes. Kinesiophobia and fear avoidance have been related to other constructs of the fear avoidance model, and the conclusions partially support the assumptions derived from it in older adults. Nevertheless, kinesiophobia proved to be a more dominant factor in determining the level of physical activity than pain in this population. None of the studies aimed to test the effectiveness of interventions directly targeting kinesiophobia or fear avoidance.

Kinesiophobia and related factors in cancer patients with TIAPs during the long term: a cross-sectional survey

OBJECTIVE

This study is designed to investigate the status of kinesiophobia and related factors in cancer patients with totally implantable venous access ports (TIAPs).

METHODS

This is a cross-sectional study; all the participants were recruited from the Oncology Department and the Daytime Chemotherapy Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, from April 1 to May 31, 2021. The participants were interviewed by researchers using the self-made general information questionnaire and the Tampa Scale of Kinesiophobia-11 (TSK-11) scale, which allows the fear of movement to be quantified. Eligible patients were aged ≥ 18 years, confirmed with cancer, and implanted with a port. The logistic regression model was used to evaluate clinical factors and the risk of kinesiophobia.

RESULTS

A total of 282 patients were recruited (aged 58.0 ± 11.5 years), of which gastrointestinal cancer accounted for 54.6%, breast cancer accounted for 22.7%, lung cancer accounted for 11.3%, and other types accounted for 11.3%. The TSK-11 score of the 282 patients was 17.84 ± 6.06 points, 45.7% of the patients reported mild kinesiophobia (TSK-11 ≥ 18), 18.4% of the patients reported moderate to severe kinesiophobia (TSK-11 ≥ 25), and the highest score reached 34 points. Results of logistic regression analysis showed that exercise habits (P = 0.025), pain (P = 0.023), and foreign body sensation (P = 0.003) were the risk factors of kinesiophobia.

CONCLUSION

Kinesiophobia is common in cancer patients with TIAPs, and it is closely related to the subjective experience of daily activities, which requires more attention and early intervention to reduce the potential adverse effects.

Using the Tampa Scale for Kinesiophobia Short Form in Patients With Upper Extremity Specific Limitations

Background: The Tampa Scale for Kinesiophobia (TSK) is used to quantify fear of painful movement. A shorter form with only 4 questions (TSK-4) can be used by physicians to look for fear of movement independent of catastrophic thinking with less responder and survey burden. We assessed the difference explained in amount of variation in the Patient-Reported Outcomes Measurement Information System Physical Function Upper Extremity (PROMIS PF UE) between the TSK and TSK-4. Additionally, we looked for other factors that were associated with the PROMIS PF UE, and we assessed reliability and validity of the TSK and TSK-4 by looking at mean scaled scores, internal consistency, floor and ceiling effects, interquestionnaire correlations, and collinearity with the Pain Catastrophizing Scale short form (PCS-4), PROMIS Depression, and PROMIS Pain Interference (PROMIS PI). Methods: One hundred forty eight new and follow-up patients were seen at 5 orthopedic clinics in a large urban area and given the TSK, PROMIS PF UE, PROMIS Depression, PROMIS PI, and PCS-4 questionnaires. Results: Both long and short measures of greater fear of painful movement were independently associated with less physical function (PROMIS PF UE). The longer version accounted for more of the variation in physical function than the short version (TSK, semipartial R² = 0.12, adjusted R² full model 0.25; TSK-4, semipartial R² = 0.03, adjusted R² full model = 0.16, respectively). The shorter measure had slight floor and ceiling effects. There was high internal consistency for both the TSK and TSK-4. Conclusions: A short measure of fear of painful movement may be an adequate screen in the care of patients with upper extremity problems. Using this short form can help decrease questionnaire burden while accounting for kinesiophobia along with catastrophic thinking.Level of Evidence: Prognostic, level II.

Overcoming fear of movement resulting from knee replacement; strategies used by patients: An interview study

BACKGROUND AND AIMS

Fear of movement is among the main concerns of patients following knee replacement surgery and a determining factor in the success of surgery. The strategies adopted by patients to overcome this fear have not yet been identified, but once pin pointed, these strategies can be strengthened and modified through intervention. The aim of the present study was to explore the personal strategies adopted by patients following knee replacement to overcome fear of movement.

MATERIALS AND METHODS

Interviews were conducted with 15 patients who had undergone knee replacement, selected by purposive sampling. Data were collected through in-depth semi-structured interviews and analyzed using inductive content analysis.

RESULTS

The patients' strategies as depicted in their narratives were classified into three categories: 1) Movement based on awareness; 2) Movement based on support; and 3) Movement based on hope. These three categories are described in eight subcategories and show what strategies the patients used to overcome their fear of movement.

CONCLUSION

These findings can help to increase awareness about strategies to overcome fear of movement in patients following knee replacement and to develop and support tailored treatment strategies with the aim of reducing such fear of movement and increasing physical activity among the patients.

The Impact of Psychological Factors and Their Treatment on the Results of Total Knee Arthroplasty

➤

There is a growing body of evidence implicating psychosocial factors, including anxiety, depression, kinesiophobia, central sensitization, and pain catastrophizing, as negative prognostic factors following total knee arthroplasty (TKA).

➤

Symptoms of anxiety and depression likely represent risk factors for negative outcomes in patients undergoing TKA. However, few studies have assessed the impact of preoperative interventions for these conditions on postoperative outcomes.

➤

The Tampa Scale of Kinesiophobia and the Central Sensitization Inventory have demonstrated value in the diagnosis of kinesiophobia and central sensitization. Higher preoperative indices of kinesiophobia and central sensitization predict worse patient-reported outcomes postoperatively.

➤

Although evidence is limited, cognitive-behavioral therapy for kinesiophobia and duloxetine for central sensitization may help to diminish the negative impact of these preoperative comorbidities. It is important to note, however, that outside the realm of TKA, cognitive-behavioral therapy has been recognized as a more effective treatment for central sensitization than medical treatment.

➤

Awareness of these issues will allow surgeons to better prepare patients regarding postoperative expectations in the setting of a comorbid psychosocial risk factor. Further research into the role of preoperative assessment and possible treatment of these conditions in patients undergoing TKA is warranted.

Effect of sedation anesthesia on kinesiophobia and early outcomes after total knee arthroplasty

BACKGROUND

Total knee arthroplasty (TKA) operation is an effective treatment method in severe osteoarthritis worldwide. However, the number of patients with chronic pain and functional limitations in the postoperative period will continue to increase. Kinesiphobia is an important factor that affects the functional outcomes postoperatively. The aim of this study is to investigate the effects of intraoperative consciousness of the patients during surgery on kinesiophobia development and early functional outcomes of TKA.

METHODS

Sixty patients with the diagnosis of primary knee osteoarthritis were enrolled in the study. Tampa Scale of Kinesiophabia (TSK) was obtained for each patient at multiple time periods. Regional anaesthesia and deep sedation were performed on group 1 (n = 30), while regional anaesthesia and light sedation were performed on group 2 (n = 30). The same surgical procedures were applied to all participants. Functional tests were performed on the patients at the postoperative 2nd and 5th days. Visual Analogue Scale (VAS) scores and knee flexion angles were also measured postoperatively.

RESULTS

The mean age of the participants (19 men (31.7%) and 41women (68.3%)) was 67.7 ± 6.7 (54-82) years. TSK ≥ 40 was detected in 18 (30%) patients preoperatively and 33 patients (55%) postoperatively. The number of kinesiophobic patients showed statistically significant increase after operation (20/30 (66.7%)) according to preoperative period (9/30 (30%)) in group 2 (p = 0.003). Postoperative functional scores, knee flexion angles and VAS scores were better in non-kinesiophobic patients. Conclusion: Patient's consciousness during TKA operations is an important factor that interferes with the postoperative kinesiophobia development, which may play a pivotal role affecting the early mobility and functional outcomes.

Unwillingly traumatizing: is there a psycho-traumatologic pathway from general surgery to postoperative maladaptation?

BACKGROUND

Surgery may possibly be undermined by psychologic, psychiatric and psychosomatic problems, as long as these problems interfere with a patient's capacity to cope with surgery adaptively. Recent studies have shown that interpersonal trauma, e.g. abuse or neglect, and its correlates are involved in the adaptation to surgery. This observation is heuristically coherent, given the respective traumatization is an interpersonal event occurring in a relationship. Notably, surgery inevitably leads to the violation of physical boundaries within a doctor-patient relationship. Based on the principles of psycho-traumatologic thinking, such a constellation is deemed qualified to activate posttraumatic symptoms in the traumatized.

METHOD

The present topical review summarizes the respective findings which point to a subgroup of patients undergoing surgery, in whom difficulty bearing tension and confiding in others may cause adaptive problems relevant to surgery. Although this theorizing is empirically substantiated primarily with respect to total knee arthroplasty (TKA), a pubmed-research reveals psychopathologic distress to occur prior to surgery beyond TKA. Likewise, posttraumatic distress occurs in large numbers in the context of several operations, including cardiac, cancer and hernia surgery.

CONCLUSION

Aspects of psychological trauma may be linked to the outcomes of general surgery, as well, e.g. biliary, hernia or appendix surgery. The mechanisms possibly involved in this process are outlined in terms of a hierarchical organization of specific anxiety and negative affect as well as in terms of psychodynamics which imply the unconscious action of psychologic defenses at their core.

IMPLICATIONS

Not least, we encourage the screening for trauma and its correlates including defenses prior to general surgery in order to identify surgical candidates at risk of, e.g. chronic postoperative pain, before the operation.

The effect of immediate post-operative knee range of motion photographs on post-operative range of motion after total knee arthroplasty : An assessor-blinded randomized controlled clinical trial in sixty patients

PURPOSE

We attempted to determine the effect of immediate post-operative knee range of motion (ROM) photographs on improving ROM after total knee arthroplasty (TKA).

METHODS

Sixty patients, scheduled for unilateral primary TKA, were randomized into two groups. The photo group (n = 30) were immediately shown post-TKA knee ROM photographs as motivation for rehabilitation. The non-photo group (n = 30) received identical post-operative pain control and rehabilitation programs. Post-operative knee ROM and Knee Society Scores (KSS) at day three, six weeks, three months, six months, one year, and two years were evaluated. Outcome assessors were blinded to the groups during the study.

RESULTS

Patients in the photo group had better knee flexion on day three (99.9° ± 15.3°, 95% confidence interval (CI) 94.1-105.7° vs. 92.3° ± 11.4°, 95% CI 87.9-96.8°; p = 0.038) and at six weeks (120.9° ± 13.4°, 95% CI 115.7-126.0° vs. 112.5° ± 13.6°, 95% CI 107.2-117.8°; p = 0.023); however, there were no differences in range of flexion beyond six weeks post-operatively. Knee extension did not significantly differ throughout. Clinical KSS was significantly higher in the photo group at six weeks (90.7° ± 6.2° vs. 86.6° ± 6.4°, p = 0.017). Functional KSS showed no differences between groups during follow-up.

CONCLUSION

Showing knee ROM photographs seemed to result in significant improvement of knee flexion and clinical KSS in the first 6 weeks post-TKA and may be recommended as part of post-TKA rehabilitation.

Tampa Scale for Kinesiophobia Short Form and Lower Extremity Specific Limitations

Background

We compared the amount of variation in Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) Computer Adaptive Test (CAT) accounted for by The Tampa Scale for Kinesiophobia (TSK) and its short form (TSK-4) independent of other factors. Questionnaire coverage, reliability, and validity were compared for both TSK and TSK-4 using mean scaled scores, internal consistency, floor and ceiling effects, interquestionnaire correlations, and collinearity with other measures as the Pain Catastrophizing Scale short form (PCS-4), PROMIS Depression CAT, and PROMIS Pain Interference (PROMIS PI) CAT.

Methods

One hundred forty eight consecutive new or return patients were enrolled. Patients were seen in an outpatient setting in several orthopaedic clinics in a large urban area. All patients completed the TSK, PROMIS PF CAT, PROMIS PI CAT, PROMIS Depression CAT, and PCS-4.

Results

Greater fear of movement (higher TSK) was associated with worse physical function (lower PROMIS PF CAT) and the full TSK explained more variation in physical function than the short form (TSK-4). In contrast to prior studies PCS-4 was not independent of TSK. Flooring and ceiling effects were seen with TSK-4. Worse physical function was associated with older age, traumatic condition, and more symptoms of depression.

Conclusion

The short form of the Tampa Scale for Kinesiophobia can be used as a brief screening measure in patient care and research in order to identify an independent influence of kinesiophobia on lower extremity specific limitations. Additional study is needed to determine whether there is utility in screening for both TSK and PCS or if one or the other provides sufficient information about cognitive biases regarding pain to guide treatment with cognitive behavioral therapy and related techniques.

High Levels of Kinesiophobia at Discharge from the Hospital May Negatively Affect the Short-Term Functional Outcome of Patients Who Have Undergone Knee Replacement Surgery

Background: Kinesiophobia is a psycho-cognitive factor that hampers recovery after orthopedic surgery. No evidence exists on the influence of kinesiophobia on the short-term recovery of function in patients with knee replacement (KR). Therefore, the aim of the present study is to investigate the impact of kinesiophobia on short-term patient-reported outcomes (PROMs) and performance-based measures (PBMs). Methods: Forty-three KR patients filled in the Tampa scale for kinesiophobia (TSK) at time of discharge. Patients with TSK ≥ 37 were allocated to the kinesiophobia group (n = 24), others to the no-kinesiophobia group (n = 19). Patients were asked to complete PROMs and to execute PBMs at discharge and at 6-weeks follow-up. An independent samples t-test was used to compare group differences for PROMs and PBMs at both measurement sessions. Multiple linear regression analysis models were used to model PBM outcomes from age, pain and TSK scores. Results: Significant differences were observed between groups for PROMs and PBMs. Kinesiophobia significantly contributed to the reduced functional outcomes. Conclusion: At discharge from the hospital, 55.8% of KR patients demonstrated high levels of kinesiophobia (TSK ≥ 37). This may negatively influence short-term recovery of these patients, by putting them at higher risk for falling and reduced functionality.

Timing of anterior cruciate ligament reconstruction and preoperative pain are important predictors for postoperative kinesiophobia

PURPOSE

Fear of movement (kinesiophobia) is a major limiting factor in the return to pre-injury sport level after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to gain insight into the prevalence of kinesiophobia pre-ACLR, 3 months post-ACLR and 12 months post-ACLR. Furthermore, the preoperative predictability of kinesiophobia at 3 months post-ACLR was addressed.

METHODS

A retrospective study with data, which were prospectively collected as part of standard care, was conducted to evaluate patients who underwent ACLR between January 2017 and December 2018 in an orthopaedic outpatient clinic. Patient characteristics (age, sex, body mass index), injury-to-surgery time, preoperative pain level (KOOS pain subscale) and preoperative knee function (IKDC-2000) were used as potential predictor variables for kinesiophobia (TSK-17) at 3 months post-ACLR in linear regression analysis.

RESULTS

The number of patients with a high level of kinesiophobia (TSK > 37) reduced from 92 patients (69.2%) preoperatively to 44 patients (43.1%) 3 months postoperatively and 36 patients (30.8%) 12 months postoperatively. The prediction model, based on a multivariable regression analysis, showed a positive correlation between four predictor variables (prolonged injury-to-surgery time, high preoperative pain level, male sex and low body mass index) and a high level of kinesiophobia at 3 months postoperatively (R² = 0.384, p = 0.02).

CONCLUSION

The prevalence of kinesiophobia decreases during postoperative rehabilitation, but high kinesiophobia is still present in a large portion of the patients after ACLR. Timing of reconstruction seems to be the strongest predictor for high kinesiophobia 3 months post-ACLR. This study is the first step in the development of a screening tool to detect patients with kinesiophobia after ACLR. Identifying patients preoperatively opens the possibility to treat patients and thereby potentially increase the return to pre-injury sport level rate after ACLR.

LEVEL OF EVIDENCE

III.

The stiff total knee arthroplasty: causes, treatment modalities and results

It is clear that the stiff total knee arthroplasty (TKA) is a multifactorial entity associated with preoperative, intraoperative and postoperative factors.

Management of the stiff TKA is best achieved by preventing its occurrence using strategies to control preoperative factors, avoid intraoperative technical errors and perform aggressive, painless postoperative physical medicine and rehabilitation; adequate pain control is paramount in non-invasive management.

Careful attention to surgical exposure, restoring gap balance, minimizing surgical trauma to the patellar ligament/extensor mechanism, appropriate implant selection, pain control and adequate physical medicine and rehabilitation (physiotherapy, Astym therapy) all serve to reduce its incidence.

For established stiff TKA, there are multiple treatment options available including mobilization under anaesthesia (MUA), arthroscopic arthrolysis, revision TKA, and combined procedures.

Cite this article: EFORT Open Rev 2019;4:602-610. DOI: 10.1302/2058-5241.4.180105

Cross-Cultural Adaptation, Reliability, and Validity of the Chinese Version of the Tampa Scale for Kinesiophobia-11 Among Patients Who Have Undergone Total Knee Arthroplasty

BACKGROUND

The shortened version of the Tampa Scale for Kinesiophobia (TSK-11) has been well characterized in the literature. However, to the best of our knowledge, no previous studies have evaluated the reliability and validity of the TSK-11 for Chinese-speaking patients who have undergone total knee arthroplasty (TKA). Thus, the objectives of this study were to translate and adapt the TSK-11 cross-culturally into Chinese and to evaluate its reliability and validity in a sample of Chinese TKA patients.

METHODS

The TSK-11 was translated and cross-culturally adapted into Chinese according to the international guidelines for the cross-cultural adaptation of self-report measures. The Chinese version of TSK-11 was administered to 254 patients following their TKA, along with the Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, Numerical Rating Scale, and 12-Item Short Form Health Survey. Psychometric testing included internal consistency, test-retest reliability, floor and ceiling effects, construct validity, and convergent validity.

RESULTS

A high completion rate of 95.8% with no floor or ceiling effects was noted in the Chinese version of the TSK-11. The questionnaire also showed good internal consistency (Cronbach's α = 0.883) and test-retest reliability (intraclass correlation coefficient = 0.798). Construct validity was assessed by exploratory factor analysis, and 3 factors were extracted that accounted for 65.2% of the variance. Convergent validity was confirmed by significant Pearson correlations between the Chinese version of the TSK-11 and the Pain Catastrophizing Scale (r = 0.751), Fear-Avoidance Beliefs Questionnaire (r = 0.719) and VAS (r = 0.450), as well as the 12-Item Short Form Health Survey subdomains Bodily Pain (r = -0.391), Mental Health (r = -0.356), Physical Functioning (r = -0.339), Role-Emotional (r = -0.317), and Role-Physical (r = -0.277).

CONCLUSION

The Chinese version of the TSK-11 demonstrated satisfactory acceptability, reliability, and validity; therefore, it can be used in clinical practice and research for assessing kinesiophobia in Chinese patients after TKA.