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Sentandreu-Mañó T, Deka P, Almenar L, Tomás JM, Ferrer-Sargues FJ, López-Vilella R, Klompstra L, Marques-Sule E. Kinesiophobia and associated variables in patients with heart failure. Eur J Cardiovasc Nurs 2024; 23:221-229. [PMID: 37534763 DOI: 10.1093/eurjcn/zvad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
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.
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Affiliation(s)
- Trinidad Sentandreu-Mañó
- Department of Physiotherapy, Advanced Research Methods Applied to Quality of Life Promotion (ARMAQoL), University of Valencia, Valencia, Spain
| | - Pallav Deka
- College of Nursing, Michigan State University, 1355 Bogue Street, East Lansing C247, MI, USA
| | - Luis Almenar
- Heart Failure and Transplants Unit, Department of Cardiology, University and Polytechnic Hospital La Fe, Valencia, Spain
- CIBERCV, Valencia, Spain
- University of Valencia, Valencia, Spain
| | - José M Tomás
- Department of Methodology for the Behavioral Sciences, University of Valencia, Valencia, Spain
| | - Francisco-José Ferrer-Sargues
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Raquel López-Vilella
- Heart Failure and Transplants Unit, Department of Cardiology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
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Mendes LP, Fidelis-de-Paula-Gomes CA, Pontes-Silva A, Barreto FS, Pinheiro JS, da Silva ACB, de Oliveira Pires F, da Cunha Leal P, Avila MA, Dibai-Filho AV. Tampa Scale for Kinesiophobia in chronic neck pain patients (TSK-neck): structural and construct validity and reliability in a Brazilian population. BMC Musculoskelet Disord 2024; 25:151. [PMID: 38368337 PMCID: PMC10874046 DOI: 10.1186/s12891-024-07268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/08/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND To date, there are no studies in the literature that define the internal structure of the Tampa Scale for Kinesiophobia (TSK) in patients with chronic neck pain based on factorial analysis. As such, we aimed to verify and identify the best structure of the Brazilian version of the TSK in patients with chronic neck pain. METHODS We included Brazilian participants aged ≥18 years, both sexes, with self-reported neck pain for more than 3 months and pain intensity ≥3 on the Numerical Pain Rating Scale (NPRS). Dimensionality and number of TSK items were assessed using confirmatory factor analysis (CFA). We tested the following internal structures: structure 1 (1 domain and 17 items), structure 2 (1 domain and 11 items), structure 3 (2 domains and 11 items), and structure 4 (2 domains and 9 items). We used the Pain-Related Catastrophizing Thoughts Scale (PCTS) and the NPRS for construct validity. In addition, we assessed test-retest reliability for the seven-day interval using intraclass correlation coefficient (ICC2,1), Cronbach's alpha to assess internal consistency, and ceiling and floor effects. RESULTS The study sample included of 335 patients. Most were women (77.6%), young adults (~ 34 years), single (48.4%), with complete primary education (57.3%), physically inactive (66.6%), with a mean pain duration of 46 months and a mean pain intensity of ~ 5 points on the NPRS. Redundancy was found in the following items: item 1 with item 2 (modification indices = 21.419) and item 13 with item 15 (modification indices = 13.641). Subsequently, based on these paired analyses, the items with the lowest factor loadings (items 2 and 15) were excluded. As such, TSK structure 4 was composed of two domains ("somatic focus" and "activity avoidance") and 9 items, which showed adequate fit indices and lower AIC and SABIC values. We observed significant values (p < 0.05) with a correlation magnitude greater than 0.142 to 0.657 between the two domains of the TSK-neck and the other instruments (PCTS and NPRS). We found excellent reliability (ICC2,1 ≥ 0.96) and adequate internal consistency (Cronbach's alpha ≥0.98) of the TSK-neck. Finally, ceiling and floor effects were not observed. CONCLUSION The TSK-neck structure with two domains (somatic focus and activity avoidance) and nine items is the most appropriate for patients with chronic neck pain.
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Affiliation(s)
| | | | - André Pontes-Silva
- Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil.
| | - Felipe Souza Barreto
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
- Sarah Network of Rehabilitation Hospitals, São Luís, Brazil
| | - Jocassia Silva Pinheiro
- Postgraduate in Rehabilitation and Functional Performance, Faculdade de Medicina de Ribeirão Preto, Universidade São Paulo, Ribeirão Preto, Brazil
| | | | - Flávio de Oliveira Pires
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
| | - Plinio da Cunha Leal
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
| | - Mariana Arias Avila
- Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Almir Vieira Dibai-Filho
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
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Yang Z, Jia H, Wang A. Predictors of home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure: a theory-driven cross-sectional study. BMC Nurs 2023; 22:415. [PMID: 37926820 PMCID: PMC10626687 DOI: 10.1186/s12912-023-01566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The factors influencing home-based cardiac rehabilitation exercise adherence among patients with chronic heart failure remain unclear. This study aimed to explore predictors of home-based cardiac rehabilitation exercise adherence in these patients, based on the theory of planned behavior. METHODS This theory-driven, cross-sectional study used convenience sampling to recruit patients with chronic heart failure undergoing home-based cardiac rehabilitation. Instruments used included the Home-Based Cardiac Rehabilitation Exercise Adherence Scale, the Multidimensional Self-Efficacy for Exercise Scale, the Perceived Social Support Scale, and the Tampa Scale for Kinesiophobia Heart. Multivariate linear hierarchical regression analysis was employed to examine the factors influencing exercise adherence. RESULTS A total of 215 patients with chronic heart failure undergoing home-based cardiac rehabilitation participated in the study. The overall score for home cardiac rehabilitation exercise adherence was (48.73 ± 3.92). Multivariate linear hierarchical regression analysis revealed that age (β=-0.087, p = 0.012), education level (β = 0.080, p = 0.020), fear of movement (β=-0.254, p < 0.001), perceived social support (β = 0.451, p < 0.001), and exercise self-efficacy (β = 0.289, p < 0.001) influenced home-based cardiac rehabilitation exercise adherence. In the second model, fear of exercise explained 23.60% of the total variance, while perceived social support and exercise self-efficacy explained 26.60% of the total variance in the third model. CONCLUSION This study found that home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was suboptimal, and identified its influencing factors. Targeted interventions addressing these factors, such as tailored education, support, and addressing fear of exercise, may help improve exercise adherence.
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Affiliation(s)
- Zhen Yang
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Honghong Jia
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Aiping Wang
- The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
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Bakırhan S, Unver B, Elibol N, Karatosun V. Fear of movement and other associated factors in older patients with total knee arthroplasty. Ir J Med Sci 2023; 192:2217-2222. [PMID: 36445627 DOI: 10.1007/s11845-022-03214-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Kinesiophobia is an important risk factor for functional activities of patients in the early stage following total knee arthroplasty (TKA). AIMS This study aimed to investigate the relationship between fear of movement and associated factors in older patients in the late stage after TKA. METHODS The study included 45 older patients (mean age:70.11 ± 0.90 years) with knee osteoarthritis who underwent TKA. Kinesiophobia was assessed with the Tampa Scale of Kinesiophobia (TSK). Pain and strength in the quadriceps femoris (QF) muscle were assessed by the Visual Analog Scale and hand-held dynamometer, respectively. Functional level was determined using the 30-s sit-to-stand test (STS) and 10-m walking test. RESULTS There were correlations between TSK and QF muscle strength (r = -0.538, p < 0.001), activity pain level (r = 0.489, p = 0.001), and 30-s STS (r = -0.306, p = 0.041). There were no correlations between TSK and age (r = 0.207, p = 0.172) and 10-m walking test (r = 0.112, p = 0.465). CONCLUSIONS Increased pain and decreased QF muscle strength and functional level on STS were related with fear of movement in TKA patients. It was concluded that kinesiophobia of older patients with TKA must be considered during the assessment and rehabilitation program in the late stage after TKA.
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Affiliation(s)
- Serkan Bakırhan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ege University, Izmir, Turkey
| | - Bayram Unver
- Department of Orthopedic Physiotherapy, Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Nuray Elibol
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ege University, Izmir, Turkey.
| | - Vasfi Karatosun
- Department of Orthopedics, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Tissot LPM, Evans DW, Kirby E, Liew BXW. Tampa Scale of Kinesiophobia may underestimate task-specific fear of movement in people with and without low back pain. Pain Rep 2023; 8:e1081. [PMID: 37293339 PMCID: PMC10247215 DOI: 10.1097/pr9.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/11/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction The Tampa Scale of Kinesiophobia (TSK) is commonly used to assess fear of movement (FoM) in people with low back pain (LBP). However, the TSK does not provide a task-specific measure of FoM, whereas image-based or video-based methods may do so. Objectives To compare the magnitude of FoM when assessed using 3 methods (TSK-11, image of lifting, video of lifting) in 3 groups of people: current LBP (LBP), recovered LBP (rLBP), and asymptomatic controls (control). Methods Fifty-one participants completed the TSK-11 and rated their FoM when viewing images and videos depicting people lifting objects. Low back pain and rLBP participants also completed the Oswestry Disability Index (ODI). Linear mixed models were used to estimate the effects of methods (TSK-11, image, video) and group (control, LBP, rLBP). Linear regression models were used to assess associations between the methods on ODI after adjusting for group. Finally, a linear mixed model was used to understand the effects of method (image, video) and load (light, heavy) on fear. Results In all groups, viewing images (P = 0.009) and videos (P = 0.038) elicited greater FoM than that captured by the TSK-11. Only the TSK-11 was significantly associated with the ODI (P < 0.001). Finally, there was a significant main effect of load on fear (P < 0.001). Conclusion Fear of specific movements (eg, lifting) may be better measured using task-specific measures, such as images and videos, than by task-generic questionnaires, such as the TSK-11. Being more strongly associated with the ODI, the TSK-11 still plays an important role in understanding the impact of FoM on disability.
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Affiliation(s)
- Liam-Pierre Mathieu Tissot
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
| | - David William Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Edward Kirby
- Musculoskeletal Physiotherapy, Essex Partnership University NHS Foundation Trust, Runwell, Wickford, United Kingdom
| | - Bernard Xian Wei Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom
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Núñez-Cortés R, Horment-Lara G, Tapia-Malebran C, Castro M, Barros S, Vera N, Pérez-Alenda S, Pablo Santelices J, Rivera-Lillo G, Cruz-Montecinos C. Role of kinesiophobia in the selective motor control during gait in patients with low back-related leg pain. J Electromyogr Kinesiol 2023; 71:102793. [PMID: 37285714 DOI: 10.1016/j.jelekin.2023.102793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
Fear of movement has been related to changes in motor function in patients with low back pain, but little is known about how kinesiophobia affects selective motor control during gait (ability of muscles performing distinct mechanical functions) in patients with low back-related leg pain (LBLP). The aim of the study was to determine the association between kinesiophobia and selective motor control in patients with LBLP. An observational cross-sectional study was performed on 18 patients. Outcome included: kinesiophobia using the Tampa Scale of Kinesiophobia; pain mechanism using Leeds Assessment of Neuropathic Signs and Symptoms; disability using Roland-Morris Disability Questionnaire; mechanosensitivity using Straight Leg Raise. Surface electromyography was used to assess selective motor control during gait by examining the correlation and coactivation in muscle pairs involved in the stance phase. Pairs included vastus medialis (VM) and medial gastrocnemius (MG), causing opposite moments around the knee joint, and gluteus medius (GM) and MG, as muscles with distinct mechanical functions (weight acceptance vs. propulsion). A strong association was observed between kinesiophobia and correlation (r = 0.63; p = 0.005) and coactivation (r = 0.69; p = 0.001) between VM versus MG. A moderate association was observed between kinesiophobia and correlation (r = 0.58; p = 0.011) and coactivation (r = 0.55; p = 0.019) between GM versus MG. No significant associations were obtained for other outcomes. A high kinesiophobia is associated with low selective motor control of the muscles involved in the weight acceptance and propulsion phases during gait in patients with LBLP. Fear of movement was better associated with decreased neuromuscular control than other clinical variables such as pain mechanism, disability, and mechanosensitivity.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Giselle Horment-Lara
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Claudio Tapia-Malebran
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Department of Physical Therapy, Catholic University of Maule, Talca, Chile
| | - Martín Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sebastián Barros
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Nicolás Vera
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Juan Pablo Santelices
- Traumatology Unit, San José Hospital, Santiago, Chile; Traumatology Unit, Clínica Santa María, Santiago, Chile
| | - Gonzalo Rivera-Lillo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Department of Neuroscience, Faculty of Medicine, University of Chile, Santiago, Chile; Research and Development Unit, Clínica Los Coihues, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile.
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Botta AFB, de Cássia Pinto da Silva J, Dos Santos Lopes H, Boling MC, Briani RV, de Azevedo FM. Group- and sex-related differences in psychological and pain processing factors in people with and without patellofemoral pain: correlation with clinical outcomes. BMC Musculoskelet Disord 2023; 24:397. [PMID: 37202816 DOI: 10.1186/s12891-023-06513-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND People with patellofemoral pain (PFP) exhibit impaired psychological and pain processing factors (i.e., kinesiophobia, pain catastrophizing and pressure pain thresholds [PPTs]). However, it remains unclear whether these factors have different presentations in women and men with PFP, as well as whether their correlation with clinical outcomes differ according to sex. The aims of this study were to: (1) compare psychological and pain processing factors between women and men with and without patellofemoral pain (PFP); (2) investigate their correlation with clinical outcomes in people with PFP. METHODS This cross-sectional study included 65 women and 38 men with PFP, 30 women and 30 men without PFP. The psychological and pain processing factors were assessed with the Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, and PPTs of shoulder and patella measured with an algometer. Clinical outcomes assessed were self-reported pain (Visual Analogue Scale), function (Anterior Knee Pain Scale), physical activity level (Baecke's Questionnaire), and physical performance (Single Leg Hop Test). Generalized linear models (GzLM) and effect sizes [Cohen's d] were calculated for group comparisons and Spearman's correlation coefficients were calculated to investigate correlations between outcomes. RESULTS Women and men with PFP had higher kinesiophobia (d = .82, p = .001; d = .80, p = .003), pain catastrophizing (d = .84, p < .001; d = 1.27, p < .001), and lower patella PPTs (d = -.85, p = .001; d = -.60, p = .033) than women and men without PFP, respectively. Women with PFP had lower shoulder and patella PPTs than men with PFP (d = -1.24, p < .001; d = -.95, p < .001), but there were no sex differences in those with PFP for psychological factors (p > .05). For women with PFP, kinesiophobia and pain catastrophizing had moderate positive correlations with self-reported pain (rho = .44 and .53, p < .001) and moderate negative correlations with function (rho = -.55 and -.58, p < .001), respectively. For men with PFP, only pain catastrophizing had moderate positive correlations with self-reported pain (rho = .42, p = .009) and moderate negative correlations with function (rho = -.43, p = .007). CONCLUSIONS Psychological and pain processing factors differ between people with and without PFP and between sexes, respectively. Also, correlations between psychological and pain processing factors with clinical outcomes differ among women and men with PFP. These findings should be considered when assessing and managing people with PFP.
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Affiliation(s)
- Ana Flavia Balotari Botta
- Laboratory of Biomechanics and Motor Control (LABCOM), Physical Therapy Department, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil.
| | - Júlia de Cássia Pinto da Silva
- Laboratory of Biomechanics and Motor Control (LABCOM), Physical Therapy Department, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Helder Dos Santos Lopes
- Laboratory of Biomechanics and Motor Control (LABCOM), Physical Therapy Department, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Michelle C Boling
- Department of Clinical and Applied Movement Sciences, University of North Florida, Jacksonville, FL, USA
| | - Ronaldo Valdir Briani
- Laboratory of Biomechanics and Motor Control (LABCOM), Physical Therapy Department, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
| | - Fábio Mícolis de Azevedo
- Laboratory of Biomechanics and Motor Control (LABCOM), Physical Therapy Department, School of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Sao Paulo, Brazil
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Pontillo M, Gunterstockman BM, Mauntel TC, Farrokhi S. The association between kinesiophobia and functional limitations in service members with knee pain. Musculoskelet Sci Pract 2023; 65:102766. [PMID: 37207505 DOI: 10.1016/j.msksp.2023.102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/17/2023] [Accepted: 04/19/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Knee diagnoses account for more than 50% of lower extremity musculoskeletal conditions in non-deployed US Service members. However, there is limited information regarding kinesiophobia in Service members with non-operative knee diagnoses. HYPOTHESES The objectives of this study were to determine the prevalence of high levels of kinesiophobia in US military Service members with knee pain across different knee diagnoses, and to determine the relationships between kinesiophobia and lower extremity function and/or specific functional limitations in Service members with knee pain. It was hypothesized Service members with knee pain would exhibit high levels of kinesiophobia across all knee diagnoses examined, and higher levels of both kinesiophobia and pain would be associated with worse self-reported function in this population. It was also hypothesized higher levels of kinesiophobia would be associated with functional activities with high knee loading. DESIGN Retrospective cohort study. LEVEL OF EVIDENCE IV. METHODS Sixty-five US Service members presenting to an outpatient physical therapy clinic were included in this study (20 females; age = 30.8 ± 7.7 years; height = 1.74 ± 0.9 m; mass = 80.7 ± 16.2 kg). Inclusion criterion was the presence of knee pain (duration = 50 ± 59 months); exclusion criterion was knee pain as a sequela of knee surgery. Data regarding demographic, pain chronicity, pain by Numeric Rating Scale (NRS), Tampa Scale of Kinesiophobia (TSK), and Lower Extremity Functional Scale (LEFS) were retrospectively obtained from patients' medical records. A high level of kinesiophobia was defined as a TSK score of greater than 37 points. Patient diagnoses included: osteoarthritis (n = 16); patellofemoral pain syndrome (n = 23); and other non-operative knee diagnoses (n = 26). Commonality analysis was utilized to determine the effects of age, height, mass, NRS, and TSK on LEFS score. Predictor values were interpreted as <1% = negligible, >1% = small; >9% = moderate, >25% = large. Additionally, exploratory item-specific analyses examined the strength of the relationships between kinesiophobia and LEFS item responses. Binary logistic regression determined if difficulty with an individual LEFS item could be predicted from either NRS or TSK score. Statistical significance was set at P < 0.05. RESULTS High levels of kinesiophobia were identified in 43 individuals (66%). NRS and TSK explained 19.4% and 8.6% of the unique variance in LEFS, and 38.5% and 20.5% of total variance, respectively. Age, height, and mass explained negligible to small proportions of the unique variance in LEFS. TSK and NRS were independent predictors for 13/20 individual LEFS items, with odds ratios ranging from 1.12 to 3.05 (P < 0.05). CONCLUSION The majority of US Service members in this study exhibited high levels of kinesiophobia. Kinesiophobia was significantly related to self-reported functional scores and performance on individual functional tasks in Service members with knee pain. CLINICAL RELEVANCE Treatment strategies addressing both fear of movement and pain reduction in patients with knee pain may help optimize functional outcomes.
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Affiliation(s)
- Marisa Pontillo
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, 7700 Arlington Blvd, Falls Church, VA, USA; Department of Physical and Occupational Therapy, Chiropractic Services, and Sports Medicine, Naval Medical Center San Diego, San Diego, CA, USA.
| | | | - Timothy C Mauntel
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, 7700 Arlington Blvd, Falls Church, VA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, NC, USA
| | - Shawn Farrokhi
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, 7700 Arlington Blvd, Falls Church, VA, USA; Department of Physical and Occupational Therapy, Chiropractic Services, and Sports Medicine, Naval Medical Center San Diego, San Diego, CA, USA; Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, USA
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9
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Watanabe K, Koshino Y, Kawahara D, Akimoto M, Mishina M, Nakagawa K, Ishida T, Kasahara S, Samukawa M, Tohyama H. Kinesiophobia, self-reported ankle function, and sex are associated with perceived ankle instability in college club sports athletes with chronic ankle instability. Phys Ther Sport 2023; 61:45-50. [PMID: 36871492 DOI: 10.1016/j.ptsp.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To investigate the association between sex, self-reported ankle function, pain intensity, kinesiophobia, and perceived ankle instability in athletes with chronic ankle instability (CAI). DESIGN Cross-Sectional Study. SETTING University. PARTICIPANTS College club sports athletes with CAI (n = 42). MAIN OUTCOME MEASURES Relationships with the Cumberland Ankle Instability Tool (CAIT) score and the Tampa Scale for Kinesiophobia-11 (TSK-11), the Foot and Ankle Ability Measure (FAAM), sex (0: male, 1: female), and ankle pain intensity by the Numeric Rating Scale were explored with multiple regression analysis. RESULTS The regression model explained 50.3% of the variance of the CAIT score (P < 0.001), and the TSK-11 score (B = -0.382, P = 0.002), the FAAM sports subscale score (B = 0.122, P = 0.038), and sex (B = -2.646, P = 0.031) were significant independent variables for the CAIT score (P < 0.001), while pain intensity was not significant (B = -0.182, P = 0.504). These results indicated that higher TSK-11 score, lower FAAM sports subscale score, and being female were related to lower CAIT score. CONCLUSIONS Kinesiophobia related to perceived instability along with self-reported function and sex in athletes with CAI. Clinicians should assess the psychological aspects of athletes with CAI.
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Affiliation(s)
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Daiki Kawahara
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Moeko Akimoto
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Masumi Mishina
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Kosumi Nakagawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | | | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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10
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Wang J, Bai C, Zhang Z, Chen O. The relationship between dyspnea-related kinesiophobia and physical activity in people with COPD: Cross-sectional survey and mediated moderation analysis. Heart Lung 2023; 59:95-101. [PMID: 36796249 DOI: 10.1016/j.hrtlng.2023.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Changing the behavior of physical activity (PA) in COPD patients remains a challenge, because this population faces the same barriers to PA as the general population, as well as disease-specific barriers, especially dyspnea-related kinesiophobia. OBJECTIVES This study aimed to assess the status of dyspnea-related kinesiophobia in people with COPD, and investigate its impact on PA levels, further examine the mediated moderation effects of exercise perception and social support on this relationship. METHODS A cross-sectional survey was conducted with COPD patients recruited from four tertiary hospitals in Jinan Province, China. We used Breathlessness Beliefs Questionnaire to identify dyspnea-related kinesiophobia. International Physical Activity Questionnaire-short-form, Exercise Benefits/Barriers Scale, and Social Support Rating Scale were used to assess PA, exercise perception and social support, respectively. The data were statistically processed using correlation analysis and a test of mediated moderation model. RESULTS A total of 223 COPD patients were included, and all of them had a symptom of dyspnea-related kinesiophobia. Dyspnea-related kinesiophobia was negatively correlated with exercise perception, subjective social support and PA. Exercise perception partially mediated the impact of dyspnea-related kinesiophobia on PA levels, and subjective social support indirectly influences PA by moderating the relationship between dyspnea-related kinesiophobia and exercise perception. CONCLUSIONS People with COPD commonly have dyspnea-related kinesiophobia and experienced physical inactivity. The mediated moderation model provides a better understanding of how dyspnea-related kinesiophobia, exercise perception, and subjective social support work together to influence PA. Interventions seeking to improve the levels of PA in COPD patients should consider these elements.
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Affiliation(s)
- Jingjing Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250012, China
| | - Chenxiao Bai
- Nursing Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100005, China
| | - Zeyi Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan 250012, China
| | - Ou Chen
- School of Nursing and Rehabilitation, Shandong University, Jinan 250012, China.
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11
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Wang H, Hu F, Lyu X, Jia H, Wang B, Liu F, Yang Y. Kinesiophobia could affect shoulder function after repair of rotator cuff tears. BMC Musculoskelet Disord 2022; 23:714. [PMID: 35883122 PMCID: PMC9316366 DOI: 10.1186/s12891-022-05679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Kinesiophobia (fear of movement) is a major limiting factor in the return to pre-injury sport level after surgery of rotator cuff tears. The study aims to gain insights into how kinesiophobia affects shoulder pain and function after the repair of full-thickness rotator cuff tears. Methods A prospective study was conducted to evaluate patients who underwent rotator cuff repair between January 2019 and December 2019 in our institution. The patients were divided into a trial group with a high kinesiophobia (Tampa Scale for Kinesiophobia [TSK], TSK > 37) and a control group with a low kinesiophobia (TSK ≤ 37). The indicators of interest included the Constant-Murley scores, numerical rating scale (NRS), visual analogue scale (VAS), Oxford Shoulder Score (OSS), and the American shoulder and elbow score (ASES), shoulder function and strength, and range of motion (ROM) at 3 days, 6 weeks, and 12 months after repair of full-thickness rotator cuff tears. Results In total, 49 patients who underwent repair of full-thickness rotator cuff tears were enrolled, which was divided into a trial group involving 26 patients (mean TSK 52.54) and a control group involving 23 patients (mean TSK 33.43). There were no statistically significant differences in basic information such as age, gender, and length of stay in the two groups. The preoperative and early postoperative functional scores and the Tampa Scale for Kinesiophobia were statistically significant differences between the two groups. However, long-term postoperative follow-up showed no statistically significant difference in ASES, and Constant-Murley scores, OSS, and VAS scores between the two groups as the kinesiophobia changed from positive to negative. Conclusion Degree of kinesiophobia reduced during post-operative rehabilitation of rotator cuff repair patients, but high kinesiophobia is still present in a large portion of the patients after rotator cuff repair. Patients after rotator cuff repair will benefit from early recognition and prevention of kinesiophobia.
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Affiliation(s)
- Huihui Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fangning Hu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xiaolong Lyu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Honglei Jia
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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12
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Jeong WJ, Holavanahalli RK, Kowalske KJ. Evaluation of Kinesiophobia in Survivors of Major Burn Injury. J Burn Care Res 2022; 43:1380-1385. [PMID: 35385580 DOI: 10.1093/jbcr/irac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Kinesiophobia, the fear of movement and re-injury, has not been described in burn injury survivors. Physical activity is a key component of burn rehabilitation programs. Yet, not all burn survivors exercise at the recommended level. This is an exploratory study examining the association of the demographics and injury characteristics of burn survivors with a fear of movement. The subjective fear of movement was measured using the Tampa Scale for Kinesiophobia (TSK). The TSK score was compared between several demographics and injury characteristics by performing the independent sample t-test. Sixty-six percent of subjects in our study (n=35), reported high levels of kinesiophobia (score 37 or above). The mean scores of the TSK were greater in males (40.7), non-White (43.0), Hispanic/Latino (41.1), age greater than 50 years (42.3), and total body surface area (TBSA) burn of >15% compared to females (36.9), White (38.5), non-Hispanic/Latino (39.3), age 50 years or less (38.1), and TBSA 15% or less (39.4) respectively. However, with the exception of time post injury, none of the mean differences were statistically significant. Subjects who had sustained a burn injury more than 12 months ago showed higher levels of kinesiophobia than the subjects who were injured within 12 months with a mean difference of 7.35 (p=.01). Thus, this study highlights the importance of (i) continued, long-term follow up for burn survivors, and (ii) appropriate educational and treatment interventions to address any underlying existing, new, or emerging medical issues that may contribute to the fear or avoidance of movement.
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Affiliation(s)
- Won J Jeong
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Radha K Holavanahalli
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Karen J Kowalske
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, U.S.A
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13
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Marques-Sule E, Söderlund A, Almenar L, Espí-López GV, López-Vilella R, Bäck M. Influence on kinesiophobia by disability, physical, and behavioural variables after a heart transplantation. Eur J Cardiovasc Nurs 2022; 21:537-543. [PMID: 35018421 DOI: 10.1093/eurjcn/zvab134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/05/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND From clinical experience, kinesiophobia represents a barrier to being physically active after a heart transplantation (HTx), but studies in this field are lacking. Identifying the factors associated with kinesiophobia is essential to determine preventive interventions to avoid negative consequences for health. AIMS To study the influence of disability, physical, and behavioural variables on kinesiophobia in patients with an HTx. METHODS A total of 117 patients with an HTx [51 women; mean age 56 (SD 12.1) years] were recruited at an outpatient clinic. These patients were asked to fill in questionnaires measuring kinesiophobia, self-reported physical activity (PA), exercise self-efficacy, motivation for PA, and disability. A multiple regression analysis was conducted to examine the statistical prediction of kinesiophobia as a dependent variable, with the questionnaires, gender and education as independent variables. RESULTS The independent variables explained 70% of the variance in kinesiophobia. The prediction model was significant (F = 32.1, P < 0.001). The time from transplantation (standardised coefficient, beta; -0.17), the total exercise self-efficacy (-0.16), extrinsic motivation (-0.23), and the disability total score (0.63) were significant predictors of kinesiophobia, while the independent variables of gender, education, intrinsic motivation, and the PA total score were not significant. CONCLUSIONS This study highlights that a short time from transplantation, low self-efficacy, low extrinsic motivation, and a high level of disability explained high levels of kinesiophobia in patients after an HTx. These results suggest that an increased awareness of the biopsychosocial health perspective is essential in order to maximising patient outcomes after an HTx.
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Affiliation(s)
- Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Gascó Oliag 5, 46010 Valencia, Spain
| | - Anne Söderlund
- Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden
| | - Luis Almenar
- Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiologia, Hospital Universitari i Politècnic La Fe, Fernando Abril Martorell, 106, 46026 Valencia, Spain.,Departamento de Medicina, Universitat de València, Blasco Ibáñez, 13, 46010 Valencia, Spain.,CIBERCV, Valencia, Spain
| | | | - Raquel López-Vilella
- Unidad de Insuficiencia Cardíaca y Trasplante, Servicio de Cardiologia, Hospital Universitari i Politècnic La Fe, Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, 581 83 Linköping, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Vita Stråket 13, 413 45Gothenburg, Sweden
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14
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Bemani S, Dehkordi SN, Sarrafzadeh J, Talebian S, Salehi R, Zarei J. Efficacy of a multidimensional versus usual care physiotherapy on pain and electroencephalography (EEG) spectrum in chronic nonspecific low back pain: study protocol for a randomized controlled trial. Trials 2021; 22:679. [PMID: 34620205 PMCID: PMC8499517 DOI: 10.1186/s13063-021-05580-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Non-specific chronic low back pain (NSCLBP) is a major public health and global socioeconomic burden associated with a complex interplay of biopsychosocial factors. Despite scientific signs of progress, treatment of NSCLBP often tends to stick to a biomechanical model, without targeting psychological and social factors. To enhance the clinical efficacy of usual physiotherapy for NSCLBP, the development of clinical strategies is to be pursued. This study aims to assess the effectiveness of multidimensional physiotherapy based on a biopsychosocial approach compared to usual care physiotherapy, on clinical findings and electroencephalography spectrum in non-specific chronic low back pain. METHODS This study is a triple-blind, two-arm (1:1) randomized controlled trial with a 4 months follow-up. Seventy NSCLBP patients will be randomly allocated to either the experimental (multidimensional physiotherapy) or the active control group (usual physiotherapy); each group will receive 6 weeks of physiotherapy. The main outcome is pain and secondary outcomes are brain function, quality of life, disability, lumbar flexion range of motion, and psychosocial correlates. Assessment will be performed at baseline, post-treatment, and at 1 and 4 months follow-up. DISCUSSION Findings may provide evidence on the effectiveness of multidimensional physiotherapy on clinical findings and brain characteristics and might provide evidence towards showing the role of brain and biopsychosocial factors on chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04270422 , Registered on 17 February 2020, IRCT Identifier: IRCT20140810018754N11.
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Affiliation(s)
- Sanaz Bemani
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blv, Tehran, Iran
| | - Shohreh Noorizadeh Dehkordi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blv, Tehran, Iran.
| | - Javad Sarrafzadeh
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St, Shahnazari St, Madar Sq. Mirdamad Blv, Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Zarei
- Department of Health Psychology, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Najafi F, Zare Z, Javad Mortazavi SM, Lundberg M, Shahsavari H. Overcoming fear of movement resulting from knee replacement; strategies used by patients: An interview study. Int J Orthop Trauma Nurs 2021; 45:100904. [PMID: 35181253 DOI: 10.1016/j.ijotn.2021.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Fear of movement is among the main concerns of patients following knee replacement surgery and a determining factor in the success of surgery. The strategies adopted by patients to overcome this fear have not yet been identified, but once pin pointed, these strategies can be strengthened and modified through intervention. The aim of the present study was to explore the personal strategies adopted by patients following knee replacement to overcome fear of movement. MATERIALS AND METHODS Interviews were conducted with 15 patients who had undergone knee replacement, selected by purposive sampling. Data were collected through in-depth semi-structured interviews and analyzed using inductive content analysis. RESULTS The patients' strategies as depicted in their narratives were classified into three categories: 1) Movement based on awareness; 2) Movement based on support; and 3) Movement based on hope. These three categories are described in eight subcategories and show what strategies the patients used to overcome their fear of movement. CONCLUSION These findings can help to increase awareness about strategies to overcome fear of movement in patients following knee replacement and to develop and support tailored treatment strategies with the aim of reducing such fear of movement and increasing physical activity among the patients.
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Affiliation(s)
- Fatemeh Najafi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Zare
- Department of Operating Room, School of Allied Medical Science, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center (JRRC), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mari Lundberg
- Department of Health Promoting Science, Sophiahemmet Unviersity, Stockholm, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Hooman Shahsavari
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Ohji S, Aizawa J, Hirohata K, Ohmi T, Mitomo S, Koga H, Yagishita K. Injury-related fear in athletes returning to sports after anterior cruciate ligament reconstruction - A quantitative content analysis of an open-ended questionnaire. Asia Pac J Sports Med Arthrosc Rehabil Technol 2021; 25:1-7. [PMID: 33936951 PMCID: PMC8058518 DOI: 10.1016/j.asmart.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/19/2021] [Indexed: 01/14/2023]
Abstract
Background/objective Injury-related fear during sport activities are major psychological factors inhibiting a person's return to sports (RTS) following anterior cruciate ligament reconstruction (ACLR). Currently, there are no studies that quantitatively analyse the open-ended questionnaire for knee injury-related fear in post-ACLR athletes.The purpose of this study was to identify knee injury-related fear in athletes who return to ball-centric sports via the use of an open-ended questionnaire. We aimed to determine the main concepts of injury-related fear according to sex, type of sport, and participation level. Methods In this study, a quantitative analysis of an open-ended questionnaire was used to examine the type of fear athletes experience after returning to ball-centric sports. The RTS and fear questionnaire collected open-ended questionnaire to knee injury-related fear during sport activities; this questionnaire was completed at the outpatient visit post-RTS. Quantitative content analysis was performed to extract frequently occurring words from the responses to the questionnaire to create a co-occurrence network. The resulting co-occurrence network and extracted words were used to create concepts regarding knee injury-related fear. The relationship between each concept and subject demographics (sex, returned sports events, and participation level) were analysed using the chi-squared test. Results Fifty-four athletes (30 females and 24 males) aged 16-45 [median age: 21.2; interquartile range (IQR): 11.0] years with an average RTS of 8.0 (IQR: 3.3) months from ACLR participated in the study. A total of 79 responses were included in the analysis. The knee injury-related fear can be summarized as follows: (1) Quick response to the opponent; (2) Ball-related play; (3) Jump-landing; (4) Contact; (5) Loss of balance; and (6) Athletic movement. Chi-squared tests showed that athletes participating in sport events with potential contact with an opponent (soccer, futsal, basketball, handball, lacrosse, and ultimate (frisbee)) were more likely to experience fear in quick response to the opponent (P < 0.01, adjusted residual = 2.943, ϕ = 0.301). Conclusion The knee injury-related fear can be summarized into six concepts. Post-ACLR athletes participating in ball-centric sports need to assess fear in situations such as quick responses to the opponent's movements and ball-related play, in addition to simple movements such as jumping, cutting, and contact.
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Affiliation(s)
- Shunsuke Ohji
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Junya Aizawa
- Department of Physical Therapy, Juntendo University, 3-2-12 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Sho Mitomo
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Thoma LM, Rethorn TJ, Best TM, Flanigan DC, Schmitt LC. High kinesiophobia and pain catastrophizing in people with articular cartilage defects in the knee and associations with knee function. Knee 2021; 28:17-24. [PMID: 33278739 DOI: 10.1016/j.knee.2020.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/06/2020] [Accepted: 10/24/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the extent to which individuals with knee articular cartilage defects (ACDs) have kinesiophobia and pain catastrophizing, and how these psychological factors relate to self-reported knee outcomes. METHODS Thirty-five individuals seeking surgical consultation for an ACD in the knee confirmed with 3.0T MRI and 18 controls without history of knee injury participated in the study. Kinesiophobia was measured with the Tampa Scale of Kinesiophobia (TSK), and scored using the modified 11-item (TSK-11) methods. Pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS). Data were analyzed using descriptive statistics, independent t-tests, chi-squared tests and Spearman's correlation coefficients, as appropriate (α = 0.05). RESULTS Participants with ACDs reported higher TSK-11 scores (median 27 [IQR 25-29]) and higher PCS scores (median 10 [IQR 4-18]) than controls (median TSK-11 16 [IQR 14-17], p < 0.001; median PCS 0 [IQR 0-9], p < 0.001). Within those with knee ACDs, higher TSK-11 scores were associated with worse knee pain, function on activities of daily living, sports/recreation, and knee-related quality of life scores (rho = -0.38 to -0.61). Higher pain catastrophizing was associated with worse function with activities of daily living and knee-related quality of life (rho = -0.37 to -0.40). CONCLUSIONS Kinesiophobia and pain catastrophizing in people with knee ACDs were higher than controls. Higher kinesiophobia and pain catastrophizing were associated with worse function and quality of life. Further study of the impact of these psychological factors on outcomes and prognosis in people with knee ACDs is warranted.
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Affiliation(s)
- Louise M Thoma
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Timothy J Rethorn
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, Columbus, OH, USA
| | - Thomas M Best
- University of Miami Sports Medicine Institute, Departments of Orthopedic Surgery, Family Medicine, Biomedical Engineering, Kinesiology, Miami, FL, USA
| | - David C Flanigan
- Jameson Crane Sports Medicine Institute, Columbus, OH, USA; The Ohio State University, College of Medicine, Department of Orthopedic Surgery, Columbus, OH, USA
| | - Laura C Schmitt
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, Columbus, OH, USA; Jameson Crane Sports Medicine Institute, Columbus, OH, USA.
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18
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Bäck M, Caldenius V, Svensson L, Lundberg M. Perceptions of Kinesiophobia in Relation to Physical Activity and Exercise After Myocardial Infarction: A Qualitative Study. Phys Ther 2020; 100:2110-2119. [PMID: 32886775 DOI: 10.1093/ptj/pzaa159] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Physical activity and exercise are central components in rehabilitation after a myocardial infarction. Kinesiophobia (fear of movement) is a well-known barrier for a good rehabilitation outcome in these patients; however, there is a lack of studies focusing on the patient perspective. The aim of this study was to explore patients' perceptions of kinesiophobia in relation to physical activity and exercise 2 to 3 months after an acute myocardial infarction. METHODS This qualitative study design used individual semi-structured interviews. Face-to-face interviews were conducted with 21 patients post-myocardial infarction who were screened for kinesiophobia (≥32 on the Tampa Scale for Kinesiophobia Heart). The interviews were transcribed and analyzed according to an inductive content analysis. RESULTS An overarching theme was defined as "coping with fear of movement after a myocardial infarction-a dynamic process over time" comprising 2 subthemes and explaining how coping with kinesiophobia runs in parallel processes integrating the patient's internal process and a contextual external process. The 2 processes are described in a total of 8 categories. The internal process was an iterative process governed by a combination of factors: ambivalence, hypervigilance, insecurity about progression, and avoidance behavior. The external process contains the categories of relatives' anxiety, prerequisites for feeling safe, information, and the exercise-based cardiac rehabilitation program. CONCLUSION Coping with fear of movement after a myocardial infarction is a dynamic process that requires internal and external support. To further improve cardiac rehabilitation programs, person-centered strategies that support the process of each person-as well as new treatment strategies to reduce kinesiophobia-need to be elaborated. IMPACT Patients with a myocardial infarction were found to be ambivalent about how they expressed their fear of movement; therefore, it is crucial for physical therapists to acknowledge signs of fear by listening carefully to the patient's full story in addition to using adequate self-reports and tests of physical fitness. These results will inform the design, development, and evaluation of new treatment strategies, with the overall aim of reducing kinesiophobia and increasing physical activity and participation in exercise-based cardiac rehabilitation.
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Affiliation(s)
- Maria Bäck
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, S-581 83 Linköping, Sweden; and Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Leif Svensson
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Mari Lundberg
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; and Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Keessen P, Latour CHM, van Duijvenbode ICD, Visser B, Proosdij A, Reen D, Scholte Op Reimer WJM. Factors related to fear of movement after acute cardiac hospitalization. BMC Cardiovasc Disord 2020; 20:495. [PMID: 33228521 PMCID: PMC7686769 DOI: 10.1186/s12872-020-01783-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background Fear of movement (kinesiophobia) after an acute cardiac hospitalization (ACH) is associated with reduced physical activity (PA) and non-adherence to cardiac rehabilitation (CR). Purpose To investigate which factors are related to kinesiophobia after an ACH, and to investigate the support needs of patients in relation to PA and the uptake of CR. Methods Patients were included 2–3 weeks after hospital discharge for ACH. The level of kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK-NL Heart). A score of > 28 points is defined as ‘high levels of kinesiophobia’ (HighKin) and ≤ 28 as ‘low levels of kinesiophobia’ (LowKin). Patients were invited to participate in a semi-structured interview with the fear avoidance model (FAM) as theoretical framework. Interviews continued until data-saturation was reached. All interviews were analyzed with an inductive content analysis.
Results Data-saturation was reached after 16 participants (median age 65) were included in this study after an ACH. HighKin were diagnosed in seven patients. HighKin were related to: (1) disrupted healthcare process, (2) negative beliefs and attitudes concerning PA. LowKin were related to: (1) understanding the necessity of PA, (2) experiencing social support. Patients formulated ‘tailored information and support from a health care provider’ as most important need after hospital discharge.
Conclusion This study adds to the knowledge of factors related to kinesiophobia and its influence on PA and the uptake of CR. These findings should be further validated in future studies and can be used to develop early interventions to prevent or treat kinesiophobia and stimulate the uptake of CR.
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Affiliation(s)
- P Keessen
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands. .,Cardiovitaal Cardiac Rehabilitation Centre, Amsterdam, The Netherlands.
| | - C H M Latour
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - I C D van Duijvenbode
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - B Visser
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - A Proosdij
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - D Reen
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands
| | - W J M Scholte Op Reimer
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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20
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Kragting M, Voogt L, Neijenhuijs KI, Pool-Goudzwaard AL, Coppieters MW. Cross-cultural adaptation and validation of the Dutch language version of the Pictorial Fear of Activity Scale - Cervical. BMC Musculoskelet Disord 2020; 21:708. [PMID: 33115471 PMCID: PMC7594286 DOI: 10.1186/s12891-020-03724-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background The Pictorial Fear of Activity Scale-Cervical (PFActS-C) is a reliable and valid instrument to assess fear of movement in people with whiplash associated disorders. It is not available in Dutch and has not been evaluated in other neck pain populations. This study aimed to systematically translate the PFActS-C into Dutch and evaluate the psychometric properties of this Dutch Language Version (DLV) in people with non-specific neck pain. Methods The PFActS-C was translated according to international guidelines. Internal consistency, test-retest reliability, floor and ceiling effects, face validity and construct validity (convergent and discriminant validity by hypotheses testing and structural validity by confirmatory and exploratory factor-analyses) of the PFActS-C-DLV were tested in 125 people with non-specific neck pain. Results The PFActS-C-DLV showed good to excellent internal consistency (Cronbach’s alpha: 0.98) and stability over time (ICC: 0.90 [95%CI: 0.82–0.93). Four out of five a priori formulated hypotheses regarding related (convergent validity) and unrelated (discriminant validity) constructs were confirmed. However, the confirmatory factor analysis could not confirm the expected 1-factor solution. Furthermore, the exploratory factor analyses revealed that also a higher factor solution would not lead to a good fit of the model. Conclusions The PFActS-C-DLV is a reliable region-specific instrument for people with non-specific neck pain. The construct validity was supported, based on hypotheses testing. However, factor analyses could not confirm a 1-factor solution, so the underlying construct of the PFActS-C-DLV remains unclear. Given the PFActS-C’s photographic format, we believe these findings also have relevance for the original English version. Supplementary information Supplementary information accompanies this paper at 10.1186/s12891-020-03724-1.
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Affiliation(s)
- Maaike Kragting
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands. .,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Lennard Voogt
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands
| | - Koen I Neijenhuijs
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Annelies L Pool-Goudzwaard
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Somt University of Physiotherapy, Amersfoort, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Menzies Health Insitute Queensland, Griffith University, Brisbane and Gold Coast, Australia
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21
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Kortlever JTP, Tripathi S, Ring D, McDonald J, Smoot B, Laverty D. Tampa Scale for Kinesiophobia Short Form and Lower Extremity Specific Limitations. Arch Bone Jt Surg 2020; 8:581-588. [PMID: 33088859 DOI: 10.22038/abjs.2020.40004.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We compared the amount of variation in Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) Computer Adaptive Test (CAT) accounted for by The Tampa Scale for Kinesiophobia (TSK) and its short form (TSK-4) independent of other factors. Questionnaire coverage, reliability, and validity were compared for both TSK and TSK-4 using mean scaled scores, internal consistency, floor and ceiling effects, interquestionnaire correlations, and collinearity with other measures as the Pain Catastrophizing Scale short form (PCS-4), PROMIS Depression CAT, and PROMIS Pain Interference (PROMIS PI) CAT. Methods One hundred forty eight consecutive new or return patients were enrolled. Patients were seen in an outpatient setting in several orthopaedic clinics in a large urban area. All patients completed the TSK, PROMIS PF CAT, PROMIS PI CAT, PROMIS Depression CAT, and PCS-4. Results Greater fear of movement (higher TSK) was associated with worse physical function (lower PROMIS PF CAT) and the full TSK explained more variation in physical function than the short form (TSK-4). In contrast to prior studies PCS-4 was not independent of TSK. Flooring and ceiling effects were seen with TSK-4. Worse physical function was associated with older age, traumatic condition, and more symptoms of depression. Conclusion The short form of the Tampa Scale for Kinesiophobia can be used as a brief screening measure in patient care and research in order to identify an independent influence of kinesiophobia on lower extremity specific limitations. Additional study is needed to determine whether there is utility in screening for both TSK and PCS or if one or the other provides sufficient information about cognitive biases regarding pain to guide treatment with cognitive behavioral therapy and related techniques.
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Affiliation(s)
- Joost T P Kortlever
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Shashwat Tripathi
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - John McDonald
- Texas Orthopedics, Sports and Rehabilitation Associates, Austin, TX, USA
| | - Brannan Smoot
- Texas Orthopedics, Sports and Rehabilitation Associates, Austin, TX, USA
| | - David Laverty
- Texas Orthopedics, Sports and Rehabilitation Associates, Austin, TX, USA
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Yildiz S, Kirdi E, Bek N. Comparison of the lower extremity function of patients with foot problems according to the level of kinesiophobia. Somatosens Mot Res 2020; 37:284-287. [PMID: 32996810 DOI: 10.1080/08990220.2020.1823362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The presence of kinesiophobia was identified in patients with foot problems. There was no finding of foot functionality according to the level of kinesiophobia in lower extremity problems. The aim of this study was to compare the lower extremity functional status in foot problems with a low or high level of kinesiophobia. MATERIALS AND METHODS Evaluated herein were 37 patients with foot problems (plantar fasciitis, hallux valgus, flat foot). Physical and demographic characteristics were recorded. Patients were divided into two groups based on if they had a high or low level of kinesiophobia using the Tampa kinesiophobia scale. Ankle plantar flexor and knee flexor muscles tightness were recorded. The foot posture was evaluated using the Foot Posture Index. Foot-related pain was measured using the Visual Analog Scale Foot & Ankle. The Foot Function Index and the American Orthopaedics Foot and Ankle Foundation Ankle-Hindfoot Scale and Hallux Metatarsophalangeal-Interphalangeal Scale were used to assess the foot function. The general functional status of the lower extremities was evaluated using the Lower Extremity Functional Scale. RESULTS Foot function was better in patients with a low level of kinesiophobia (p < 0.05). Pain was higher in patients with high level of kinesiophobia than in patients with a low level of kinesiophobia (p < 0.05). There was no difference between the groups in terms of foot posture index and muscle tightness (p > 0.05). The general lower extremity function was more negatively affected in patients with a high level of kinesiophobia (p < 0.05). CONCLUSIONS Patients with a high level of kinesiophobia presented with more functional problems in the foot and whole lower extremity; hence, function-based rehabilitation and pain coping strategies should be a crucial part of the rehabilitation program at the earliest opportunity.
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Affiliation(s)
- Sulenur Yildiz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Elif Kirdi
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Nilgun Bek
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Lokman Hekim University, Ankara, Turkey
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23
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Ranger TA, Cicuttini FM, Jensen TS, Manniche C, Heritier S, Urquhart DM. Catastrophization, fear of movement, anxiety, and depression are associated with persistent, severe low back pain and disability. Spine J 2020; 20:857-865. [PMID: 32045707 DOI: 10.1016/j.spinee.2020.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 01/13/2020] [Accepted: 02/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Psychological characteristics are important in the development and progression of low back pain (LBP); however, their role in persistent, severe LBP is unclear. PURPOSE To investigate the relationship between catastrophization, depression, fear of movement, and anxiety and persistent, severe LBP, and disability. STUDY DESIGN/ SETTING One-year prospective cohort study. PATIENT SAMPLE Participants were selected from the SpineData registry (Denmark), which enrolls individuals with LBP of 2 to 12 months duration without radiculopathy and without satisfactory response to primary intervention. OUTCOME MEASURES Psychological characteristics, including catastrophization, depression, fear of movement, and anxiety, were examined at baseline using a validated screening questionnaire. Current, typical, and worst pain in the past 2 weeks were assessed by 11-point numeric rating scales and an average pain score was calculated. Disability was measured using the 23-item Roland-Morris Disability Questionnaire. METHODS Participants completed baseline questionnaires on initial presentation to the Spine Center (Middelfart, Denmark), and follow-up questionnaires were sent and returned electronically. Statistical analysis involved multivariable Poisson regression to investigate the association between psychological factors and the number of episodes of severe pain or disability. This study received no direct funding. RESULTS Of the 952 participants at baseline, 633 (63.4%) provided data 1 year later. Approximately half of the participants reported severe LBP (n=299, 47.2%, 95% confidence interval [CI] 43.3%-51.2%) or disability (n=315, 57.6%, 95% CI 53.3%-61.8%) at a minimum of one time point, and 14.9% (n=94, 95% CI 12.2%-17.9%) and 24.3% (n=133, 95% CI 20.8%-28.1%) experienced severe LBP or disability at two time points, respectively. Multivariable Poisson regression showed a relationship between catastrophization, depression, fear of movement, and anxiety and a greater number of time points with severe LBP and disability, after adjusting for age, gender, body mass index, and duration of symptoms. However, when all psychological factors were added to the regression model, only catastrophization and depression remained significantly associated. CONCLUSIONS This study showed that persistent, severe LBP, and disability is common in a secondary care population with LBP and is associated with a variety of psychological risk factors, in particular catastrophization and depression, highlighting the importance of considering these factors in the design and evaluation of outcomes studies for LBP.
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Affiliation(s)
- Tom A Ranger
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Tue Secher Jensen
- Imaging Section, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Claus Manniche
- Department of Research, Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark
| | - Stephane Heritier
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Donna M Urquhart
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.
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van der Straaten R, Wesseling M, Jonkers I, Vanwanseele B, Bruijnes AKBD, Malcorps J, Bellemans J, Truijen J, De Baets L, Timmermans A. Functional movement assessment by means of inertial sensor technology to discriminate between movement behaviour of healthy controls and persons with knee osteoarthritis. J Neuroeng Rehabil 2020; 17:65. [PMID: 32430036 PMCID: PMC7236325 DOI: 10.1186/s12984-020-00694-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/07/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Apart from biomechanical alterations in movement patterns, it is known that movement limitations in persons with knee osteoarthritis (PwKOA) are related to an individual's perception and belief regarding pain and disability. To gain more insights into the functional movement behaviour of PwKOA in a clinical setting, inertial sensor technology can be applied. This study first aims to evaluate the ability of inertial sensors to discriminate between healthy controls (HC) and PwKOA. Secondly, this study aims to determine the relationship between movement behaviour, pain-related factors and disability scores. METHODS Twelve HC and 19 PwKOA were included. Five repetitions of six functional movement tasks (walking, forward lunge, sideward lunge, ascent and descent stairs, single leg squat and sit-to-stand) were simultaneously recorded by the inertial sensor system and a camera-based motion analysis system. Statistically significant differences in angular waveforms of the trunk, pelvis and lower limb joints between HC and PwKOA were determined using one-dimensional statistical parametric mapping (SPM1D). The Knee injury and Osteoarthritis Outcome Score and TAMPA scale for Kinesiophobia were used to evaluate the relationship between discriminating joint motion, pain-related factors and disability using spearman's correlation coefficients. RESULTS PwKOA had significantly less trunk rotation, internal pelvis rotation and knee flexion ROM during walking. Additionally, the reduced knee flexion (i.e. at the end of the stance phase and swing phase) was related to increased level of perceived pain. During the sideward lunge, PwKOA had significantly less knee flexion, ankle plantarflexion and hip abduction. This decreased hip abduction (i.e. during stance) was related to higher fear of movement. Finally, PwKOA had significantly less knee flexion during the forward lunge, single leg squat and during ascent and descent stairs. No significant correlations were observed with disability. CONCLUSIONS Inertial sensors were able to discriminate between movement characteristics of PwKOA and HC. Additionally, significant relationships were found between joint motion, perceived pain and fear of movement. Since inertial sensors can be used outside the laboratory setting, these results are promising as they indicate the ability to evaluate movement deviations. Further research is required to enable measurements of small movement deviations in clinically relevant tasks.
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Affiliation(s)
| | - Mariska Wesseling
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - Benedicte Vanwanseele
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | | | - Jan Malcorps
- Department of Orthopaedic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Johan Bellemans
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jan Truijen
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Liesbet De Baets
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
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Uritani D, Kasza J, Campbell PK, Metcalf B, Egerton T. The association between psychological characteristics and physical activity levels in people with knee osteoarthritis: a cross-sectional analysis. BMC Musculoskelet Disord 2020; 21:269. [PMID: 32334578 PMCID: PMC7183118 DOI: 10.1186/s12891-020-03305-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background The aim of this study was to examine the relationship between psychological characteristics and physical activity levels, measured as the average number of steps per day, in people with knee osteoarthritis (OA). Methods This study analysed baseline data from a randomized controlled trial (Australian New Zealand Clinical Trials Registry reference: ACTRN12612000308897). A total of 167 adults aged over 50 years, with knee pain rated as four or more on an 11-point numeric rating scale, and knee OA diagnosed using American College of Rheumatology clinical criteria, were recruited from the community (62 men and 105 women, mean age, 62.2 ± 7.5 years). The average number of steps per day over seven consecutive days was measured using an accelerometer-based device. Psychological characteristics evaluated were: depressive symptoms (Depression Anxiety Stress Scale), self-efficacy (Arthritis Self-Efficacy Scale for pain and other symptoms), fear of movement (Brief Fear of Movement Scale for Osteoarthritis), and pain catastrophizing (Pain Catastrophizing Scale). The association between the average number of steps per day and psychological characteristics was analyzed using a multiple linear regression analysis, with the average number of steps per day as the dependent variable, adjusting for each psychological characteristic separately, and age, sex, body mass index, and pain entered as covariates. Results There was evidence that the amount of physical activity was associated with fear of movement (coefficient [B]: − 117, 95% confidence interval [95%CI]: − 227 to − 8) and with pain catastrophizing (B: -44, 95%CI: − 86 to − 1). The association with self-efficacy was similar (B:117, 95%CI: − 12 to 246). However, the direction of the association with depressive symptoms was less clear (B: -59, 95%CI: − 138 to 19). Conclusions The results of this study revealed that the relationship was such that lower fear of movement and lower pain catastrophizing may be associated with more steps per day. It may be hypothesized that fear of moving and pain catastrophizing lead to activity avoidance and that strategies to improve these disease-related psychological aspects may be useful in enhancing physical activity participation, although this hypothesis is highly speculative and needs further testing given the cross-sectional design of this study.
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Affiliation(s)
- Daisuke Uritani
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan.
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Penny K Campbell
- Centre for Health, Exercise, and Sports Medicine, The University of Melbourne, 161 Barry Street, Melbourne, Victoria, 3010, Australia
| | - Ben Metcalf
- Centre for Health, Exercise, and Sports Medicine, The University of Melbourne, 161 Barry Street, Melbourne, Victoria, 3010, Australia
| | - Thorlene Egerton
- Centre for Health, Exercise, and Sports Medicine, The University of Melbourne, 161 Barry Street, Melbourne, Victoria, 3010, Australia
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KoÇyİĞİt BF, Akaltun MS. Kinesiophobia Levels in Fibromyalgia Syndrome and the Relationship Between Pain, Disease Activity, Depression. Arch Rheumatol 2020; 35:214-219. [PMID: 32851370 DOI: 10.46497/archrheumatol.2020.7432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/01/2019] [Indexed: 11/03/2022] Open
Abstract
Objectives This study aims to compare kinesiophobia levels between patients with fibromyalgia syndrome (FMS) and healthy volunteers and to investigate the factors associated with kinesiophobia in FMS. Patients and methods This case-control study included 88 female patients with FMS (mean age 41.61 years; range 21 to 61 years) and 67 female healthy volunteers (mean age 41.34 years; range 19 to 59 years). The participants' age, body mass index (BMI), and educational status were recorded. Patients were evaluated using a visual analog scale for pain, the Fibromyalgia Impact Questionnaire (FIQ) for disease activity, the Hamilton Depression Scale (HAM-D) for depression level, and the Tampa Scale for Kinesiophobia (TSK) for kinesiophobia. Additionally, the patients' serum 25-hydroxyvitamin D levels were measured. Results No significant differences were found between the patient and control groups in terms of age, BMI, and educational status (p>0.05). The mean TSK scores were 42.0±7.6 in the patient group and 37.2±8.8 in the control group. TSK score was significantly higher in the patient group (p<0.001). BMI levels, FIQ scores, and vitamin D concentrations were significantly associated with TSK scores according to the linear regression analysis (p<0.05). However, age, symptom duration, and HAM-D scores were not found to be associated with TSK scores (p>0.05). Conclusion Kinesiophobia scores were significantly higher in patients with FMS. Physicians should focus on kinesiophobia when evaluating patients with FMS and inform patients about the importance and treatment strategies of kinesiophobia.
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Affiliation(s)
- Burhan Fatih KoÇyİĞİt
- Department of Physical Medicine and Rehabilitation, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Kahramanmaraş Necip Fazıl State Hospital, Kahramanmaraş, Turkey
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Theunissen WWES, van der Steen MC, Liu WY, Janssen RPA. Timing of anterior cruciate ligament reconstruction and preoperative pain are important predictors for postoperative kinesiophobia. Knee Surg Sports Traumatol Arthrosc 2020; 28:2502-10. [PMID: 31879792 DOI: 10.1007/s00167-019-05838-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE Fear of movement (kinesiophobia) is a major limiting factor in the return to pre-injury sport level after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to gain insight into the prevalence of kinesiophobia pre-ACLR, 3 months post-ACLR and 12 months post-ACLR. Furthermore, the preoperative predictability of kinesiophobia at 3 months post-ACLR was addressed. METHODS A retrospective study with data, which were prospectively collected as part of standard care, was conducted to evaluate patients who underwent ACLR between January 2017 and December 2018 in an orthopaedic outpatient clinic. Patient characteristics (age, sex, body mass index), injury-to-surgery time, preoperative pain level (KOOS pain subscale) and preoperative knee function (IKDC-2000) were used as potential predictor variables for kinesiophobia (TSK-17) at 3 months post-ACLR in linear regression analysis. RESULTS The number of patients with a high level of kinesiophobia (TSK > 37) reduced from 92 patients (69.2%) preoperatively to 44 patients (43.1%) 3 months postoperatively and 36 patients (30.8%) 12 months postoperatively. The prediction model, based on a multivariable regression analysis, showed a positive correlation between four predictor variables (prolonged injury-to-surgery time, high preoperative pain level, male sex and low body mass index) and a high level of kinesiophobia at 3 months postoperatively (R2 = 0.384, p = 0.02). CONCLUSION The prevalence of kinesiophobia decreases during postoperative rehabilitation, but high kinesiophobia is still present in a large portion of the patients after ACLR. Timing of reconstruction seems to be the strongest predictor for high kinesiophobia 3 months post-ACLR. This study is the first step in the development of a screening tool to detect patients with kinesiophobia after ACLR. Identifying patients preoperatively opens the possibility to treat patients and thereby potentially increase the return to pre-injury sport level rate after ACLR. LEVEL OF EVIDENCE III.
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Ferrari S, Striano R, Lucking E, Pillastrini P, Monticone M, Vanti C. Does the awareness of having a lumbar spondylolisthesis influence self-efficacy and kinesiophobia? A retrospective analysis. Arch Physiother 2019; 9:16. [PMID: 31890291 PMCID: PMC6913011 DOI: 10.1186/s40945-019-0070-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/15/2019] [Indexed: 12/27/2022] Open
Abstract
Background High pain self-efficacy and low kinesiophobia seem related to a better prognosis in patients complaining of low back pain (LBP). The literature stresses the potential negative effects of anatomical defect diagnosis (e.g. lumbar spondylolisthesis) on the psychological profile. The aim of this study is to investigate the relationships between awareness of having a spondylolisthesis, pain self-efficacy and kinesiophobia. Methods A secondary retrospective analysis was done. Ninety-eight subjects with subacute and chronic LBP were included: 49 subjects with diagnosed symptomatic lumbar spondylolisthesis and 49 subjects with diagnosed non-specific LBP. The pain self-efficacy measured with the Pain Self-Efficacy Questionnaire and the fear of movement measured with the Tampa Scale of Kinesiophobia were considered variables to investigate, whereas diagnosis and demographic/clinical variables were considered predictors or potential confounders. Results By comparing the two groups, the awareness of having a spondylolisthesis did not significantly influence neither pain self-efficacy (p = 0.82), nor kinesiophobia (p = 0.75). Higher perceived pain reduces pain self-efficacy and increases kinesiophobia in both groups (p = 0.002 and p = 0,031 respectively). Conclusions It seems that the awareness of an anatomical defect as spondylolisthesis does not significantly affect the beliefs of carry out activities and movements despite the pain. Other studies with wider samples are required, to confirm these preliminary results.
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Affiliation(s)
- Silvano Ferrari
- 1Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Rosa Striano
- Progetto Persona Onlus, Korian Group, Milan, Italy
| | | | - Paolo Pillastrini
- 4Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Monticone
- 5Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Carla Vanti
- 4Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Fowler CA, Ballistrea LM, Mazzone KE, Martin AM, Kaplan H, Kip KE, Murphy JL, Winkler SL. A virtual reality intervention for fear of movement for Veterans with chronic pain: protocol for a feasibility study. Pilot Feasibility Stud 2019; 5:146. [PMID: 31890259 PMCID: PMC6907328 DOI: 10.1186/s40814-019-0501-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A key concern for people with chronic pain is experiencing increased pain and/or re-injury. Consequently, individuals with chronic pain can develop a maladaptive fear of movement that leads to adverse functional consequences. A primary goal of chronic pain rehabilitation is re-engagement in feared movements through exposure. This is often challenging since safe movement can be uncomfortable. Virtual environments provide a promising opportunity to safely and gradually expose Veterans to movements that are avoided in the real world. The current study will utilize multiple virtual reality (VR) applications (APPs) of varying the intensity levels ranging from passive distraction from pain to active exposure to feared movement. The primary aims of this pilot are to examine VR as an adjunctive nonpharmacological intervention to assist with the adoption and implementation of skills to decrease fear of movement and increase overall functioning among Veterans with chronic pain. Second, to build a hierarchy of VR APPs to assist in gradual exposure to feared movements. METHODS This study will be conducted in the Chronic Pain Rehabilitation Program (CPRP) at the James A. Haley Veterans Hospital, a unique inpatient program within the VA system. Participants will include up to 20 Veterans who receive a VR intervention as part of their physical therapy. A rating form containing qualitative and quantitative experiences will be administered following each VR session to assess feasibility and to provide descriptive information for the proposed hierarchy. Effect sizes will be calculated from intake and discharge measures for the primary outcome fear of movement and secondary pain and functional outcomes. DISCUSSION This study will inform the feasibility of a randomized controlled trial examining the clinical utility of using VR to reduce fear of movement and increase function among Veterans with chronic pain. VR has the advantage of being easily implemented both within VA healthcare settings as well as in Veterans' own residences, where engagement in ongoing self-management approaches is often most challenging. Presumably, VR that is matched to patient needs, progresses in intensity, immerses Veterans in the applications, and is perceived positively by Veterans, will result in positive functional outcomes.
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Affiliation(s)
- Christopher A. Fowler
- Research and Development Service, James A. Haley Veterans Hospital and Clinics, 8900 Grand Oak Circle, Tampa, FL 33705 USA
| | - Lisa M. Ballistrea
- Research and Development Service, James A. Haley Veterans Hospital and Clinics, 8900 Grand Oak Circle, Tampa, FL 33705 USA
| | - Kerry E. Mazzone
- James A. Haley Veterans Hospital and Clinics, 13000 Bruce B. Downs Blvd, Tampa, FL 33612 USA
| | - Aaron M. Martin
- James A. Haley Veterans Hospital and Clinics, 13000 Bruce B. Downs Blvd, Tampa, FL 33612 USA
| | - Howard Kaplan
- Advanced Visualization Center, University of South Florida – Information Technology, 4202 E. Fowler Avenue, CMC147, Tampa, FL 33620 USA
| | - Kevin E. Kip
- Research and Development Service, James A. Haley Veterans Hospital and Clinics, 8900 Grand Oak Circle, Tampa, FL 33705 USA
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL 33612 USA
| | - Jennifer L. Murphy
- Research and Development Service, James A. Haley Veterans Hospital and Clinics, 8900 Grand Oak Circle, Tampa, FL 33705 USA
- James A. Haley Veterans Hospital and Clinics, 13000 Bruce B. Downs Blvd, Tampa, FL 33612 USA
- Department of Neurology, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL 33612 USA
| | - Sandra L. Winkler
- Research and Development Service, James A. Haley Veterans Hospital and Clinics, 8900 Grand Oak Circle, Tampa, FL 33705 USA
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Quack V, Boecker M, Mueller CA, Mainz V, Geiger M, Heinemann AW, Betsch M, El Mansy Y. Psychological factors outmatched morphological markers in predicting limitations in activities of daily living and participation in patients with lumbar stenosis. BMC Musculoskelet Disord 2019; 20:557. [PMID: 31759398 PMCID: PMC6875026 DOI: 10.1186/s12891-019-2918-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent demographic changes have led to a large population of older adults, many of whom experience degenerative disc diseases. Degenerative lumbar spinal stenosis (DLSS) is associated with considerable discomfort and limitations in activities of daily living (ADL). Symptomatic DLSS is one of the most frequent indications for spinal surgery. The aim of this study was to identify sociodemographic variables, morphological markers, depression as well as fear of movement that predict ADL performance and participation in social life in patients with DLSS. METHODS Sixty-seven patients with DLSS (mean age 62.5 years [11.7], 50.7% females) participated in the study. Predictor variables were age, gender, duration of disease, three morphological markers (severity of the lumbar stenosis, the number of affected segments and presence of spondylolisthesis) as well as self-reported depression and fear of movement. Dependent variables were pain interference with the performance of ADLs, ADLs and participation in social life. Correlations between predictor and dependent variables were calculated before stepwise, linear regression analyses. Only significant correlations were included in the linear regression analyses. RESULTS Variance explained by the predictor variables ranged between 12% (R2 = .12; pain interference-physical) and 40% (R2 = .40; ADL requiring lower extremity functioning; participation). Depression and fear of movement were the most powerful predictors for all dependent variables. Among the morphological markers only stenosis severity contributed to the prediction of ADLs requiring lower extremity functioning. CONCLUSION Depression and fear of movement were more important predictors of the execution of ADLs and participation in social life compared to morphological markers. Elevated depressive symptoms and fear of movement might indicate limited adaptation and coping regarding the disease and its consequences. Early monitoring of these predictors should therefore be conducted in every spine centre. Future studies should investigate whether psychological screening or a preoperative psychological consultation helps to avoid operations and enables better patient outcomes.
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Affiliation(s)
- V. Quack
- Department of Orthopedic Surgery, RWTH Aachen University, Aachen, Germany
| | - M. Boecker
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Aachen, Germany
| | - C. A. Mueller
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - V. Mainz
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Aachen, Germany
| | - M. Geiger
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - A. W. Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - M. Betsch
- Department of Orthopedic Surgery, RWTH Aachen University, Aachen, Germany
| | - Y. El Mansy
- Department of Orthopedic Surgery, RWTH Aachen University, Aachen, Germany
- The Orthopedic Department, Alexandria University, Alexandria, Egypt
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Gonçalves C, Silva AG. Reliability, measurement error and construct validity of four proprioceptive tests in patients with chronic idiopathic neck pain. Musculoskelet Sci Pract 2019; 43:103-109. [PMID: 31376618 DOI: 10.1016/j.msksp.2019.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/26/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND There are different neck proprioceptive tests that are believed to be targeting different sources of proprioceptive information. OBJECTIVE To assess the reliability, measurement error, discriminative validity and convergent validity of four proprioceptive tests (head repositioning to neutral - HRNT, torsion test - TT, head repositioning to 30° rotation - HR30T and figure of eight relocation test - F8T) in individuals with chronic idiopathic neck pain and asymptomatic individuals. A secondary aim was to assess the divergent validity of these tests by correlating them against measures of disability, pain catastrophizing and fear of movement. DESIGN - Reliability and validity study. METHODS - 66 participants (33 with chronic neck pain and 33 asymptomatic) were assessed using four proprioceptive tests, pain catastrophizing scale, neck disability index, tampa scale of kinesiophobia and visual analogue scale. RESULTS Proprioceptive tests showed moderate to good reliability (ICC: 0.55 to 0.85), but high measurement error. All tests but the HR30T were significantly different between participants with and without neck pain (p < 0.05). Only the HRNT showed an area under the curve above 0.5 (AUC95% CI = 0.51; 0.78, p ≤ 0.042). Between test correlations ranged between 0.35 and 0.61 and correlations between proprioceptive tests and catastrophizing, fear of movement and disability were, in general, lower than 0.3. CONCLUSION The four proprioceptive tests showed reliability and measurement errors good enough for group comparisons but of limited utility for individual comparisons. They seem to measure related but dissimilar constructs and the HRNT seemed better at discriminating individuals with and without NP and easier to perform in clinical practice.
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Affiliation(s)
- Catarina Gonçalves
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - Anabela G Silva
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal; Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal.
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de Oliveira Silva D, Barton CJ, Briani RV, Taborda B, Ferreira AS, Pazzinatto MF, Azevedo FM. Kinesiophobia, but not strength is associated with altered movement in women with patellofemoral pain. Gait Posture 2019; 68:1-5. [PMID: 30408709 DOI: 10.1016/j.gaitpost.2018.10.033] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Evidence indicates the presence of both kinesiophobia and knee extension strength deficits in women with patellofemoral pain (PFP). Both impairments may contribute to apparent compensatory gait patterns including reduced cadence and peak knee flexion during stair negotiation. RESEARCH QUESTION Is kinesiophobia or knee extension strength associated with movement pattern in women with patellofemoral pain? METHODS Forty women with PFP were assessed with three-dimensional kinematic analyses during stair descent; isokinetic dynamometry of the knee extensors (isometric, concentric and eccentric); and the Tampa scale for kinesiophobia. Pearson coefficients were calculated to determine relationship among variables. RESULTS Kinesiophobia correlated significantly with cadence (r = -0.62, p < 0.001), and peak knee flexion (r = -0.76, p < 0.001). No significant correlations were found between any knee extensor strength variables and kinematics (cadence or peak knee flexion); or kinesiophobia (p > 0.05). SIGNIFICANCE Findings of this study could suggest addressing strength impairments alone may not adequately address kinesiophobia and movement pattern impairments in women with PFP. However, high-quality randomised controlled trials are needed to test this assumption. Further value may be added if currently evidence-based knee strengthening exercise is combined with education and/or graded exposure to address kinesiophobia, and consideration to gait retraining to address altered movement patterns at the knee.
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Söderlund A, Löfgren M, Stålnacke BM. Predictors before and after multimodal rehabilitation for pain acceptance and engagement in activities at a 1-year follow-up for patients with whiplash-associated disorders (WAD)-a study based on the Swedish Quality Registry for Pain Rehabilitation (SQRP). Spine J 2018; 18:1475-1482. [PMID: 29155342 DOI: 10.1016/j.spinee.2017.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/03/2017] [Accepted: 11/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in patients with whiplash-associated disorders (WAD). PURPOSE The purpose of this study was to predict chronic pain acceptance and engagement in activities at 1-year follow-up with pain intensity, fear of movement, perceived responses from significant others, outcome expectancies, and demographic variables in patients with WAD before and after multimodal rehabilitation (MMR). STUDY DESIGN The design of this investigation was a cohort study with 1-year postrehabilitation follow-up. STUDY SETTING The subjects participated in MMR at a Swedish rehabilitation clinic during 2009-2015. PATIENT SAMPLE The patients had experienced a whiplash trauma (WAD grade I-II) and were suffering from pain and reduced functionality. A total of 386 participants were included: 297 fulfilled the postrehabilitation measures, and 177 were followed up at 1 year after MMR. OUTCOME MEASURES Demographic variables, pain intensity, fear of movement, perceived responses from significant others, and outcome expectations were measured at the start and after MMR. Chronic pain acceptance and engagement in activities were measured at follow-up. METHODS The data were obtained from a Swedish Quality Registry for Pain Rehabilitation (SQRPR). RESULTS Outcome expectancies of recovery, supporting and distracting responses of significant others, and fear of (re)injury and movement before MMR were significant predictors of engagement in activities at follow-up. Pain intensity and fear of (re)injury and movement after MMR significantly predicted engagement in activities at follow-up. Supporting responses of significant others and fear of (re)injury and movement before MMR were significant predictors of pain acceptance at the 1-year follow-up. Solicitous responses of significant others and fear of (re)injury and movement at postrehabilitation significantly predicted pain acceptance at follow-up. CONCLUSION For engagement in activities and pain acceptance, the fear of movement appears to emerge as the strongest predictor, but patients' perceived reactions from their spouses need to be considered in planning the management of WAD.
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Affiliation(s)
- Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden.
| | - Monika Löfgren
- Department of Clinical Sciences Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital AB, Mörbygårdsvägen, SE 182 88 Stockholm, Sweden
| | - Britt-Marie Stålnacke
- Department of Clinical Sciences Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital AB, Mörbygårdsvägen, SE 182 88 Stockholm, Sweden; Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Vårdvetarhuset, Umeå University, SE-901 87 Umeå, Sweden
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Caneiro JP, O'Sullivan P, Smith A, Moseley GL, Lipp OV. Implicit evaluations and physiological threat responses in people with persistent low back pain and fear of bending. Scand J Pain 2017; 17:355-366. [PMID: 29031589 DOI: 10.1016/j.sjpain.2017.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Pain and protective behaviour are dependent on implicit evaluations of danger to the body. However, current assessment of perceived danger relies on self-report, on information of which the person is aware and willing to disclose. To overcome this limitation, attempts have been made to investigate implicit evaluation of movement-related threatening images in people with persistent low back pain (PLBP) and pain-related fear. Lack of specificity of the sample and stimuli limited those explorations. This study investigated implicit evaluations and physiological responses to images of tasks commonly reported as threatening by people with PLBP: bending and lifting. We hypothesized that people who differ in self-reported fear of bending with a flexed lumbar spine (fear of bending) would also differ in implicit evaluations and physiological responses. METHODS This study used a convenience sample of 44 people (54% female) with PLBP, who differed in self-reported fear of bending. Participants completed a picture-viewing paradigm with pleasant, neutral and unpleasant images, and images of people bending and lifting with a flexed lumbar spine ('round-back') to assess physiological responses (eye-blink startle modulation, skin conductance). They also completed an implicit association test (IAT) and an affective priming task (APT). Both assessed implicit associations between (i) images of people bending/lifting with a flexed lumbar spine posture ('round-back' posture) or bending/lifting with a straight lumbar spine posture ('straight-back' posture), and (ii) perceived threat (safe vs. dangerous). RESULTS An implicit association between 'danger' and 'round-back' bending/lifting was evident in all participants (IAT (0.5, CI [0.3; 0.6]; p<0.001) and APT (24.2, CI [4.2; 44.3]; p=0.019)), and unrelated to self-reported fear of bending (IAT (r=-0.24, 95% CI [-0.5, 0.04], p=0.117) and APT (r=-0.00, 95% CI [-0.3, 0.3], p=0.985)). Levels of self-reported fear of bending were not associated with eye-blink startle (F(3, 114)=0.7, p=0.548) or skin conductance responses (F(3, 126)=0.4, p=0.780) to pictures of bending/lifting. CONCLUSIONS Contrary to our expectation, self-reported fear of bending was not related to physiological startle response or implicit measures. People with PLBP as a group (irrespective of fear levels) showed an implicit association between images of a round-back bending/lifting posture and danger, but did not display elevated physiological responses to these images. These results provide insight to the understanding of the relationship between pain and fear of movement. IMPLICATIONS The potential clinical implications of our findings are twofold. First, these results indicate that self-report measures do not always reflect implicit associations between particular movements and threat. Implicit association tasks may help overcome this limitation. Second, a lack of the predicted physiological and behavioural responses may reflect that the visualization of a threatening task by people in pain does not elicit the same physiological defensive responses measured in people with fear of specific objects. It may be necessary to expose the person to the actual movement to elicit threat-responses. Together, these results are consistent with current views of the role of 'fear' in the fear-avoidance model, in which a fear response may only be elicited when the threat is unavoidable.
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Affiliation(s)
- J P Caneiro
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia; Body Logic Physiotherapy Clinic, Shenton Park, Australia.
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia; Body Logic Physiotherapy Clinic, Shenton Park, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - G Lorimer Moseley
- Sansom Institute for Health Research, University of South Australia, Australia
| | - Ottmar V Lipp
- School of Psychology and Speech Pathology, Curtin University, Bentley, Australia
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Güney-Deniz H, Irem Kınıklı G, Çağlar Ö, Atilla B, Yüksel İ. Does kinesiophobia affect the early functional outcomes following total knee arthroplasty? Physiother Theory Pract 2017; 33:448-453. [PMID: 28481125 DOI: 10.1080/09593985.2017.1318988] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to investigate the effects of kinesiophobia on early functional outcomes in patients following total knee arthroplasty (TKA) and how kinesiophobia is related to functional outcomes and pain. The Tampa Scale for Kinesiophobia (TSK), 2-minute walk test (2-MWT), and the timed up and go test (TUG) were used to assess 46 TKA patients on discharge day. The pain levels and active knee flexion range of motion (ROM) were recorded. Patients were divided into two groups as high kinesiophobia (Group I, n = 22) and low kinesiophobia (Group II, n = 24) based on the TSK levels. The TUG results were similar between groups (p = 0.826). 2-MWT results (p < 0.001), pain levels (p = 0.003), and knee flexion ROM (p = 0.025) scores were better in Group II when compared to Group I. The TSK scores were significantly correlated with 2-MWT results (r = -0.40; p = 0.003), pain levels (r = 0.80; p < 0.001), and knee flexion ROM (r = -0.47; p = 0.001). The regression analysis revealed that 41% of 2-MWT score, 47% of knee flexion ROM, and 60% of pain level changes could be explained by kinesiophobia level. The results suggest that early outcomes following TKA were affected by the pain-related fear of movement. The clinicians need to consider the interrelationships between fear of movement and functional outcomes when designing, implementing, and monitoring daily therapeutic exercise programs.
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Affiliation(s)
- Hande Güney-Deniz
- a Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Gizem Irem Kınıklı
- a Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Ömür Çağlar
- b Department of Orthopedics and Traumatology , Hacettepe University , Ankara , Turkey
| | - Bülent Atilla
- b Department of Orthopedics and Traumatology , Hacettepe University , Ankara , Turkey
| | - İnci Yüksel
- c Department of Physiotherapy and Rehabilitation , Dogu Akdeniz University , Gazimagusa , Cyprus
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Wakaizumi K, Yamada K, Oka H, Kosugi S, Morisaki H, Shibata M, Matsudaira K. Fear-avoidance beliefs are independently associated with the prevalence of chronic pain in Japanese workers. J Anesth 2017; 31:255-262. [PMID: 28050703 DOI: 10.1007/s00540-016-2303-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/19/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Pain is a global public health problem with implications for both personal and social heath. Fear-avoidance beliefs (FABs) have been demonstrated to negatively impact and prolong pain in many Western countries, but little is known about the association between FABs and chronic pain (CP) in Asian countries, including Japan. We examined the relationship between FABs and CP in Japanese white-collar workers, a growing population with a high prevalence of CP. METHODS Questionnaires and company records were used to gather data from 433 Japanese white-collar workers. Data were related to experience of pain, participant sociodemographic/health/lifestyle characteristics, fear-avoidance beliefs [Tampa Scale for Kinesiophobia (TSK)], work-related psychosocial factors (Brief Job Stress Questionnaire), and depressive illness [Psychological Distress Scale (K6)]. Analysis of covariance and multilevel logistic regression modeling were used to analyze associations between the data while controlling for factors known to influence CP prevalence. RESULTS Prevalence rate of CP was 11.1% (48 of 433 persons). Adjusted odds ratios for participants with CP significantly increased in participants with high TSK scores, even after adjusting for factors known to influence CP prevalence. CONCLUSION We found a significant association between high TSK scores and CP in Japanese white-collar workers when controlling for other known factors that influence CP such as work-related psychosocial characteristics and depressive conditions. This finding suggests that FABs are independently associated with prevalence of CP.
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Affiliation(s)
- Kenta Wakaizumi
- Department of Anesthesiology, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-0016, Japan.
| | - Keiko Yamada
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita-Shi, Osaka, Japan.,Center for Pain Management, Osaka University Hospital, Suita-Shi, Osaka, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shizuko Kosugi
- Department of Anesthesiology, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-0016, Japan
| | - Hiroshi Morisaki
- Department of Anesthesiology, Keio University School of Medicine, 35, Shinanomachi, Shinjyuku-ku, Tokyo, 160-0016, Japan
| | - Masahiko Shibata
- Center for Pain Management, Osaka University Hospital, Suita-Shi, Osaka, Japan.,Department of Pain Medicine, Osaka University Graduate School of Medicine, Suita-Shi, Osaka, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Archer KR, Seebach CL, Mathis SL, Riley LH, Wegener ST. Early postoperative fear of movement predicts pain, disability, and physical health six months after spinal surgery for degenerative conditions. Spine J 2014; 14:759-67. [PMID: 24211099 DOI: 10.1016/j.spinee.2013.06.087] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 04/25/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The fear-avoidance model offers a promising framework for understanding the development of chronic postoperative pain and disability. However, limited research has examined this model in patients undergoing spinal surgery. PURPOSE To determine whether preoperative and early postoperative fear of movement predicts pain, disability, and physical health at 6 months following spinal surgery for degenerative conditions, after controlling for depressive symptoms and other potential confounding variables. STUDY DESIGN/SETTING A prospective cohort study conducted at an academic outpatient clinic. PATIENT SAMPLE One hundred forty-one patients undergoing surgery for lumbar or cervical degenerative conditions. OUTCOME MEASURES Self-reported pain and disability were measured with the Brief Pain Inventory and the Oswestry Disability Index/Neck Disability Index, respectively. The physical composite scale of the 12-Item Short-Form Health Survey (SF-12) measured physical health. METHODS Data collection occurred preoperatively and at 6 weeks and 6 months following surgery. Fear of movement was measured with the Tampa Scale for Kinesiophobia and depression with the Prime-MD PHQ-9. RESULTS One hundred and twenty patients (85% follow-up) completed the 6-month postoperative assessment. Multivariable mixed-method linear regression analyses found that early postoperative fear of movement (6 weeks) predicted pain intensity, pain interference, disability, and physical health at 6-month follow-up (p<.05). Preoperative and early postoperative depression predicted pain interference, disability, and physical health. CONCLUSION Results provide support for the fear-avoidance model in a postsurgical spine population. Early postoperative screening for fear of movement and depressive symptoms that do not acutely improve following surgical intervention appears warranted. Cognitive and behavioral strategies may be beneficial for postsurgical patients with high fear of movement and/or depressive symptoms.
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Affiliation(s)
- Kristin R Archer
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University, School of Medicine, Medical Center East - South Tower, Suite 4200, Nashville, TN 37232, USA.
| | - Caryn L Seebach
- Department of Psychology, Washington DC VA Medical Center, 50 Irving St, NW, Washington, DC 20422, USA
| | - Shannon L Mathis
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University, School of Medicine, Medical Center East - South Tower, Suite 4200, Nashville, TN 37232, USA
| | - Lee H Riley
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, 601 N. Carolina St, Baltimore, MD 21287, USA
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, 600 N. Wolfe St, Baltimore, MD 21287, USA
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