Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review

Examining Psychological Factors as Contributors to Pain, Disability, and Physical Function in Geriatric Chronic Low Back Pain: A Prospective Analysis of the Delaware Spine Studies Cohort

In younger populations, risk factors from psychologically-focused theoretical models have become accepted as primary drivers behind the persistence of low back pain (LBP), but these risk factors have not been thoroughly assessed in older adult populations (60-85 years). To address this knowledge gap, we sought to examine longitudinal associations between both general and pain-related psychological risk factors and future pain intensity, LBP-related disability, and physical function (gait speed) outcomes in older adults with chronic LBP (n = 250). Questionnaires for general (ie, depressive symptoms) and pain-related psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were collected at baseline. Questionnaire values were entered into principal component analysis to yield a combined psychological component score. LBP intensity (pain thermometers), LBP-related disability (Quebec Back Pain Disability Scale), and gait speed were measured at baseline and 12-month follow-up. Multiple linear regression was used to examine adjusted associations between baseline psychological component scores and each prospective outcome. The baseline psychological component score failed to independently predict 12-month LBP-related disability and gait speed after adjustment for baseline outcomes. Though the psychological component score was associated with 12-month LBP intensity after adjusting for baseline LBP intensity, this association diminished with full adjustment for other baseline characteristics. Cumulatively, general and pain-related psychological risk factors did not independently predict longitudinal pain, disability, and physical function outcomes in this cohort. Compared to younger populations with this condition, general and pain-related psychological risk factors may have less influence on the maintenance of chronic LBP in older adults. PERSPECTIVE: This article failed to establish consistent independent relationships between psychological factors and worse longitudinal pain, disability, and physical function outcomes in older adults with chronic LBP. The findings highlight a need to determine other age-specific biopsychosocial risk factors that may impact the maintenance of chronic pain in this patient population.

Comparison of Pain Characteristics, Strength, and Movement Patterns in Adolescents with Juvenile Fibromyalgia and High versus Low Fear of Movement

Physical activity avoidance and fear of movement (FOM) is often observed in individuals with chronic musculoskeletal pain, along with difficulties coping with pain. There is little research regarding how FOM may also relate to reduced physical strength and altered movement patterns that may perpetuate a cycle of pain, FOM, and disability. The objective of this observational study was to compare how adolescents with juvenile fibromyalgia (JFM) exhibiting high versus low FOM (Tampa Scale of Kinesiophobia [TSK-11]) differed on patient-reported measures of pain, fatigue, catastrophizing and pain interference, and performance-based measures of strength, postural control and biomechanical function. Participants were youth with JFM (N=135, Meanage = 15.6 years, 88.9% female) enrolled in an ongoing clinical trial who completed self-report questionnaires and standardized tests including knee and hip strength, the Star Excursion Balance Test and the Drop Vertical Jump (with 3-D motion capture). Participants were categorized into Low, Medium and High FOM groups based on TSK-11 tertile scores. Relative to the Low FOM group, the High FOM group reported significantly greater fatigue, pain interference and catastrophizing, as well as reduced dominant leg knee strength. Additionally, those with High FOM showed altered lower extremity movement patterns. This preliminary study highlights the importance of combining self-reported measures of symptoms and functioning with physical assessments to gain a more comprehensive view of the impact of FOM in patients with chronic musculoskeletal pain. Results could inform the development of more precise interventions to reduce FOM using a combination of behavioral and exercise-based interventions.

PERSPECTIVE

Results of this study demonstrate the association between fear of movement, fatigue and pain interference in adolescents with juvenile fibromyalgia as well as preliminary evidence for altered movement patterns in that may predispose them to further pain/injury and activity avoidance.

CLINICAL TRIALS

GOV REGISTRATION

NCT03268421.

Correlations of The Central Sensitization Inventory, conditioned pain modulation, cognitions and psychological factors in individuals with chronic neck pain: A cross-sectional study

INTRODUCTION

Chronic neck pain (CNP) is a global public health problem, with high prevalence and absenteeism rates. Central sensitization (CS) as a basis for chronic pain may play an essential role in its development and progression. It is often comorbid with low conditioned pain modulation (CPM) effects, cognitions, and psychological problems.

OBJECTIVES

The purposes of this study were to (1) explore the relationship between pain-related cognitions and psychological factors, CPM effects, and the central sensitization inventory (CSI) scores; and (2) determine whether cognitions and psychological factors can predict CSI scores and CPM effects in individuals with CNP.

METHODS

Fifty-four individuals with CNP were recruited for this cross-sectional study. The following outcome measures were evaluated: The CSI (screening tool) was compared with the cold pressor test (CPT), which was the psychophysical test used to assess the CPM; neck pain intensity using the visual analogue scale (VAS), as well as pain-related cognitions (including kinesiophobia and pain catastrophization) and psychological states (including anxiety and depression) using self-report questionnaires.

RESULTS

CSI score was not associated with the CPM effect (r = 0.257, p > 0.05), and no cognitions or psychological factors were associated with CPM (p > 0.05), but CSI score was moderately positively correlated with kinesiophobia (r = 0.554, p < 0.01), lowly positively correlated with pain catastrophization (r = 0.332, p = 0.017) and anxiety (r = 0.492, p < 0.01), but not depression (r = 0.207, p = 0.132). Multiple linear regression analysis showed that kinesiophobia (B = 1.308, p < 0.01) and anxiety (B = 1.806, p = 0.02) were significant positive predictors of CSI score.

CONCLUSIONS

The findings confirm some of our hypotheses. Accordingly, the findings inferred that the CSI does not seem to respond to CPM effect in patients with CNP effectively. In addition, CSI score was associated with cognitions and psychological factors, of which kinesiophobia and anxiety were effective predictors. In clinical practice, pain-related cognitions and psychological factors should be fully considered to manage neck pain efficiently.

Effects of MLS Laser on pain, function, and disability in chronic non-specific low back pain: A double-blind placebo randomized-controlled trial

BACKGROUND

Among non-pharmacological interventions, Multiwave Locked System (MLS) Laser therapy has been used in patients with several musculoskeletal pathologies and in combination with other therapeutical interventions. The effects of sole MLS therapy on pain and function in patients with chronic non-specific low-back pain are unknown.

OBJECTIVE

The objective of this study was to investigate the effects of MLS Laser therapy on pain, function, and disability in patients with chronic non-specific low back pain in comparison to a placebo treatment group.

METHODS

Forty-five patients were randomized into two groups: the MLS Laser group and the Sham Laser group, undergoing 8 sessions of either a MLS Laser therapy or a Sham Laser therapy, respectively. At the beginning of the therapy (T0), at the end of the therapy (T1), and 1 month after the end of therapy (T2) patients were assessed for low back pain (by means of a VAS scale), function (by means of kinematic and electromyographic assessment of a forward bending movement) and self-reported disability (by means of the Roland-Morris and Oswestry Disability questionnaires).

RESULTS

There was a significant reduction of pain and disability in both groups at T1 and T2 in comparison with T0. At T2 patients in the MLS group showed a significantly lower pain in comparison with patients in the Sham group (VAS = 2.2 ± 2 vs. 3.6 ± 2.4; p< 0.05). No differences between the two groups were found for function and disability.

CONCLUSION

Both MLS Laser and Sham Laser therapies lead to a significant and comparable reduction in pain and disability in patients with chronic non-specific low back pain. However, one month after treatment, MLS Laser therapy has been found to be significantly more effective in reducing pain as compared to sham treatment.

Exploring physical activity preferences and motivation in long-term cardiac prevention: An Austrian cross-sectional survey

Cardiac rehabilitation (CR) patients often do not sustain physical activity (PA) behaviour in the long run, once they progress into a self-management stage of secondary prevention. This study aimed to explore former CR patients' PA preferences, determinants (i.e., influencing factors) and motivation for sustained PA engagement. We conducted a cross-sectional multi-centre survey using an original questionnaire based on prior qualitative interviews with cardiac patients. Five CR centres in Austria posted 500 questionnaires to former CR patients who had completed CR approximately three years prior, and 117 patients (23%) responded. Descriptive analysis was used to analyse closed-ended questions, and self-determination theory (SDT) was applied as a qualitative framework to analyse open-ended questions concerning motivation for PA engagement. Patients were generally physically active, but the majority (75.3%) did not fulfil the World Health Organisation's recommendations for aerobic PA and muscle strengthening. Most patients preferred being physically active outdoors (70%), engaging in aerobic-related (95%), individual and non-competitive exercises, with cycling (52%), walking (32%) and hiking (25%) among the most popular activities. Main determinants of PA were health, pain and motivation for 80%, 68%, 67% of patients, respectively. A subset of patients (77%) expanded on their motivations behind PA. According to SDT, most reasons (90%) were regulated by autonomous motivation (either extrinsically autonomously-regulated or intrinsic motivation) and stemmed mostly from health-related goals (e.g., fitness, general health, weight control), future quality-of-life aspirations (e.g., self-sufficiency in old age, presence for loved ones, preserving mobility) and enjoyment of PA. Patients' responses underscore the importance of promoting not only general PA, but also muscle strengthening training in CR interventions to maximise optimal health benefits. Our data further suggest that interventions which are aligned to patients' health goals and foster autonomous motivation may be particularly beneficial in increasing adherence to PA in the long-term.

Pain and daily interference among reproductive-age women with myofascial pelvic pain: Serial mediation roles of kinesiophobia, self-efficacy and pain catastrophizing

BACKGROUND

Myofascial pelvic pain (MFPP), which is identified by tender points in the pelvic floor musculature, is a prevalent source of chronic pelvic pain in women. It may lead to physical and mental exhaustion, reproductive concerns, and coping difficulties in daily life and work than the disease itself. Pain-related cognitive processes can affect pain relief and quality of life. Kinesiophobia, self-efficacy and pain catastrophizing are frequently treated as mediators between pain and its related consequences. Greater kinesiophobia and pain catastrophizing have been shown to be associated with adverse functional outcomes, while higher self-efficacy has been related with improved quality of life. Regarding MFPP in females of childbearing age, it remains unclear whether the effects of kinesiophobia, self-efficacy and pain catastrophizing on daily interference are direct or indirect; the influence on each variable is, therefore, not entirely evident.

AIM

The present study aimed to evaluate the relationship between pain and daily interference in reproductive-age women with MFPP through kinesiophobia, self-efficacy and pain catastrophizing, as well as to identify areas for future investigation and intervention based on the data collected from this population.

METHODS

This is a multi-center cross-sectional study. The study was conducted from November 15, 2022 to November 10, 2023, 202 reproductive-age women with MFPP were recruited from 14 hospitals in ten provinces of China. The demographic variables, Brief Pain Inventory, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, and Pain Catastrophizing Scale were used to measure the participants' related information. The data was described and analyzed using Descriptive analyses, Pearson correlation analysis, and Serial mediation modeling.

RESULTS

Pain not only had a direct positive impact (B = 0.575; SE   =   0.081; 95%CI: LL = 0.415, UL = 0.735) on daily interference, but also had an indirect impact on daily interference through the independent mediating role of pain catastrophizing (B = 0.088; SE  =  0.028; 95%CI: LL = 0.038, UL = 0.148), the chain mediating of kinesiophobia and catastrophizing (B = 0.057; SE  =   0.019; 95%CI: LL = 0.024, UL = 0.098), and the four-stage serial mediating of kinesiophobia, self-efficacy and catastrophizing (B = 0.013; SE   =  0.006; 95%CI: LL = 0.003, UL = 0.027). The proposed serial mediation model showed a good fit with the collected data.

CONCLUSION

The findings illustrate the significance of addressing pain catastrophizing and kinesiophobia (especially catastrophizing), and increasing self-efficacy in pain therapy, and suggest that functional recovery be integrated into pain therapy for reproductive-age women suffering from MFPP.

How Chronic Pain Patients' and Physicians' Communication Influences Patients' Uncertainty: A Pre- and Post-Consultation Study

Chronic pain is a health problem that is difficult to diagnose, treat, and manage, partly owing to uncertainty surrounding ambiguous causes, few treatment options, and frequent misunderstandings in clinical encounters. Pairing uncertainty management theory with medical communication competence, we predicted that both physicians and patients are influential to patients' uncertainty appraisals and uncertainty management. We collected pre- and post-consultation data from 200 patients with chronic neck and spine/back pain and their physicians. Patients' reports of their physician's communication were a consistent predictor of their post-consultation uncertainty outcomes. Physicians' reports of both their own and patients' communication competence were associated with patients' positive uncertainty appraisals. Physicians' reports of patients' communication competence were also associated with reductions in patients' uncertainty. Findings illustrate how both interactants' perceptions of communication competence-how they view their own (for physicians) and the other's-are associated with patients' post-consultation outcomes.

Pain attitudes and pain outcomes among people with bleeding disorders: Results from community voices in research

INTRODUCTION

Among people with bleeding disorders (PwBD), pain is a major problem and pain treatments are often ineffective. Understanding of psychological factors involved in pain processing is limited. Maladaptive pain attitudes are associated with worse pain outcomes and adaptive pain attitudes are associated with better outcomes in high pain conditions, but relationships between pain attitudes and pain outcomes are so far unexplored among PwBD.

AIM

To investigate relationships between pain attitudes and pain outcomes among PwBD.

METHODS

Pain attitudes were measured with the Survey of Pain Attitudes, containing two adaptive scales (Control and Emotion) and five maladaptive scales (Disability, Harm, Medication, Solicitude, Medical Cure). Adults with bleeding disorders, who had pain, and were enrolled in Community Voices in Research were eligible. Participants (n = 72) completed an online survey. Cross sectional associations between pain attitudes and pain outcomes (pain and prescribed pain medication use) were investigated using logistic regression.

RESULTS

After adjustment for covariates, greater Control attitudes were associated with lower odds of more severe pain, and greater Disability, Harm, and Medication attitudes were all associated with higher odds of more severe pain and with higher odds of any prescribed pain medication use and opioid pain medication use.

CONCLUSIONS

We presented compelling evidence of relationships between pain attitudes and pain outcomes in PwBD, though corroboration is needed from other populations. Our findings suggest that modification of pain attitudes presents a possible avenue for interventions to improve pain outcomes and increase patient satisfaction with pain management.

Fear of movement and competence frustration mediate the relationship between pain catastrophising and physical function in people living with axSpA: an online cross-sectional survey

The objective of this study is to examine the contribution of pain catastrophising to Axial Spondyloarthritis (axSpA) patient's physical function and to test the mediating role of fear of movement, and uniquely, the contribution of competence frustration to the fear-avoidance model. Participants (N = 98, 70% female, M age = 45.62, SD 12.16) completed an online survey (December 2020-May 2021) distributed in the United Kingdom via the National Axial Spondyloarthritis Society (n ≈ 3500; NASS, 2019). The PROCESS SPSS macro was used to test three mediation models using percentile bootstrap 95% confidence intervals (PBCI). A significant indirect effect on the relationship between pain and physical function via fear of movement (β = 0.10, 95% PBCI = 0.030-0.183) was observed (Model 1). Model 2 showed the relationship between pain catastrophising and physical function to be significantly mediated by fear of movement (β = 0.16, 95% PBCI = 0.005-0.322). Finally, Model 3 showed a significant indirect effect on the relationship between pain catastrophising and physical function via competence frustration (β = 0.15, 95% PBCI = 0.014-0.309) but not through fear of movement (β = 0.062, 95% PBCI = - 0.134 to 0.248). To our knowledge, this is the first study to examine and demonstrate the unique contribution of competence need frustration to the Fear-avoidance model in people that live with axSpA. Identifying modifiable factors that contribute to disease outcomes such as physical function can improve the care and quality of life for people living with a disease currently without a cure.

Are women with endometriosis more likely to experience reduced physical performance compared to women without the condition?

Background

Endometriosis is a condition of the female reproductive system associated with pelvic pain. Chronic pain can affect physical performance by limiting the functional activities, thus, it is hypothesized that women with endometriosis may also present decreased functional capacity, decreased strength, and mobility. The objective of this study is to compare physical performance in women with and without endometriosis.

Methods

This is a cross-sectional study composed of 115 women equally divided into two groups: the endometriosis group (EG), composed of women with a confirmed diagnosis of the disease by magnetic resonance imaging, and the comparator group (CG), consisting of women without suspicion of the disease. Physical performance (dependent variable) was assessed using hand dynamometry, the 6-min walk test (6MWT), gait speed, and the chair stands test. CG participants performed the tests during the luteal phase of the menstrual cycle. Descriptive statistics, unpaired t-tests, and chi-square tests were used to describe and compare the groups. Multiple linear regression tested the associations adjusted for covariates (age, income, education, age at menarche, and body mass index).

Results

The EG had worse gait speed (mean difference: -0.11; 95% CI: [-0.18 to -0.04]), weaker grip strength (mean difference: -3.32; 95% CI: [-5.30 to -1.33]), shorter distance covered in the 6MWT (mean difference: -83.46; 95% CI: [-121.38 to -45.53]), and a lower number of repetitions in the chair stands test (mean difference: -8.44; 95% CI: [-10.64 to -6.25]) than the CG, even after adjusting for covariates.

Conclusion

Grip strength, lower limb strength, mobility, and functional capacity were worse in women diagnosed with endometriosis. Women with endometriosis should be encouraged to engage in physical exercise, adopt healthy lifestyle habits, and participate in rehabilitation activities to control pain, with the aim of reducing functional impairments.

Kinesiophobia and associated variables in patients with heart failure

AIMS

Patients with heart failure (HF) can exhibit kinesiophobia, an excessive, debilitating, and irrational fear of movement. This study aimed to enhance the understanding of kinesiophobia in patients with HF by analysing associations with the following variables: musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, frailty, sex, and age.

METHODS AND RESULTS

In this cross-sectional study, 107 participants were included, with ages ranging from 28 to 97 years (57% men, mean age 73.18 ± 12.68 years). Multiple regression analyses were performed with all variables, including polynomial regressions for variables with a non-linear relationship. Kinesiophobia was significantly correlated (P < 0.01) with musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, and being at risk of frailty, while age and sex were not statistically significant. Frailty disability and musculoskeletal pain intensity were variables linearly associated with kinesiophobia, while quality of sleep and disability had a non-linear relationship with kinesiophobia.

CONCLUSION

Kinesiophobia needs to be evaluated and better understood in patients with HF to improve physical activity and exercise adherence. This study found that musculoskeletal pain intensity, quality of sleep, disability, and frailty risk have a significant association with kinesiophobia in patients with HF. Our results suggest multi-dimensional associations of kinesiophobia in patients with HF, which require further examination and understanding.

The mediating role of cardiac patients' perception of nursing care on the relationship between kinesiophobia, anxiety and depression in rural hospitals: a cross-sectional study

BACKGROUND

Kinesiophobia could act as a significant barrier against physical activity following cardiac procedures worsening cardiovascular health problems and potentially leading to conditions like hospital-acquired anxiety and depression among patients with cardiovascular disease (CVD). Nurses are the vanguard health care team who can aid patients in taking proactive steps to overcome fear of movement following cardiac procedures.

AIM

The overarching aim is to investigate the relationship between kinesiophobia, anxiety and depression, and patients' perception of nursing care.

METHOD

A descriptive correlational research design in two rural hospitals, conducted at cardiac intensive care units of Kafr Eldawar Hospital and Damanhur Medical National Institute. Data were collected from 265 nurses, using the following patient-reported outcome measures, the Tampa Scale for Kinesiophobia (TSK), the Hospital Anxiety and Depression Scale (HADS), the Person-Centered Critical Care Nursing Questionnaire (PCCNP) and the patients' demographic and clinical profile.

RESULT

A significant negative correlation was found between HADS and PCCNP (r: -0.510, p < 0.001) however, Kinesiophobia was significantly and positively correlated (r: 0.271, p < 0.001). A direct effect of PCCNP in the presence of the mediator was found to be not statistically significant (-0.015, CR = 0.302, p = 0.763). Nonetheless, PCCNP indirectly affects kinesiophobia through HADS (p=-0.099).

IMPLICATION FOR NURSING PRACTICE

Customizing individualized cardiac rehabilitation (CR) programs based on the emotional experience of cardiac patients will be conducive to rehabilitation and prognosis for patients, thereby lessening the physical burden and improving their quality of life.

Low back pain and kinesiophobia in pregnant women

BACKGROUND

During pregnancy, many pregnant women experience lumbopelvic pain due to mechanical, systemic, and hormonal reasons and this pain and fear of movement (kinesiophobia) causes daily life limitations.

OBJECTIVE

To examine low back pain (LBP), kinesiophobia, disability, and related conditions that develop together during pregnancy.

METHODS

The was a cross-sectional and analytical study. The presence, severity, and duration of pain in the lumbopelvic region were questioned. Postpartum LBP was evaluated using a self-administered questionnaire, disability using the Oswestry Disability Index (ODI), pain intensity using a visual analog scale (VAS), physical activity levels using the physical activity level during pregnancy questionnaire and the international physical activity questionnaire short form, and kinesiophobia was evaluated using the Tampa Scale for Kinesiophobia.

RESULTS

The study comprised 120 pregnant women with a mean age of 27.4 ± 6.1 years. It was observed that 42.3% of the pregnant had LBP (n= 69). The mean body mass index (BMI) was 73.6 ± 16.2 kg/m2, and the mean VAS score was 5.5 ± 2 cm. When we divided the group according to the presence of LBP, age (p= 0.49), gestational week (p= 0.75), and gravida (p= 0.81) were similar. BMI (p= 0.038) and ODI scores (p< 0.001) were higher in the group with LBP.

CONCLUSION

LBP in pregnant women has a higher frequency than in the normal population, regardless of age, gestational week, and gravida. Obesity appears to be a risk factor for LBP and increases disability. Kinesiophobia in pregnant women is significantly associated with obesity and disability. Unless there are contraindications, a physically active pregnancy process and regular exercise should be recommend.

Evaluating Sensitization-associated, Neuropathic-like Symptoms and Psychological Factors in Patients With Interstitial Lung Disease

The aims of this study were to phenotype pain in patients with interstitial lung disease (ILD) by investigating the association between sensitization-associated symptoms with quality of life, anxiety/depression, pain catastrophizing, and kinesiophobia levels and identifying those risk factors explaining the variance of quality of life in individuals with ILD and pain. One hundred and thirty-two (38.6% women, mean age: 70, standard deviation: 10.5 years) patients with ILD completed clinical (age, sex, height, weight), psychological (Hospital Anxiety and Depression Scale [HADS] and the Pittsburgh Sleep Quality Index), and health-related quality of life (EQ-5D-5L) variables, as well as the Central Sensitization Inventory (CSI), the Self-Report Leeds Assessment of Neuropathic Symptoms (S-LANSS), Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia (TSK-11) questionnaires. The prevalence of sensitization-associated symptomatology (CSI), neuropathic-like features (S-LANSS), anxiety symptoms, depressive symptoms, or poor sleep was 20.5%, 23.5%, 23.6%, 22.9%, or 51.6%. Significant associations between CSI, S-LANSS, HADS-A, HADS-D, Pain Catastrophizing Scale, TSK-11, and EQ-5D-5L (.220 < r < .716) were found. The regression analysis revealed that CSI, TSK-11, and HADS-D explained 44.8% of the variance of EQ-5D-5L (r2 adjusted: .448). This study found the presence of sensitization-associated and neuropathic-like symptoms as well as other central nervous system-derived symptoms, such as anxiety, depression, poor sleep, pain catastrophizing, and kinesiophobia in 25% of ILD patients with pain. Sensitization-associated symptoms, depression, and kinesiophobia were associated with a worse quality of life. These findings would support that individuals with ILD can exhibit different pain phenotypes, including nociplastic-like pain phenotype based on self-reported measurements. PERSPECTIVE: Pain in patients with ILD can fulfill features of different phenotypes, including nociplastic pain, when sensory, emotional, and cognitive mechanisms are involved at the same time.

Tackling Kinesiophobia in Chronic Shoulder Pain: A Case Report on the Combined Effect of Pain Education and Whole-Body Cryostimulation

BACKGROUND

Chronic shoulder pain may cause significant functional disability and reduced psychosocial well-being. Detailed Case Description: In this case, we propose the use of pain neuroscience education and whole-body cryostimulation (WBC) to treat a 64-year-old woman with severe functional limitations and chronic right shoulder pain. The aim was to overcome kinesiophobia and improve her motor function, autonomy, and quality of life. Functional and clinical assessments were conducted at admission, discharge, and at a one-month follow-up via phone call. The patient's global health, shoulder function, and quality of life showed improvement during hospitalisation and were maintained after one month.

DISCUSSION

Pain education is crucial in managing chronic shoulder pain, especially in addressing kinesiophobia and promoting positive patient outcomes. In this context, WBC was used as a supplementary treatment to traditional pain relief and exercise tolerance therapies. This can help individuals to participate more actively in their rehabilitation process, ultimately promoting functional recovery and an improved quality of life.

CONCLUSION

The combination of cryostimulation, tailored physical exercises, pain education, manual therapy, and psychological support created a synergistic effect that addressed both the physical and psychological aspects of pain and 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.

Clinical Presentation Differences Among Four Subtypes of Femoroacetabular Impingement: A Case-Control Study

OBJECTIVE

The aims of this study were to assess the psychological, functional, and physical differences between patients with femoroacetabular impingement (FAI) syndrome and individuals who were asymptomatic (controls) to analyze clinical differences among 4 subtypes of FAI (cam type, cam type with labral tear, pincer type, and pincer type with labral tear), to calculate the correlations among the variables described, and to identify risk factors contributing to the hip function variance.

METHODS

A case-control study was conducted at a hospital rehabilitation unit with a cohort of individuals who were asymptomatic (controls) and a cohort of patients with FAI. Sociodemographic characteristics, pain intensity, psychological health status, hip range of motion (RoM), hip isometric strength, and hip function were assessed.

RESULTS

A total of 69 controls and 69 patients with FAI were analyzed. Although sociodemographic characteristics were comparable between samples, poorer hip RoM, strength, and psychological health were found for the cases. FAI subtypes showed no significant pain intensity, psychological health, or RoM differences (except for hip adduction), but hip strength differed among FAI subtypes. Multiple significant correlations between psychological health, pain intensity, RoM, strength, and hip function were found. The variance values of the International Hip Outcome Tool, Hip Outcome Score (HOS) for daily living activities, and HOS for sports activities were partially explained (47.6%, 36.0%, and 21.6%, respectively) on the basis of kinesiophobia, hip strength, self-efficacy, and anxiety.

CONCLUSION

Patients with FAI showed poorer psychological health, hip RoM, and strength than individuals who were asymptomatic and had similar sociodemographic characteristics. FAI subtype influenced the patients' clinical presentations. Hip strength, kinesiophobia, anxiety, and self-efficacy should be targeted for improving hip function, as they have been demonstrated to be important contributors to hip disability.

IMPACT

This study demonstrated that pain catastrophizing, hip strength, and hip adduction differed among FAI subtypes. However, hip function and pain intensity were comparable between FAI subtypes.

To what degree patient-reported symptoms of central sensitization, kinesiophobia, disability, sleep, and life quality associated with 24-h heart rate variability and actigraphy measurements?

OBJECTIVES

Chronic musculoskeletal pain is associated with decreased parasympathetic and increased sympathetic activity in the autonomic nervous system. The objective of this study was to determine the associations between objective measures of heart rate variability (a measure of autonomic nervous system function), actigraphy (a measure of activity and sleep quality), respiration rates, and subjective patient-reported outcome measures (PROMs) of central sensitization, kinesiophobia, disability, the effect of pain on sleep, and life quality.

METHODS

Thirty-eight study subjects were divided into two subgroups, including low symptoms of central sensitization (n = 18) and high symptoms of central sensitization (n = 20), based on patient-reported scores on the Central Sensitization Inventory (CSI). Heart rate variability (HRV) and actigraphy measurements were carried out simultaneously in 24 h measurement during wakefulness and sleep.

RESULTS

A decrease in HRV during the first 2 h of sleep was stronger in the low CSI subgroup compared to the high CSI subgroup. Otherwise, all other HRV and actigraphy parameters and subjective measures of central sensitization, disability, kinesiophobia, the effect of pain on sleep, and quality of life showed only little associations.

DISCUSSION

The high CSI subgroup reported significantly more severe symptoms of disability, kinesiophobia, sleep, and quality of life compared to the low CSI subgroup. However, there were only small and nonsignificant trend in increased sympathetic nervous system activity and poorer sleep quality on the high central sensitization subgroup. Moreover, very little differences in respiratory rates were found between the groups.

Variables associated with nonresponders to high-frequency (10 kHz) spinal cord stimulation

INTRODUCTION

The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high-frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention.

MATERIALS AND METHODS

This was a retrospective single-center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences.

RESULTS

The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self-perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant.

CONCLUSION

Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self-perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre-rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation.

Joint position sense testing at the wrist and its correlations with kinesiophobia and pain intensity in individuals who have sustained a distal radius fracture: A cross-sectional study

BACKGROUND

Sensorimotor impairment following distal radius fracture (DRF) has been associated with a significant decline in function. Joint position sense (JPS) testing is a meaningful and responsive way to assess sensorimotor impairment for individuals who have sustained a DRF; however, there are factors that may influence the results of JPS testing, including kinesiophobia and pain intensity.

PURPOSE

This study aimed to evaluate the influence kinesiophobia may have on wrist JPS testing and if pain intensity impacts kinesiophobia and JPS in individuals with a DRF.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Participants referred from two medical centers with a diagnosis of DRF treated with at least 3 weeks of immobilization were enrolled in the study. Data were collected at 1 week and 6 weeks postimmobilization period. Demographics were summarized with descriptive statistics, and linear relationships between kinesiophobia, pain intensity, and wrist JPS were examined using Pearson correlation coefficient.

RESULTS

Forty-eight participants were included in this study (mean age 42.9 years). Significant positive correlations were found between the Tampa Scale for Kinesiophobia (TSK) and Numeric Rating Scale (NRS; r = 0.951, p < 0.001), TSK and JPS error (r = 0.942, p < 0.001), as well as NRS and JPS error (r = 0.898, p < 0.001). These correlations indicate that higher levels of kinesiophobia are associated with increased pain intensity and greater JPS error. T-tests reveal no significant difference between male and female for the TSK, NRS, or JPS scores.

CONCLUSIONS

There is an association for individuals with high levels of kinesiophobia and both greater pain and errors with JPS testing.

Digging deeper into pain: an ethological behavior assay correlating well-being in mice with human pain experience

ABSTRACT

The pressing need for safer, more efficacious analgesics is felt worldwide. Preclinical tests in animal models of painful conditions represent one of the earliest checkpoints novel therapeutics must negotiate before consideration for human use. Traditionally, the pain status of laboratory animals has been inferred from evoked nociceptive assays that measure their responses to noxious stimuli. The disconnect between how pain is tested in laboratory animals and how it is experienced by humans may in part explain the shortcomings of current pain medications and highlights a need for refinement. Here, we survey human patients with chronic pain who assert that everyday aspects of life, such as cleaning and leaving the house, are affected by their ongoing level of pain. Accordingly, we test the impact of painful conditions on an ethological behavior of mice, digging. Stable digging behavior was observed over time in naive mice of both sexes. By contrast, deficits in digging were seen after acute knee inflammation. The analgesia conferred by meloxicam and gabapentin was compared in the monosodium iodoacetate knee osteoarthritis model, with meloxicam more effectively ameliorating digging deficits, in line with human patients finding meloxicam more effective. Finally, in a visceral pain model, the decrease in digging behavior correlated with the extent of disease. Ultimately, we make a case for adopting ethological assays, such as digging, in studies of pain in laboratory animals, which we believe to be more representative of the human experience of pain and thus valuable in assessing clinical potential of novel analgesics in animals.

Linking patient reported shoulder outcomes to the international classification of functioning, disability and health

PURPOSE

To link the items from shoulder-specific Patient Reported Outcome Measures (PROMs) to the International Classification of Functioning, Disability and Health (ICF) domains and categories, and to determine if the items fit into the ICF framework.

MATERIALS AND METHODS

The Brazilian versions of the Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST) and Western Ontario Rotator Cuff Index (WORC) were linked to the ICF by two researchers independently. Agreement between raters was determined by calculating the Kappa Index.

RESULTS

Fifty-eight items from the PROMs were linked to eight domains and 27 categories of ICF. The PROMs covered components of body functions, activities, and participation. Components of body structure and environmental factors were not covered by any of the PROMs. ​There was substantial agreement between raters when linking the OSS (Kappa index = 0.66), SPADI (Kappa index = 0.92), SST (Kappa index = 0.72) and WORC (Kappa index = 0.71).

CONCLUSIONS

WORC and SST were the PROMs that covered the highest number of ICF domains (seven and six, respectively). However, SST is short and may be less time consuming in a clinical assessment. Clinicians can benefit from this study to decide which shoulder-specific PROM may be more adequate according to the clinical demand.Implications For RehabilitationWestern Ontario Rotator Cuff Index was the shoulder-specific Patient Reported Outcome Measure (PROM) that best showed a broader view of functionality through the International Classification of Functioning, Disability and Health (ICF) domains that can influence shoulder pain and disability.Simple Shoulder Test seems to be the most recommended shoulder-specific PROM considering the number of domains covered by the ICF and the clinical evaluation time consumption.Shoulder Pain and Disability Index fails to provide a broader view of functioning through other ICF domains that may influence shoulder pain and disability.

Impact of yoga asanas on flexion and relaxation phenomenon in women with chronic low back pain: Prophet model prospective study

Chronic nonspecific low back pain (NSLBP) is a prevalent condition with socioeconomic and healthcare challenges. The flexion-relaxation phenomenon (FRP) evaluation is a valid clinical tool for low back pain (LBP) assessment. Yoga, a holistic mind-body practice, has been explored as an LBP intervention. This study aimed to evaluate the impact of yoga asanas on the FRP in women with NSLBP. The study included healthy and chronic NSLBP females who underwent an eight-session yoga asanas program, with the first session conducted in-clinic and the rest delivered with tele-approach. Outcome measures included pain intensity, flexion-relaxation ratio (FRR), and trough surface electromyography collected during trunk maximum voluntary flexion (MVF). The study included 11 healthy and 10 NSLBP women. Repeated measures test in chronic NSLBP group showed a significant decrease in pain intensity after the 4 weeks follow-up (visual analog scale [VAS]: 6.80 ± 1.48 vs. 3.30 ± 1.25; p < 0.001) and an FRR improvement after the intervention (5.12 ± 0.93 vs. 9.49 ± 0.92; p < 0.001). VAS and FRR effect sizes were 0.77 and 0.47, respectively. Therefore, we performed a Prophet evaluation to assess FRR trends, finding a growth rate (k) of 0.405 ± 0.448, with a forecast 1 month after the end of the intervention approaching the trend line of the control group. The findings suggested that tele-yoga asana might have a positive impact on pain intensity and the FRP in chronic LBP. Further research is warranted to confirm the long-term effects of yoga for managing LBP.

The relationship of kinesiophobia in patients with lymphedema: a case-control investigation

Introduction

Kinesiophobia and lymphedema appear to be related conditions, and it is important to understand this relationship, as many of the symptoms and comorbidities presented by individuals with lower limb lymphedema are prevented and treated through movement, thus constituting kinesiophobia as a barrier to intervention. The objective of this study is, therefore, to evaluate and analyze the kinesiophobic beliefs reported by individuals with and without lower limb lymphedema, regarding the agreement, severity and differences found, and to establish levels of kinesiophobia.

Methods

A case-control study with a total sample of 80 participants (40 with lower limb lymphedema and 40 without) was performed. Both groups (with and without lymphedema) were characterized anthropologically, sociodemographically, and clinically. In the case group, lymphedema was evaluated. Participants in both groups completed the Tampa Scale for Kinesiophobia - 13 items (TSK-13).

Results

Individuals with lower limb lymphedema had higher TSK-13 scores than their matched group without lymphedema. The items belonging to the activity avoidance subscale had the highest agreement and score in both groups. Differences between groups were mainly established for items belonging to the somatic focus subscale, showing that individuals with lower limb lymphedema have kinesiophobic beliefs related to the perceived severity of their lymphedema. The prevalence of kinesiophobia was increased in both groups, but the severity was mild.

Conclusions

Considering the apparent tendency of people with lower limb lymphedema to present kinesiophobia and movement-limiting beliefs regarding the condition, greater attention should be paid to its assessment, prevention and treatment from a multidisciplinary and multimodal perspective, which takes into account the multiplicity of factors inherent to kinesiophobia and lymphedema and thus reduce their impact on the management of lymphedema.

Is Adding Education to Trunk and Hip Exercises Beneficial for Patellofemoral Pain? A Randomized Controlled Trial

OBJECTIVE

To investigate the effect of adding education to trunk and hip exercises in patients with patellofemoral pain (PFP).

DESIGN

A randomized controlled trial.

SETTING

Research laboratory.

PARTICIPANTS

Sixty patients with PFP (N=60) were randomly assigned to either an experimental group (education followed by trunk and hip exercises, n=30) or a control group (trunk and hip exercises, n=30).

INTERVENTIONS

Both groups received 8 weeks of trunk and hip exercises, while patients in the experimental group participated in 3 prior education sessions.

MAIN OUTCOME MEASURES

The primary outcome was pain; secondary outcomes were pain catastrophizing, kinesiophobia, function, and muscle strength. Outcomes were assessed at baseline, after 8 weeks (post-intervention), and 3 months post-intervention (follow-up).

RESULTS

No significant between-group differences were observed for pain outcome post-intervention. The experimental group showed superiority over the control group in the improvement of pain catastrophizing (mean difference: -2.32; 95% confidence interval [CI] -1.059 to 0.028) and kinesiophobia (mean difference: -3.56; 95% CI -1.067 to -0.035) at post-intervention. In the experimental group, improvements were maintained at follow-up assessment for all outcomes, except muscle strength.

CONCLUSION

Adding education to trunk and hip exercises was associated with greater improvements in psychological outcomes than trunk and hip exercises alone after the intervention. Education can be incorporated when designing trunk and hip exercises for patients with PFP.

Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review

Breast cancer is the most commonly diagnosed cancer among women and many women suffer from persistent physical and psychological complaints following their cancer treatment. Altered motor behavior at the shoulder region and upper limb, that is, alterations in movement patterns, spatiotemporal movement characteristics and muscle activation patterns, is a common physical consequence of breast cancer treatment, that can have a clear impact on daily life functioning and quality of life. Furthermore, altered upper limb motor behavior is suggested to relate to upper limb pain, which is very commonly reported in breast cancer survivors (BCS). This review, prepared according to the SANRA guidelines, looks into the current understanding of alterations in motor behavior at shoulder and upper limb in BCS, by discussing the factors related to this altered behavior. In this, we specifically focus on the relation between motor behavior and pain. Results of our search show that cancer treatment modality is predictive for shoulder range of motion. Furthermore, single prospective studies show depressive symptoms, living alone, being non-white and low physical activity levels as predicting factors for reduced shoulder range of motion. Pain as factor related to altered motor behavior is only assessed in cross-sectional research, limiting its interpretation in context of being cause or consequence of motor behavioral adaptations, and on the underlying mechanism explaining their relation. It is concluded that studies which explain the mechanisms how and in which subgroup of BCS motor behavioral alterations are associated with pain at the upper limb, are necessary in future.

Which Psychological and Psychosocial Constructs Are Important to Measure in Future Tendinopathy Clinical Trials? A Modified International Delphi Study With Expert Clinician/Researchers and People With Tendinopathy

OBJECTIVE: To identify which psychological and psychosocial constructs to include in a core outcome set to guide future clinical trials in the tendinopathy field. DESIGN: Modified International Delphi study. METHODS: In 3 online Delphi rounds, we presented 35 psychological and psychosocial constructs to an international panel of 38 clinician/researchers and people with tendinopathy. Using a 9-point Likert scale (1 = not important to include, 9 = critical to include), consensus for construct inclusion required ≥70% of respondents rating "extremely critical to include" (score ≥7) and ≤15% rating "not important to include" (score ≤3). Consensus for exclusion required ≥70% of respondents rating "not important to include" (score ≤3) and ≤15% of rating "critical to include" (score ≥7). RESULTS: Thirty-six participants (95% of 38) completed round 1, 90% (n = 34) completed round 2, and 87% (n = 33) completed round 3. Four constructs were deemed important to include as part of a core outcome set: kinesiophobia (82%, median: 8, interquartile range [IQR]: 1.0), pain beliefs (76%, median: -7, IQR: 1.0), pain-related self-efficacy (71%, median: 7, IQR: 2.0), and fear-avoidance beliefs (73%, median: -7, IQR: 1.0). Six constructs were deemed not important to include: perceived injustice (82%), individual attitudes of family members (74%), social isolation and loneliness (73%), job satisfaction (73%), coping (70%), and educational attainment (70%). Clinician/researchers and people with tendinopathy reached consensus that kinesiophobia, pain beliefs, pain self-efficacy, and fear-avoidance beliefs were important psychological constructs to measure in tendinopathy clinical trials. J Orthop Sports Phys Ther 2024;54(1):1-12. Epub 20 September 2023. doi:10.2519/jospt.2023.11903.

The relationship between kinesiophobia severity and clinical parameters in patients with mechanical low back pain

BACKGROUND

Low back pain is an important widespread health problem that can occur at any age, causing serious socioeconomic losses.

OBJECTIVE

The objective of this study is to investigate the relationship between kinesiophobia severity and pain severity, depression, and quality of life in patients with mechanical low back pain.

METHODS

The study sample consisted of 155 patients, of whom 72 were female and 83 were male, aged between 18 and 75 years with mechanical low back pain. Quality of life was assessed with the 36-Item Short Form Health Survey (SF-36), pain intensity with the Visual Analogue Scale (VAS), kinesiophobia with the Tampa Kinesiophobia Scale (TKS), and depression with the Beck Depression Inventory (BDI). Patients were divided into the low (TKS ⩽ 37) and high kinesiophobia (TKS > 37) groups according to the scores they obtained from TKS.

RESULTS

VAS-pain severity and BDI scores were significantly higher in the high kinesiophobia group than in the low kinesiophobia group (p< 0.001). On the other hand, the SF-36 subscale scores were significantly higher in the low kinesiophobia group than in the high kinesiophobia group (p< 0.001). The TKS scores were moderately correlated with VAS-pain severity (r= 0.470; p< 0.001) and BDI scores (r= 0.584; p< 0.001) in the positive direction, and strongly correlated with all sub-parameters of quality of life in the negative direction (p< 0.001).

CONCLUSION

The results indicated that the severity of kinesiophobia in patients with non-inflammatory low back pain is associated with pain severity, depression, and poor quality of life.

Pain alleviation improves balance control and muscular coordination of lower limbs in patients with chronic ankle instability during sinusoidal perturbations

BACKGROUND

It is well established that individuals with chronic ankle instability manifest deficits in balance control and muscle activation. Given the prevalence of pain as a prominent symptom in this population, there is a need for in-depth investigation of its role in contributing to these impairments.

METHODS

A Stewart platform was used to generate translational sinusoidal perturbations in the antero-posterior direction. Eighteen individuals with chronic ankle instability and concurrent ankle pain were recruited. They were instructed to assume a central stance on the support surface with open eyes both before and 30 min after local analgesia. Data of center of pressure and electromyography of the tibialis anterior and medial gastrocnemius were recorded. Statistical analysis was performed to make comparisons pre- and post-analgesia using two-tailed paired t-test for the continuous variables.

FINDINGS

Pain intensity was significantly decreased after local anesthetic injections. Antero-posterior center of pressure parameters significantly decreased following the injection. Also, there was an increase in the regularity of the center of pressure pattern. The electromyographic pattern of the tibialis anterior and medial gastrocnemius exhibited various activation patterns. After pain alleviation, the characteristic electromyographic response of the tibialis anterior and medial gastrocnemius was reciprocal contraction and relaxation that corresponded with the sinusoidal pattern of the perturbations.

INTERPRETATION

Individuals who had chronic ankle instability and ankle pain demonstrated impaired balance control during sinusoidal perturbations. Mitigating pain improved their balance performance, evident in the center of pressure pattern and the coordination of lower limb muscles.

The effects of kinesiophobia on postural control with chronic ankle instability

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.

Cross-cultural adaptation and validation of the Mental Health Quality of Life (MHQoL) questionnaire in a Chinese-speaking population with chronic musculoskeletal pain

BACKGROUND

The Mental Health Quality of Life (MHQoL) questionnaire is concise and suitable for rapid assessment of CMP (chronic musculoskeletal pain) patients in primary care. However, there is a lack of Chinese versions of the MHQoL.

OBJECTIVE

To cross-culturally translate the MHQoL into Chinese and to assess its psychometric properties in Chinese-speaking patients with CMP.

METHODS

The MHQoL was translated into Chinese according to the International Guidelines for the Cross-Cultural Adaptation of Self-Report Measures. 171 CMP patients were recruited to receive the Chinese versions of the MHQoL, SF-36, and HADS tests, and the MHQoL was retested seven days later.

RESULT

The Chinese version of MHQoL had good retest reliability (MHQoL-7D: ICC = 0.971; MHQoL-VAS: ICC = 0.988) and internal consistency (Cronbach's alpha = 0.829). It showed a moderate correlation with the SF-36 total score (r=-0.509); the MHQoL-VAS moderately correlated with the Hospital Anxiety Depression Scale (r=-0.548). The MHQoL-7D showed no correlations with the SF-36's PF (r=-0.083) and BP (r=-0.170), weak correlations with RP (r=-0.284), RE (r=-0.298), and SF (r=-0.380), and moderate-to-strong correlations with GH (r=-0.638), VT (r=-0.480), and MH (r=-0.632).

CONCLUSION

The Chinese version of the MHQoL can be used in clinical practice and research in Chinese-speaking CMP patients.

"Restoring That Faith in My Shoulder": A Qualitative Investigation of How and Why Exercise Therapy Influenced the Clinical Outcomes of Individuals With Rotator Cuff-Related Shoulder Pain

OBJECTIVE

Rotator cuff-related shoulder pain (RCRSP) is the most common form of shoulder pain. Exercise therapy is a first-line recommended treatment for RCRSP. However, the causal mechanisms underpinning the benefits of exercise for RCRSP are not well understood. Moreover, how individuals with lived experience of RCRSP believe exercise helped or did not help them is unknown. This study aimed to gain insights into how individuals with RCRSP believe exercise influenced their shoulder pain and identify the clinical conditions that promoted or inhibited their beliefs.

METHODS

This qualitative study was underpinned by a critical realist approach to thematic analysis. Participants were recruited using hybrid purposive and convenience sampling techniques. Each participant attended an online semi-structured interview. The data were coded by 2 members of the research team (J.K.P. and N.C.) and verified by a third (B.S.). Recruitment continued until theoretical sufficiency was achieved. Participants reviewed and validated preliminary causal explanations.

RESULTS

Three causal explanations were consistently expressed by 11 participants to explain the benefits of exercise therapy: (1) shoulder strength; (2) changes to psychoemotional status; and (3) exercise has widespread health effects. However, the activation of these causal mechanisms depended on (1) the presence of a strong therapeutic relationship; (2) the provision of a structured and tailored exercise program; and (3) experiencing timely clinical progress.

CONCLUSION

Participants believed exercise improved their shoulder pain through associated health benefits, improved shoulder strength, and psychoemotional variables. Whether an exercise program was able to cause a clinical improvement for an individual with RCRSP was contingent on clinical contextual features. Thus, the clinical context that an exercise program is delivered within may be just as important as the exercise program itself.

IMPACT

Exercise is a recommended first-line intervention to manage RCRSP. The results of this study suggest that a positive experience and outcome with exercise for RCRSP is contingent on several clinical contextual features, such as a strong therapeutic relationship. The clinical context that an exercise program is prescribed and delivered within should be considered by clinicians.

Gait speed and kinesiophobia explain physical activity level in adults with osteoarthritis: A cross-sectional study

Identifying potential contributing factors for physical inactivity in people with knee osteoarthritis is vital for designing practical activity promoting interventions. Walking is a common activity, but it is unknown how gait characteristics may influence physical activity and if psychological factors, specifically fear of movement (kinesiophobia), contribute to this relationship. The aim of our study was to investigate the contributions of select gait parameters and kinesiophobia to activity levels. Cross-sectional data from 40 participants (F 24|M 16; age 57.6 ± 8.9 years; BMI 34.7 ± 7.0 kg/m2 ) with uni- or bilateral knee osteoarthritis were included. Physical activity and kinesiophobia were assessed by self-report using the University of California, Los Angeles activity rating scale, and Tampa scale for kinesiophobia, respectively. Gait parameters were collected with three-dimensional gait analysis while participants walked on an instrumented split-belt treadmill at a self-selected speed. Higher peak sagittal plane joint moments at the ankle (ρ = 0.418, p = 0.007), and hip (ρ = 0.348, p = 0.028), faster self-selected gait speed (ρ = 0.553, p < 0.001), and less kinesiophobia or fear of movement (ρ = -0.695, p < 0.001) were independently related to higher physical activity level in adults with knee osteoarthritis. In hierarchical regression models, after accounting for covariates, only self-selected gait speed, and kinesiophobia significantly contributed to explaining the variation in physical activity level. Statement of clinical significance: Interventions aimed at improving physical activity participation in those with lower limb osteoarthritis should consider assessing the contribution of pain-related fear of movement.

Barriers, perceived benefits and preferences to exercise in adults with an opioid use disorder in the U.S

Introduction

Over 10 million Americans misuse opioids and more than 5 million have been diagnosed with an opioid use disorder (OUD). In 2021, over 100,000 Americans died of a drug overdose and more than 75% of these deaths involved an opioid. Exercise has been shown to increase abstinence and decrease anxiety and depression in people with a substance use disorder. However, only a few small trials have focused on persons with OUD who often experience additional challenges including chronic pain, mental health disorders and cardio-metabolic abnormalities.

Methods

We aimed to describe the barriers, perceived benefits and preferences to exercise in adults with OUD in residential treatment in the U.S. as part of a larger study. We conducted 33 individually administered, semi-structured interviews and transcribed audiotapes verbatim, conducted coding and thematic analysis using NVivo v12 software (QSR International Inc.).

Results

Our sample had nearly equal representation of males and females and, was predominantly Caucasian (88%) with a mean of age of 34.5 (s.d. 7.5) years old. Participants stated that exercise helps to reduce drug cravings, anxiety, depression and pain and improve mood, physical health and build "normalcy". Barriers included lack of time, access to resources, fear of poor health and triggering pain. Participants preferred moderate intensity exercise 3 times/week and 30-60 min sessions.

Conclusions

Our findings indicate that adults with OUD believe exercise is a valuable tool to use in their recovery but they encounter several barriers. Many barriers, however, could be overcome with structured programs offered by residential treatment centers.

Kinesiophobia and Associated Factors in Patients With Myocardial Infarction

Kinesiophobia is a well-known barrier to positive clinical outcomes among patients with various diseases, but there remain few comprehensive studies of kinesiophobia among patients with myocardial infarction (MI). In this cross-sectional study, we investigated the presence of kinesiophobia and its relationship with clinical outcomes among 42 patients with MI who completed the Tampa Scale of Kinesiophobia Swedish Version for Heart (TSK-SV Heart) the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the Six-Minute Walk Test (6MWT), the Hospital Anxiety and Depression Scale (HADS), the modified Medical Research Council (mMRC) Dyspnea Scale, the Charlson Comorbidity Index (CCI), and the MacNew Heart Disease Health-Related Quality of Life Questionnaire. The participants' mean TSK-SV Heart score was 39.24 (SD = 6.65), and 71.4% of these patients reported a high level of kinesiophobia. The TSK-SV Heart score demonstrated a strong correlation with the IPAQ-SF, 6MWT walking distance, and mMRC score (p < .001), and a moderate correlation with the HADS, CCI, and MacNew Heart Disease HRQoL (p < .05). Patients with a high level of kinesiophobia had lower IPAQ-SF, 6MWT walking distance, and HRQoL and higher mMRC, CCI, and HADS scores than patients with low levels of kinesiophobia (p < .05). Kinesiophobia was common and represented a considerable risk factor for physical-psychosocial dysfunctions in these patients with MI. To maintain functional independence and to increase physical activity level, clinicians should consider kinesiophobia from early to late-stage disease and should add a treatment focus that seeks to eliminate kinesiophobia in cardiac rehabilitation programs.

The relationship of pain, disability, physical activity, and body awareness with kinesiophobia in pregnant women with low back pain

PURPOSE/AIM

To investigate the relationship of pain intensity, disability level, physical activity level, and body awareness with kinesiophobia in pregnant women with low back pain (LBP).

MATERIALS AND METHODS

This cross-sectional study was conducted in the obstetrics and gynaecologic clinic of a tertiary centre. Eighty-six pregnant women were included in the study. Pain intensity, disability level, physical activity, body awareness, and kinesiophobia were assessed with a Visual Analogue Scale, the Oswestry Disability Index (ODI), the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the Body Awareness Questionnaire (BAQ), and the Tampa Scale for Kinesiophobia (TSK), respectively.

RESULTS

Kinesiophobia score was high in pregnant women with LBP (40.01 ± 9.02). In pregnant women with LBP, a weak positive correlation was found between kinesiophobia with mean intensity of LBP (r = 0.339, p = 0.001) and intensity of LBP in activity (r = 0.283, p = 0.008); a moderate positive correlation between kinesiophobia and disability score (r = 0.539, p = 0.001); and a weak negative correlation between kinesiophobia and physical activity level (r = -0.308, p = 0.004) and body awareness (r = -0.324, p = 0.002). There was no relationship between kinesiophobia and intensity of LBP at rest (r = 0.160, p = 0.142) and nocturnal LBP intensity (r = 0.176, p = 0.105).

CONCLUSIONS

LBP intensity, disability level, physical activity level, and body awareness were significantly correlated with kinesiophobia in pregnant women with LBP. Therefore, kinesiophobia may be addressed as an important issue in pregnancy education programs.

Multifidus dysfunction and restorative neurostimulation: a scoping review

OBJECTIVE

Chronic low back pain (CLBP) is multifactorial in nature, with recent research highlighting the role of multifidus dysfunction in a subset of nonspecific CLBP. This review aimed to provide a foundational reference that elucidates the pathophysiological cascade of multifidus dysfunction, how it contrasts with other CLBP etiologies and the role of restorative neurostimulation.

METHODS

A scoping review of the literature.

RESULTS

In total, 194 articles were included, and findings were presented to highlight emerging principles related to multifidus dysfunction and restorative neurostimulation. Multifidus dysfunction is diagnosed by a history of mechanical, axial, nociceptive CLBP and exam demonstrating functional lumbar instability, which differs from other structural etiologies. Diagnostic images may be used to grade multifidus atrophy and assess other structural pathologies. While various treatments exist for CLBP, restorative neurostimulation distinguishes itself from traditional neurostimulation in a way that treats a different etiology, targets a different anatomical site, and has a distinctive mechanism of action.

CONCLUSIONS

Multifidus dysfunction has been proposed to result from loss of neuromuscular control, which may manifest clinically as muscle inhibition resulting in altered movement patterns. Over time, this cycle may result in potential atrophy, degeneration and CLBP. Restorative neurostimulation, a novel implantable neurostimulator system, stimulates the efferent lumbar medial branch nerve to elicit repetitive multifidus contractions. This intervention aims to interrupt the cycle of dysfunction and normalize multifidus activity incrementally, potentially restoring neuromuscular control. Restorative neurostimulation has been shown to reduce pain and disability in CLBP, improve quality of life and reduce health care expenditures.

The effect of virtual reality on pain, kinesiophobia and function in total knee arthroplasty patients: A randomized controlled trial

BACKGROUND

Virtual reality (VR) has emerged as a promising new therapeutic approach, showing promise in the treatment of patients with a variety of diseases. This study aimed to investigate the effect of VR on pain, kinesiophobia, and function in patients undergoing total knee arthroplasty (TKA).

METHODS

This randomized controlled trial was performed on patients who had TKA due to osteoarthritis at Gazi University Hospital from October 2019 to August 2021. For this study, 21 female TKA patients were divided into two groups by the blocked randomization method: VR (n = 10) and exercise (n = 11). The exercise group was given a home exercise program. The VR group received immersive VR application in addition to the exercise. Pain, kinesiophobia, pain catastrophizing, knee range of motion, functional status, and quality of life were assessed. The Wilcoxon Test and Mann-Whitney U Test were used for comparison of the results.

RESULTS

The VR group had a statistically significant difference in the intensity of pain at rest, at night, and during the Timed Up and Go Test (TUG), kinesiophobia, pain catastrophizing, active knee flexion, the TUG, and the stair-climb test scores (P = 0.005 (95% confidence interval (CI) (-5.000, -1.000)), P = 0.005 (95% CI (-7.000, -2.000)), P = 0.023 (95% CI (-4.000, 0)), P = 0.006 (95% CI (-15.000, -3.000)), P = 0.012 (95% CI (-19.000, -3.000)), P = 0.010 (95% CI (4.000, 17.333)), P = 0.017 (95% CI (-14.700, -0.850)), P = 0.011 (95% CI (-23.100, -1.000)), respectively).

CONCLUSION

In the early period following total knee arthroplasty, using virtual reality integrated with exercise helps to reduce pain, kinesiophobia and pain catastrophizing, and to improve functional outcomes in female patients.

Factors associated with persistent pain in college athletes with a history of lateral ankle sprain

OBJECTIVES

To determine the factors associated with and prevalence of persistent pain in college athletes with chronic ankle instability (CAI) and with previous lateral ankle sprain (LAS) without CAI.

DESIGN

Cross-Sectional Study.

SETTING

Online survey at one university.

PARTICIPANTS

Of the 385 respondents surveyed online, 140 were identified as having experienced at least one LAS (CAI group: 69, coper group: 24, LAS group not classified as either: 47).

MAIN OUTCOME MEASURES

Factors associated with the presence of pain during activities of daily living (ADL) and sports were identified using multivariate logistic regression analyses. Independent variables were demographics, injury characteristics, the Identification of Functional Ankle Instability (IdFAI) score, the Foot and Ankle Ability Measure Sports (FAAM-Sports) and ADL subscales, and the Tampa Scale for Kinesiophobia-11 score.

RESULTS

The prevalence of pain during ADL and sports in the three groups was 16.7%-42.0% and 33.3%-56.5%, respectively. FAAM-Sports and IdFAI score were significantly associated with pain during ADL and sports in the CAI group (odd ratio: 0.923 and 1.145), respectively. No significant pain-related factors were found in the coper and LAS groups.

CONCLUSIONS

Lower self-reported function and greater perceived ankle instability may be important factors in pain management in athletes with CAI.

Exploring the pain and disability continuum in adolescents with non-traumatic anterior knee pain: a mediation analysis using individual participant data of prospective studies

OBJECTIVE

To use individual patient data (IPD) to investigate if the effect of pain on sports-related disability is mediated through physical (lower extremity isometric strength) or psychological (depression/anxiety and knee confidence) factors in adolescents with non-traumatic anterior knee pain.

METHODS

This study included four datasets from a previously harmonised IPD dataset. Prior to analysis, the protocol and analysis approach were predefined and published on Open Science Framework. Potential mediators were pre-sepcified as isometric knee and hip strengths, self-reported anxiety/depression and confidence in the knee, allmeasured at 12 weeks after baseline evaluation. Mediation analyses were undertaken using the CMAVerse package in RStudio using the regression-based approach to decompose the total effect of the exposure (pain at baseline evaluation) on the outcome (sports-related disability at 6 months) into the 'indirect effect' (the portion of the total effect acting through the mediators) and the 'direct effect'.

RESULTS

Two-hundred and seventy-nine adolescents with non-traumatic knee pain were included in the analysis. Median age was 13 (range 10-19), and 72% were women. Baseline pain was associated with sports-related disability at 6 months. There was no evidence of the association being mediated by any of the proposed mediators (total natural indirect effect for strength 0.01 (-1.14 to 1.80) and psychological factors 0.00 (-0.66 to 2.02)).

CONCLUSION

We found an effect of pain on sports-related disability at 6 months which appears to be independent of lower extremity muscle strength, or depression/anxiety and knee confidence in adolescents with non-traumatic anterior knee pain.

Acute Effects of Whole-Body Electrostimulation Combined with Stretching on Lower Back Pain

Data from recent studies suggest that whole-body electromyostimulation (WB-EMS) is a time-effective and tailored intervention for chronic lower back pain (CLBP). The aim of this non-randomized controlled study was to compare the efficacy of a WB-EMS training and the association between WB-EMS specific training with passive stretching (Well Back System, [WBS]) on CLBP. Forty patients with CLBP, 43-81 years old, were assigned to one of the two groups: WB-EMS (n=20) and WB-EMS+WBS (n=20). Both groups completed 12 sessions (8 weeks) of the WB-EMS protocol (2×20 minutes/week). The second group performed core-specific exercises with WB-EMS plus 6 extra stretching sessions (30 minutes each). Primary study endpoints were based on changes on the visual analogue scale (VAS) and changes on the Oswestry Low Back Disability Questionnaire (ODI). Secondary study endpoints were percentage changes of maximum trunk flexion (Sit & Reach, [SR]) and changes in consumption of painkillers. Both interventions significantly improved VAS, ODI, and SR values (p range: 0.04;<0.001). However, the change of VAS (-46% vs. -17%, p<0.001), ODI (-53% vs. -17%, p<0.001), and SR (+ 7 vs.+3 cm, p=0.001) were significantly higher in the WB-EMS+WBS group compared to the WB-EMS group. The working method with WB-EMS+WBS can be a joint-friendly, individualized form to decrease CLBP.

Specific versus general exercise programme in adults with subacromial impingement syndrome: a randomised controlled trial

Objectives

Current evidence on the clinical effectiveness about the different types of exercises in the subacromial impingement syndrome (SIS) remains controversial. This study aims to compare the short-term (at 5 weeks) effects of a specific exercise programme with a general exercise programme on shoulder function in adults with SIS.

Methods

In total, 52 adults with SIS were randomly allocated to 5 weeks to perform specific exercises (experimental group, n=26) or general exercises (control group, n=26). The primary outcome was change in shoulder function, it was assessed using the Shoulder Pain and Disability Index (SPADI) from baseline to 5 weeks. Secondary end points included changes in upper limb function (Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire), pain intensity (Visual Analog Scale (VAS)) and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)).

Results

All participants completed the trial. The between-group differences at 5 weeks were: SPADI, 13.5 points (95% CI: 4.3 to 15.6; ƞ2=0.22; p=0.001); DASH, 10.1 points (95% CI: 5.6 to 15.2; ƞ2=0.27; p<0.001); VAS at rest, 0.2 cm (95% CI: 0.1 to 0.3; ƞ2=0.07; p=0.553); VAS on movement, 1.7 cm (95% CI: 0.9 to 2.2; ƞ2=0.24; p<0.001); and TSK, 16.3 points (95% CI: 13.2 to 15.3; ƞ2=0.33; p<0.001). All differences favoured the experimental group and effect sizes were medium to large for most outcomes. Mediation analyses showed that the effect of the specific exercises on shoulder function was mediated by kinesiophobia (β=2.800; 95% CI: 1.063 to 4.907) and pain on movement (β= -0.690; 95% CI: -1.176 to -0.271).

Conclusion

In adults with SIS, specific exercises may have a larger effect than general exercises. However, most differences did not reach the minimum threshold to be considered clinically important and the evidence to support exercise as standard treatment warrant further study.

Trial registration number

Brazilian Registry of Clinical Trials UTN number U111-1245-7878. Registered on 17 January 2020 (https://ensaiosclinicos.gov.br/rg/RBR-4d5zcg).

The effectiveness of cognitive behavioural therapy in chronic neck pain: A systematic review with meta-analysis

We evaluated the effects of Cognitive Behavioural Therapy (CBT) alone or with additional interventions on pain, disability, kinesiophobia, anxiety, stress, depression, quality of life, and catastrophizing of patients with chronic neck pain (CNP). Nineteen studies met the inclusion criteria, and fourteen studies were quantitatively analysed. Risk of bias was assessed using the PEDro scale and the certainty of evidence using the GRADE approach. Studies were pooled (where applicable) and subgroup analyses were performed for CNP, or whiplash associated disorders. Studies compared-directly or indirectly-CBT interventions to no treatment, conservative interventions such as exercise and/or physiotherapy, or multimodal interventions. We present effect estimates at 8-week, 12-week, 6-month, and 1-year follow-up. Low certainty evidence suggests a clinically significant pain reduction (short-term) favouring CBT with or without additional intervention compared to no intervention SMD = -0.73; 95%CI: -1.23 to -0.23). Very low and low certainty evidence suggest clinically significant improvements in kinesiophobia (very short-term SMD = -0.83; 95%CI: -1.28 to -0.39 and short-term SMD = -1.30, 95%CI: -1.60 to -0.99), depression SMD = -0.74, 95%CI: -1.35 to -0.14) and anxiety SMD = -0.76, 95%CI: -1.34 to -0.18) favouring a multimodal intervention with CBT (short-term) compared to other conservative interventions. Combining different types of CBT interventions resulted in potentially heterogeneous comparisons.

Correlates of musculoskeletal pain and kinesiophobia in older adults with heart failure: A structural equation model

The study aimed to study the influence of musculoskeletal pain on kinesiophobia in patients with heart failure. This cross-sectional study recruited 107 heart failure patients aged 73.18±12.68 years (57% men) from an outpatient setting. Participants self-reported pain using the Musculoskeletal System Assessment Inventory and the Cornell Musculoskeletal Discomfort Questionnaire. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia-11. About 62% reported musculoskeletal pain, with knees (16.8%) and lower back (12.%) being the most painful locations. About 31% reported moderate levels and 24% indicated high levels of kinesiophobia. There were positive and significant associations between the indicators of pain and kinesiophobia. Results showed an adequate structural equation model fit to the data with musculoskeletal pain factors explaining 22.09% of the variance in kinesiophobia. Assessment of kinesiophobia in patients with heart failure with musculoskeletal pain is essential to improve self-care and overall quality of life.

Associations of Pain Vigilance and Past and Current Pain with Kinesiophobia after Sport Injury in Current and Former Athletes from Iran and the United States

High levels of kinesiophobia (fear of movement/reinjury) have been related to reinjury and adverse injury rehabilitation outcomes in athletes. To examine the extent to which pain vigilance, memory of injury-related pain, and current injury-related pain were associated with kinesiophobia, a cross-sectional study was conducted with 172 current and former athletes from Iran (n = 113) and the United States (n = 59) who reported having experienced a serious injury that affected their participation or performance in sport. Questionnaires were administered to participants via an online survey platform. Hierarchical multiple regression analysis revealed that pain vigilance and memory of pain were positively associated with kinesiophobia, with the full model accounting for 31% of the variance in kinesiophobia scores. The findings suggest that excessive attention to pain-related stimuli and memory of pain for an injury that occurred an average of four years earlier may contribute to the experience of fear of movement and reinjury in current and former athletes.

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.

Effects of exercise/physical activity on fear of movement in people with spine-related pain: a systematic review

Background

Kinesiophobia (i.e., fear of movement) can be an important contributor for ongoing pain and disability in people with spine-related pain. It remains unclear whether physical activity interventions/exercise influence kinesiophobia in this population. A systematic review was therefore conducted to synthesize the available evidence on whether physical activity interventions/exercise influence kinesiophobia in people with chronic non-specific spine-related pain.

Methods

The study protocol was registered prospectively with PROSPERO (CRD42021295755). The following databases were systematically searched from inception to 31 January 2022 and updated on 22 June 2023: PubMed, MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, ZETOC, PROSPERO and Google Scholar. Inclusion criteria were randomized or non-randomized controlled studies investigating adults aged ≥18 years, reporting the effect of exercise or physical activity on kinesiophobia in individuals with chronic non-specific spine-related pain. Two reviewers independently extracted data and assessed the quality of the included studies. Bias was assessed using the Cochrane ROB2 tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results

Seventeen studies from seven countries involving a total of 1,354 individuals were selected for inclusion. The majority of studies (n = 13) involved participants with chronic low back pain (LBP), and Pilates was the most common form of exercise evaluated. Most of the studies reported a positive direction of effect in favor of exercise reducing kinesiophobia when compared to a control group. There was moderate to high risk of bias among the studies and the overall certainty of the evidence was very low.

Conclusion

This review supports the use of exercise for reducing kinesiophobia in people with chronic LBP albeit with very low certainty of evidence; Pilates (especially equipment-based) was shown to be effective as were strengthening training programmes. There was limited evidence available on the effects of exercise on kinesiophobia for people with chronic neck or thoracic pain and further research is required.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295755.

Preoperative and Postoperative Kinesiophobia Influences Postoperative Outcome Measures Following Anterior Cruciate Ligament Reconstruction: A Prospective Study

The anterior cruciate ligament (ACL) is the most injured ligament of the knee, and the treatment of choice is usually ACL reconstruction. Kinesiophobia refers to an irrational and paralyzing fear of movement caused by the feeling of being prone to injury or reinjury. The aim of the present study is to evaluate the relationship between preoperative and postoperative kinesiophobia with postoperative outcomes of ACL-R evaluated through SF-36, ACL-RSI, KOOS, and OKS scores. Included patients all underwent ACL reconstruction. The preoperative TSK-13 questionnaire and six-month postoperative TSK-13, ACL-RSI, SF-36, KOOS, and OKS questionnaires were assessed in included patients. Normal distribution was assessed using the Shapiro-Wilk test. The study included 50 patients who filled out the questionnaires at the 6-month postoperative follow-up. Correlations between preoperative TSK-13 and postoperative outcome measures revealed a low-moderate negative correlation between preoperative TSK-13 and SF-36 PCS at 6-month follow-up. Correlations between postoperative TSK-13 and postoperative outcome measures revealed a high negative correlation between preoperative TSK-13 and ACL-RSI, KOOS Symptoms, KOOS Pain, KOOS ADL, and OKS at 6-month follow-up. Preoperative and postoperative kinesiophobia were found to influence postoperative ACL-R outcomes negatively, more specifically an increase in kinesiophobia showed a statistically significant correlation with worse postoperative SF-36 PCS scores in patients.

Kinesiophobia and its associated factors in patients with coronary heart disease: a cross-sectional study based on latent feature analysis

OBJECTIVES

The aim of this study was to explore the current situation of kinesiophobia in patients with coronary heart disease, classify it based on potential profile analysis and explore the relevant factors of kinesiophobia in different categories of patients with coronary heart disease.

DESIGN

Cross-sectional study.

SETTING

Patients with coronary heart disease in China.

PARTICIPANTS

Adult (aged >18 years) patients with coronary heart disease in China; 252 participants in this study answered the questionnaire.

PRIMARY AND SECONDARY OUTCOME MEASURES

The study investigated the scores of Tampa Scale for Kinesiophobia Heart, and collected information on the patient's age, gender, monthly household income, education level, place of residence, marital status, occupational status, hypertension, diabetes, heart failure and body mass index (BMI).

RESULTS

Kinesiophobia in patients with coronary heart disease can be divided into low fear type (C1), intermediate fear type (C2) and high fear type (C3). Elderly patients were classified as type C3. Women and patients with a normal BMI were classified as type C1; patients with a normal BMI and patients with an overweight BMI were classified as type C2.

CONCLUSION

Kinesiophobia of patients with coronary heart disease can be divided into three categories, and intervention measures are implemented according to their different demographic characteristics to reduce kinesiophobia of patients and promote the participation of patients in exercise rehabilitation.

Spinal Mobility Limitation Can Be the Main Reason of Kinesiophobia in Ankylosing Spondylitis

Objective The aim of this study is to determine the presence of kinesiophobia in patients with ankylosing spondylitis (AS) and to examine the factors affecting kinesiophobia. Materials and methods Sixty patients with AS participated in the study. Kinesiophobia was evaluated using the Tampa Scale for Kinesiophobia (TSK). Disease activity was assessed using the Bath AS Disease Activity Index (BASDAI) and AS Disease Activity Score with C-reactive protein (ASDAS-CRP), functional status using the Bath AS Functional Index (BASFI), spinal mobility using the Bath AS Metrology Index (BASMI), and quality of life using the AS Quality of Life Questionnaire (ASQoL). Those with a TSK score of >37 were classified as patients with high kinesiophobia, while those with a score of ≤37 as patients with low kinesiophobia. Results High kinesiophobia was detected in 29 (48.3%) patients. Age, disease duration, BASDAI, ASDAS-CRP, BASFI, ASQoL, and BASMI values were higher in these patients. The TSK scores correlated with age, duration of disease, ASDAS-CRP, BASFI, BASMI, and ASQoL (r = 0.697, r = 0.600, r = 0.410, r = 0.690, r = 0.889, and r = 0.576, respectively). As a result of the multivariate binary logistic regression analysis, BASMI was found to be the only statistically significant factor for high kinesiophobia (OR 5.338, 95% CI: 1.133-25.159, p = 0.034). Conclusion Kinesiophobia is seen at a high rate in patients with AS. In this study, the most important risk factor for kinesiophobia is found to be decreased spinal mobility. To prevent kinesiophobia - which prevents exercise, the cornerstone of AS treatment - patients should be encouraged to exercise and be active.