The relationships between kinesiophobia and clinical outcomes after ACL reconstruction differ by self-reported physical activity engagement

Relationship between Kinesiophobia and Dynamic Postural Stability after Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study

Anterior cruciate ligament (ACL) injuries in young, active patients generally require ACL reconstruction (ACLR) to restore mechanical and postural stability. The fear of movement or reinjury (kinesiophobia) has become increasingly recognized in the post-ACLR population; however, the association between restoration of postural stability and kinesiophobia remains largely unknown. The purpose of this study was to investigate changes in mean Tampa Scale of Kinesiophobia-11 (TSK-11), dynamic motion analysis (DMA) scores, and time on the testing platform, as well as any correlation between TSK-11 and mean overall and individual translational and rotational DMA scores during the first 12 months following ACLR. Cohort study. Patients undergoing ACLR were prospectively enrolled and dynamic postural stability and kinesiophobia based on the TSK-11 were collected within 2 days prior to surgery and at 6 and 12 months following ACLR. Dynamic postural stability was quantified by calculating a DMA score, with score calculated in three translational (anterior/posterior [AP], up/down [UD], medial/lateral [ML]) and three rotational (left/right [LR], flexion/extension, and internal/external rotation) independent planes of motions. Correlations between DMA and TSK-11 scores at each time point were analyzed. A total of 25 patients meeting inclusion criteria were analyzed. Mean overall DMA and TSK-11 scores increased with each successive testing interval. At 6-month follow-up, a weakly positive association between TSK-11 and DMA scores was appreciated based on overall DMA, AP, UD, ML, and LR. At 12 months, a moderately positive correlation was appreciated between TSK-11 and the translational, but not rotational, planes of motion. Following ACLR, lower level of kinesiophobia were found to be moderately associated with improved dynamic stability, especially in the translation planes of motion.

In the medium term, more than half of males report kinesiophobia after anterior cruciate ligament reconstruction

OBJECTIVES

Anterior cruciate ligament rupture is a serious trauma with long-term consequences for the patient. Psychological and physiological factors may negatively affect patient recovery after anterior cruciate ligament reconstruction (ACLR), and development of kinesiophobia is possible. The aim of this study was to examine the presence of kinesiophobia and lower-leg muscle strength recovery in both sexes after ACLR.

METHODS

140 ACLR patients agreed to participate in the study. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). The Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS) and Tegner Activity Scale (TAS) were used for patient-related outcome measurements. In both legs quadriceps and hamstring muscle strength at 60°/s and 180°/s were measured with an isokinetic dynamometer. For dynamic balance and leg function, the Y-balance test and single-leg hop test were used.

RESULTS

100 (71%) males and 40 (29%) females-mean age 32.5 (±8.3)-were examined 5.5 (±1.25) years after ACLR. 68/140 patients (48.6%) reported a TSK kinesiophobia score equal to or higher than 37 points: 54/100 (54%) males and 14/40 (35%) females (p ​= ​0.04). Patients with kinesiophobia had significantly lower KOOS values (p ​< ​0.001). In terms of the TAS no significant differences were found between those with or without kinesiophobia. Knee strength deficiency at 180°/sec and 60°/sec was significantly higher in the kinesiophobia group in knee extension in males (p ​= ​0.009) and knee flexion in females (p ​= ​0.001). Normalized body weight isokinetic average peak torque strength tests were significantly better in males compared to females in both groups (p ​< ​0.001).

CONCLUSION

Both sexes reported high rates of kinesiophobia, but males are at higher risk of developing kinesiophobia than females in the medium term after ACLR. Furthermore, patients with kinesiophobia have significantly lower total KOOS scores, and females were significantly weaker than males in knee flexion and extension according to normalized body weight muscle strength tests. Also, a longer time from injury to surgery increases the risk of kinesiophobia in females.

LEVEL OF EVIDENCE

Level IV.

TYPE OF STUDY

Retrospective case series study.

CLINICAL TRIAL REGISTRATION

Trial registration in ClinicalTrials.gov. Identifier: NCT05762809.

Electrocortical activity associated with movement-related fear: a methodological exploration of a threat-conditioning paradigm involving destabilising perturbations during quiet standing

Musculoskeletal trauma often leads to lasting psychological impacts stemming from concerns of future injuries. Often referred to as kinesiophobia or re-injury anxiety, such concerns have been shown to hinder return to physical activity and are believed to increase the risk for secondary injuries. Screening for re-injury anxiety is currently restricted to subjective questionnaires, which are prone to self-report bias. We introduce a novel approach to objectively identify electrocortical activity associated with the threat of destabilising perturbations. We aimed to explore its feasibility among non-injured persons, with potential future implementation for screening of re-injury anxiety. Twenty-three participants stood blindfolded on a translational balance perturbation platform. Consecutive auditory stimuli were provided as low (neutral stimulus [CS-]) or high (conditioned stimulus [CS+]) tones. For the main experimental protocol (Protocol I), half of the high tones were followed by a perturbation in one of eight unpredictable directions. A separate validation protocol (Protocol II) requiring voluntary squatting without perturbations was performed with 12 participants. Event-related potentials (ERP) were computed from electroencephalography recordings and significant time-domain components were detected using an interval-wise testing procedure. High-amplitude early contingent negative variation (CNV) waves were significantly greater for CS+ compared with CS- trials in all channels for Protocol I (> 521-800ms), most prominently over frontal and central midline locations (P ≤ 0.001). For Protocol II, shorter frontal ERP components were observed (541-609ms). Our test paradigm revealed electrocortical activation possibly associated with movement-related fear. Exploring the discriminative validity of the paradigm among individuals with and without self-reported re-injury anxiety is warranted.

Impact of Psychological Factors on Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Systematic Review

CONTEXT

Anterior cruciate ligament (ACL) tears are a common orthopaedic injury, and the incidence of ACL reconstruction (ACLR) continues to increase. Current clinical practice guidelines (CPGs) recognize the role of psychological factors in rehabilitation, but patient-reported outcome measures (PROs) and psychological readiness are rarely incorporated into rehabilitation.

OBJECTIVE

The purpose of this review was to highlight the importance of psychological health after ACL injury, understand the current metrics used to monitor psychological recovery, and outline how psychological recovery can be better incorporated in current CPGs.

DATA SOURCES

A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA); 63 studies were identified with a PubMed search using the term "ACL Injuries/psychology".

STUDY SELECTION

Exclusion criteria included lack of consideration of psychological effects or studies validating PROs after ACLR. Studies were reviewed by multiple reviewers, and a total of 38 studies were included after applying exclusion criteria.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 3b.

DATA EXTRACTION

Two independent reviewers analyzed the included articles to extract sample size, psychological readiness scale or other measures used, and key results.

RESULTS

Psychological outcomes, especially kinesiophobia and fear of reinjury, are seen commonly after ACLR. Psychological factors were shown to impede return to sport (RTS), alter measurable knee biomechanics, and potentially increase the risk for re-rupture. Targeted interventions such as kinesiotaping, knee bracing, and imagery training can help improve psychological and functional testing after ACLR.

CONCLUSION

ACLR is often complicated by psychological factors. Psychological readiness is a crucial yet often unincorporated part of rehabilitation. Patients with higher levels of kinesiophobia and lower psychological readiness to RTS specifically should be identified to allow for administration of interventions, such as imagery training, knee bracing, or kinesiotaping, that can mitigate the negative effects of psychological outcomes and improve recovery.

A Mind-Body Intervention to Improve Physical Activity for Patients with Chronic Hip-Related Pain: Protocol for a Mixed Methods Study

BACKGROUND

Pain and dysfunction persist for most patients following hip-related pain treatment. Additionally, individuals with hip-related pain are typically less physically active than individuals without hip pain, despite evidence that regular physical activity reduces chronic musculoskeletal pain. Poor psychological health is common in patients with hip-related pain and further reinforces low physical activity. Mind-body interventions can improve psychological health and activity levels but have yet to be integrated to provide comprehensive, psychologically informed care for patients with hip-related pain. Thus, we are using the NCCIH intervention development framework to develop Helping Improve PSychological Health (HIPS), a novel, multimodal mind-body intervention to improve physical activity for individuals with hip-related pain and poor psychological health.

METHODS

We will recruit physical therapists (N = 20) and patients with hip-related pain (N = 20) to participate in 60 min qualitative interviews (focus groups with therapists; one-on-one interviews with patients). Using these data, we will develop the initial HIPS intervention and provider training materials. One physical therapist will be trained to deliver the HIPS intervention to five participants in an open pilot trial. Participants will attend six 30 min HIPS intervention sessions. We will collect quantitative data on satisfaction, improvement, and physical activity, alongside qualitative exit interviews with participants and the physical therapist in order to refine the HIPS intervention and provider training materials.

RESULTS

This study has been approved by the MGB IRB. We aim to develop and test the initial feasibility of the HIPS intervention in an open pilot trial. The findings from this project will inform a subsequent feasibility RCT.

What makes an athlete? A scoping review: Assessing the use of the word athlete with anterior cruciate ligament rehabilitation review studies. Is there a standard?

The term athlete does not currently have an agreed definition or standardized use across the literature. We analyzed the use of the term "athlete" amongst review studies specific to Anterior Cruciate Ligament (ACL) rehabilitation to investigate if the term was justified in its use. A comprehensive review of a database was performed to identify review papers which used the term "athlete" in the title, and which were related to ACL rehabilitation and surveillance. These papers were analyzed and their source papers were extracted for review. Twenty-eight review papers were identified. Source studies were extracted and analyzed. After removal of duplicates 223 source papers were identified. Despite using the term "athlete" in the review study titles only 5/17 (10.7%) sufficiently justified the use of this term. The term athlete was used in 117/223 (52.5%) of the source studies. Of those, 78/117 source studies (66.7%) justified the term athlete. The remaining 39/117 (33.3%) papers where participants were stated to be athletes, gave no justification. The ambiguous use of the term athlete amongst published studies highlights the need for a definition or justification of the term to be used in studies. The lack of a standard definition leads to the potential for studies to dilute high quality data by the potentially differing rehabilitation requirements and access to resources available to those with varying exercise levels. The indiscriminate use of the term athlete could lead to participants with widely ranging physical activity levels being included in the same study, and being used to create clinical advice for all. Advice could potentially vary across those of differing physical activity levels.

Effects of neuromuscular and proprioceptive training on self-reported wellness and health scores and knee sensorimotor characteristics in active seniors

INTRODUCTION

Athletes regularly engage in comprehensive neuromuscular and proprioceptive training (NPT) to prevent musculoskeletal (MSK) injuries. NPT exercises such as movement technique, agility, balance, and posture as well as yoga-based stretching and slow/deep breathing have shown added benefits in psychological and other well-being. This study aimed to examine the effects of NPT on knee sensorimotor characteristics and multi-domain wellness and health scores in active seniors.

METHODS

Twenty seniors participated in the NPT intervention (15-20min session twice a week for 10 weeks) while the control group did not receive any intervention. All participants completed surveys (general health, frailty, anxiety, stress, mindfulness, optimism, and sleep quality) and laboratory testing before and after intervention. Laboratory testing included frailty tests (grip strength, 4-m walk speed, and calcaneal ultrasound-based bone density) and knee sensorimotor characteristics (peak force, visual-motor reaction time, and force steadiness).

RESULTS

There was significant increase in general mental health (Short Form 36 Mental Health; p = 0.005) and decrease in stress (Perceived Stress Scale; p = 0.010) and sleep disturbances (Pittsburgh Sleep Quality Index; p = 0.019) post-intervention while no significant changes were observed in the control group (p = 0.310-0.654). Peak knee forces in all directions and some visual-motor reaction time and force steadiness were significantly improved post-intervention only in the experimental group (p = 0.001-0.038).

CONCLUSION

A simple, yet, comprehensive NPT has potential to improve MSK health as well as various domains of well-being among active seniors.

The association between kinesiophobia and functional limitations in service members with knee pain

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.

Association Between Preoperative Multidimensional Psychological Distress and Physical Function After Surgery for Sports-Related Injury

Background

Psychological distress after orthopaedic surgery can lead to worse outcomes, including higher levels of disability and pain and lower quality of life. The 10-item Optimal Screening for Prediction for Referral and Outcome-Yellow Flag (OSPRO-YF) survey screens for multiple psychological constructs relevant to recovery from orthopaedic injury and may be useful to preoperatively identify patients who may require further psychological assessment and possible intervention after surgery.

Purpose/Hypothesis

To determine the association between the OSPRO-YF and physiological patient-reported outcomes (PROs). It was hypothesized that higher OSPRO-YF scores (indicating worse psychological distress) would be associated with worse PRO scores at time of return to sport.

Study Design

Case series; Level of evidence, 4.

Methods

This study evaluated 107 patients at a single, academic health center who were assessed at a sports orthopaedics clinic and ultimately treated surgically for injuries to the knee, shoulder, foot, or ankle. Preoperatively, patients completed the OSPRO-YF survey as well as the following PRO measures: Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numeric Evaluation, numeric rating scale for pain; American Shoulder and Elbow Surgeons standardized shoulder assessment form for patients with shoulder injuries, the International Knee Documentation Committee score (for patients with knee injuries), and the Foot and Ankle Ability Measure (FAAM; for patients with foot or ankle injuries). At the time of anticipated full recovery and/or return to sport, patients again completed the same PRO surveys. Multivariable regression was used to evaluate the association between total OSPRO-YF score at baseline and PRO scores at the time of functional recovery.

Results

The baseline OSPRO-YF score predicted postoperative PROMIS Physical Function and FAAM Sports scores only. A 1-unit increase in the OSPRO-YF was associated with a 0.55-point reduction in PROMIS Physical Function (95% CI, -1.05 to -0.04; P = .033) indicating worse outcomes. Among patients who underwent ankle surgery, a 1-unit increase in OSPRO-YF was associated with a 6.45-point reduction in FAAM Sports (95% CI, -12.0 to -0.87; P = .023).

Conclusion

The study findings demonstrated that the OSPRO-YF survey predicts certain long-term PRO scores at the time of expected return to sport, independent of baseline scores.

The Relationship of Knee-related Quality of Life With Function, Psychological Factors, Strength, Performance, and Postural Stability After ACL Reconstruction: A Cross-Sectional Study

BACKGROUND

Patients after anterior cruciate ligament reconstruction (ACLR) have decreased health-related quality of life (QoL) compared with healthy control participants. Few studies have verified the predictors of QoL using Quality of Life Outcome Measure Questionnaire for Chronic Anterior Cruciate Ligament Deficiency (ACL-QoL), and no study has verified the relationship of psychological factors and knee function with ACL-QoL in patients after ACLR.

HYPOTHESIS

Knee functional status, muscle strength, performance in hop tests, postural stability, and psychological factors would be the predictors of QoL after ACLR.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 131 participants who had undergone ACLR at least 6 months previously were evaluated. QoL was assessed using ACL-QoL; knee functional status, using International Knee Documentation Committee Subjective Knee (IKDC) and global rating scale (GRS); psychological readiness, using Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI); kinesiophobia, using Tampa Scale for Kinesiophobia (TSK-17); knee strength, using isokinetic dynamometer; performance, using single-leg hop tests; and postural stability, using Biodex Balance System. Pearson's linear correlation and stepwise hierarchical multiple linear regression analyses were performed to verify the predictors of QoL.

RESULTS

ACL-QoL showed a moderate correlation with IKDC (r = 0.69), GRS (r = 0.55), ACL-RSI (r = 0.50), and TSK-17 (r = -0.49). ACL-QoL presented none to low correlations with the variables of muscle strength, postural stability, and performance in hop tests. The variables related to the knee functional status and psychological factors (IKDC, GRS, ACL-RSI, and TSK-17) were found to be the predictors of QoL (R2 = 0.56; P = 0.01).

CONCLUSION

Knee functional status, psychological readiness, and kinesiophobia were the predictors of knee-related QoL in patients after ACLR.

CLINICAL RELEVANCE

These results can assist clinicians in the therapeutic monitoring of the factors that may interfere with QoL in patients after ACLR.

Fear of reinjury following primary anterior cruciate ligament reconstruction: a systematic review

PURPOSE

This review aims to elucidate the most commonly reported method to quantify fear of reinjury or kinesiophobia and to identify key variables that influence the degree of kinesiophobia following primary anterior cruciate ligament reconstruction (ACLR).

METHODS

A systematic search across three databases (Pubmed, Ovid (MEDLINE), and EMBASE) was conducted from database inception to August 7th, 2022. The authors adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Quality assessment of the included studies was conducted according to the Methodological Index for Non-Randomized Studies (MINORS) criteria.

RESULTS

Twenty-six studies satisfied the inclusion criteria and resulted in 2,213 total patients with a mean age of 27.6 years and a mean follow-up time of 36.7 months post-surgery. The mean MINORS score of the included studies was 11 out of 16 for non-comparative studies and 18 out of 24 for comparative studies. Eighty-eight percent of included studies used variations of the Tampa Scale of Kinesiophobia (TSK) to quantify kinesiophobia and 27.0% used Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI). The results of this study shows a common association between higher kinesiophobia and poor patient-reported functional status measured using International Knee Documentation Committee (IKDC) Scores, Activity of Daily Living (ADL), Quality of Life (QOL), and Sports/Recreation (S/R) subscales of Knee Osteoarthritis and Outcome Score (KOOS) and Lysholm scores. Postoperative symptoms and pain catastrophizing measured using the KOOS pain and symptom subscales and Pain Catastrophizing Score (PCS) also influenced the degree of kinesiophobia following ACLR. Patients with an increased injury to surgery time and being closer to the date of surgery postoperatively demonstrated higher levels of kinesiophobia. Less common variables included being a female patient, low preoperative and postoperative activity status and low self-efficacy.

CONCLUSION

The most common methods used to report kinesiophobia following primary ACLR were variations of the TSK scale followed by ACL-RSI. The most commonly reported factors influencing higher kinesiophobia in this patient population include lower patient-reported functional status, more severe postoperative symptoms such as pain, increased injury to surgery time, and being closer to the date of surgery postoperatively. Kinesiophobia following primary ACLR is a critical element affecting post-surgical outcomes, and screening should be implemented postoperatively to potentially treat in rehabilitation and recovery.

LEVEL OF EVIDENCE

IV.

Deficits in Dynamic Balance and Hop Performance Following ACL Reconstruction Are Not Dependent on Meniscal Injury History

Background

Athletes often exhibit persistent deficits in dynamic balance and hop performance in their involved limb following ACL reconstruction. However, it is unclear how meniscal injury history affects inter-limb asymmetry.

Purpose

The purpose of this study was to compare inter-limb asymmetry in dynamic balance and hop performance in athletes with and without a history of concomitant meniscal injury.

Study Design

Cross-sectional study.

Methods

Dynamic balance and hop test data were analyzed for 34 adolescent athletes who had undergone ACL reconstruction; 19 athletes had sustained an isolated ACL tear, while 15 had sustained an ACL tear along with a meniscus injury. Athletes who had sustained a meniscus injury were sub-divided into those who underwent a meniscal repair (n = 9) versus a partial meniscectomy (n = 6). Dynamic balance was assessed using the Y-Balance Test, while hop performance was assessed using the single and triple hop tests. Data were recorded at the time of return-to-sport testing (5-11 months post-surgery). For each variable, mixed-model analysis of variance, with a between-subjects factor of group (isolated ACL tear, meniscal repair, partial meniscectomy) and a within-subjects factor of limb (involved, uninvolved), was conducted.

Results

The groups exhibited similar degrees of inter-limb asymmetry in dynamic balance and hop test performance, as there was not a group-by-limb interaction effect for the Y-Balance Test distances (p ≥ 0.43) or hop test distances (p ≥ 0.96). However, there was a main effect of limb for the anterior and posteromedial Y-Balance Test distances and the single and triple hop test distances (p ≤ 0.004). For each variable, performance was worse for the involved limb, compared to the uninvolved limb.

Conclusion

It appears that deficits in dynamic balance and hop performance among adolescent athletes who have undergone ACL reconstruction are not dependent on meniscal injury/surgery history.

Level of Evidence

3.

The effect of kinesiophobia on functional outcomes following anterior cruciate ligament reconstruction surgery: an integrated literature review

PURPOSE

Evaluate the effect of kinesiophobia on functional outcomes following anterior cruciate ligament reconstruction (ACLR).

MATERIALS AND METHODS

A three-phase, integrated mixed-methods review of observational and qualitative studies was undertaken. (1) Systematic search of studies with participants over 12 years old, following ACLR and focusing on kinesiophobia, using the Tampa Scale of Kinesiophobia (TSK) for observational studies. Exclusion criteria included ipsilateral knee surgery and the involvement of elite athletes. (2) Critical appraisal for both design types was undertaken. (3) Synthesis occurred in five stages. Results were reported as a relationship between the TSK and other functional outcome measures. Finally, qualitative results were integrated to explain the results.

RESULTS

Twenty-four studies (1174 participants) were included with no exclusion based on the quality appraisal. Six themes were identified: (1) return to sport (RTS); (2) activities of daily living; (3) knee-related quality of life; (4) gait; (5) reinjury; and (6) knee disability and physical function. The highest strength of evidence was the negative association between increased TSK scores and both decreased activity levels and RTS.

CONCLUSIONS

Kinesiophobia affects a range of functional outcomes. Further research is required to identify screening tools and interventions for patients with kinesiophobia.IMPLICATIONS FOR REHABILITATIONKinesiophobia affects the effectiveness of rehabilitation following anterior cruciate ligament reconstruction, therefore addressing kinesiophobia both pre- and post-ACLR is important to optimise rehabilitation.Validated screening tools are required to identify kinesiophobia in individuals early to allow appropriate rehabilitation.Physiotherapists need to use a range of physiotherapeutic techniques, such as motor imagery and prehabilitation to assist individuals to overcome their kinesiophobia and improve their functional outcomes post-ACLR.

Association Between Self-Reported Kinesiophobia and Single-Leg Hop for Distance in Patients With ACL Reconstruction: A Systematic Review

CONTEXT

Psychological readiness is a significant factor in determining successful return to sport (RTS) and physical activities after anterior cruciate ligament (ACL) reconstruction. Knowing the influence of kinesiophobia on physical tests that are used to guide RTS, such as the single-leg hop for distance (SLHD), would contribute to advancing clinical practice.

OBJECTIVE

To investigate the association between kinesiophobia and SLHD performance in patients after ACL reconstruction.

DATA SOURCES

A comprehensive search strategy entailed surveying 6 databases for relevant articles published from January 2009 to March 2021.

STUDY SELECTION

Articles published in English that were a minimum of level 3 evidence describing kinesiophobia, as measured by the Tampa Scale for Kinesiophobia, and related to SLHD performance in patients after ACL reconstruction.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Study characteristics, sample population demographics, instrument(s), or approach(s) used to assess kinesiophobia and SLHD performance, and corresponding results.

RESULTS

A total of 152 potential studies were identified, 106 studies underwent screening, 40 were reviewed in full, and 7 studies were included. Meta-analysis could not be performed because of differences in experimental design among studies and instances of missing outcome data. Currently, moderate evidence indicates patients with ACL reconstruction that exhibit less kinesiophobia perform better on the SLHD test.

CONCLUSION

The outcomes of this review propose that sports health practitioners consider the influence of kinesiophobia on SLHD performance as a criterion for RTS and physical activities in patients after ACL reconstruction. Higher quality studies are necessary to establish the extent of association between these variables.

Kinesiophobia, Knee Self-Efficacy, and Fear Avoidance Beliefs in People with ACL Injury: A Systematic Review and Meta-Analysis

BACKGROUND

To improve the understanding of the psychological impacts of anterior cruciate ligament (ACL) injury, a systematic review synthesizing the evidence on knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury is needed.

OBJECTIVE

The aim of this systematic review was to investigate knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury, and compare these outcomes following management with rehabilitation alone, early and delayed ACL reconstruction (ACLR).

METHODS

Seven databases were searched from inception to April 14, 2022. Articles were included if they assessed Tampa Scale of Kinesiophobia (TSK), Knee Self-Efficacy Scale (KSES), or Fear Avoidance Beliefs Questionnaire (FABQ). Risk of bias (RoB) was assessed using domain-based RoB tools (ROBINS-1, RoB 2, RoBANS), and GRADE-assessed certainty of evidence. Random-effects meta-analyses pooled outcomes, stratified by time post-injury (pre-operative, 3-6 months, 7-12 months, > 1-2 years, > 2-5 years, > 5 years).

RESULTS

Seventy-three studies (70% high RoB) were included (study outcomes: TSK: 55; KSES: 22; FABQ: 5). Meta-analysis demonstrated worse kinesiophobia and self-efficacy pre-operatively (pooled mean [95% CI], TSK-11: 23.8 [22.2-25.3]; KSES: 5.0 [4.4-5.5]) compared with 3-6 months following ACLR (TSK-11: 19.6 [18.7-20.6]; KSES: 19.6 [18.6-20.6]). Meta-analysis suggests similar kinesiophobia > 3-6 months following early ACLR (19.8 [4.9]) versus delayed ACLR (17.2 [5.0]). Only one study assessed outcomes comparing ACLR with rehabilitation only.

CONCLUSIONS

Knee self-efficacy and kinesiophobia improved from pre-ACLR to 3-6 months following ACLR, with similar outcomes after 6 months. Since the overall evidence was weak, there is a need for high-quality observational and intervention studies focusing on psychological outcomes following ACL injury.

Sensibility and measurement properties of the Tampa Scale of Kinesiophobia to measure fear of movement in children and adults in surgical settings

Purpose: Fear of movement, or kinesiophobia, is a risk factor for developing chronic post-surgical pain (CPSP) and may impede recovery. Identifying people with kinesiophobia peri-operatively is potentially valuable to intervene to optimize rehabilitation and prevent CPSP. This narrative review aims to describe and critically appraise the sensibility and measurement properties of the Tampa Scale of Kinesiophobia (TSK) in the surgical setting in both pediatric and adult populations.Material and methods: PubMed was searched for relevant articles using search terms related to the TSK and measurement properties; the search was restricted to articles published in English. COSMIN guidelines were used to rate measurement property sufficiency and study quality.Results: Four articles examined the measurement properties of the TSK-17 in the surgical setting. Included studies demonstrated sufficient internal consistency, structural validity, construct validity, but insufficient predictive validity. Study quality was variable. Although the TSK was not originally intended for the surgical setting, with minor modification, it appears sensible to use in this population.Conclusions: The TSK is a sensible tool to measure fear of movement in children and adults undergoing, or who underwent, surgery. Future studies are needed to test content validity, test-retest reliability, measurement error, and responsiveness in the surgical setting.IMPLICATIONS FOR REHABILITATIONFear of movement is a predictor of developing chronic post-surgical pain in children and adults.Rehabilitation interventions can address fear of movement in hopes to optimize surgical outcomes and prevent chronic post-surgical pain.The Tampa Scale of Kinesiophobia (TSK), with minor modification, is a sensible tool to measure fear of movement in surgical settings.There is some evidence that the TSK is reliable and valid to use with older children, adolescents, and adults who are undergoing or underwent surgery.

ACL repair for athletes?

Background

The current gold standard treatment for an anterior cruciate ligament (ACL) tear in an athlete is an arthroscopic ACL reconstruction with autografts. This restores the knee stability but is associated with unique complications like graft re-tear, kinesiophobia and graft donor site morbidity. ACL suture repair (ACLSR) is an attractive alternative method of surgical management of this injury.

Current science of ACLSR

The potential advantages of performing a repair are the preservation of native biology and proprioceptive function of ACL, elimination of a graft and preservation of bone stock. The purported benefits are better stability, reduction of kinesiophobia and faster rehabilitation. ACLSR is now performed only for proximal (femoral-sided) tears in the acute phase, when the tissue quality is good and using high-strength nonabsorbable sutures. There are several techniques for performing ACLSR but broadly speaking are either non-augmented, static augmented with suture tape, dynamic augmented or using bio-scaffolds.

Clinical outcome of ACLSR

There is a lot of literature on ACLSRs including case series, cohort studies and randomized controlled trials. The results from these studies are encouraging but mostly pertain to patient reported outcome measures, are in small numbers and in the short-term. The results are also inconsistent across different studies and not specifically performed for the athletic population. Moreover, most of these studies are from the innovator or designer surgeons and groups and have not been independently validated.

Conclusion

Currently, there is insufficient evidence to recommend ACLSR as a preferred method of managing even acute proximal tears in athletes. Improved rates of return to sports, lower retear rate and lesser kinesiophobia needs to be proven in athletes.

Association between landing biomechanics, knee pain, and kinesiophobia in athletes following anterior cruciate ligament reconstruction: A cross-sectional study

INTRODUCTION

Kinesiophobia is a fear of physical movement and activity and is known to impact return to sports and second injury after anterior cruciate ligament reconstruction.

OBJECTIVE

To determine the association among landing biomechanics, knee pain, and kinesiophobia in athletes following anterior cruciate ligament reconstruction.

DESIGN

A cross-sectional study SETTING: Clinical center of sports medicine PARTICIPANTS: This study included 31 athletes who participated in sports after primary, unilateral anterior cruciate ligament reconstruction (age, median [interquartile range]: 20.0 [7.0] years; body mass index: 22.2 [2.6] kg/m² ; time from anterior cruciate ligament reconstruction: 24.0 [23.0] months).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Kinesiophobia was measured using the Tampa Scale for Kinesiophobia-11. Knee function included joint laxity, strength, and single-leg hop distance. Knee pain intensity during sports activities was measured using a numerical rating scale. Vertical ground reaction force was measured, and electromyography data for the vastus medialis and semitendinosus muscles during single-leg jump landing were collected. Univariate correlation analysis and multiple regression analysis were performed to identify the associations between the Tampa Scale for Kinesiophobia-11 score and outcome measures.

RESULTS

There was no correlation between peak vertical ground reaction force and Tampa Scale for Kinesiophobia-11 score (Spearman's r = -0.172, P = 0.355). On multiple regression analyses, lower preparatory vastus medialis activity during landing (beta coefficient = -0.513, P < 0.001) and knee pain intensity (beta coefficient= 0.569, P < 0.001) were significantly associated with greater Tampa Scale for Kinesiophobia-11 scores.

CONCLUSIONS

In athletes who have participated in sports following anterior cruciate ligament reconstruction, lower preparatory vastus medialis activity during landing and knee pain intensity are associated with greater kinesiophobia. These findings indicate that interventions to address the landing muscle activity pattern and pain control should be performed to decrease kinesiophobia after anterior cruciate ligament reconstruction. This article is protected by copyright. All rights reserved.

Effects of Blood Flow Restriction Training on Clinical Outcomes for Patients With ACL Reconstruction: A Systematic Review

CONTEXT

Knee muscle atrophy and weakness are common impairments after anterior cruciate ligament (ACL) reconstruction. Blood flow restriction (BFR) training represents a new approach to treat such impairments. However, limited evidence currently exists to support this intervention in related patients.

OBJECTIVE

To appraise literature comparing the effects of BFR training with conventional therapy on knee muscle morphological and strength properties in ACL-reconstructed patients.

DATA SOURCES

PubMed, SPORTDiscus, CINAHL, and Cochrane Central Register databases were searched for relevant articles from January 1991 through April 2021.

STUDY SELECTION

Articles were minimum Level 3 evidence focusing on knee muscle morphologic as well as extensor and flexor strength outcomes in ACL-reconstructed patients of all graft types.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 2.

DATA EXTRACTION

Critical appraisal instruments (Downs and Black checklist, Cochrane Collaboration tool, ROBINS-1 tool) were used to evaluate study quality. We independently calculated effect sizes (ESs) (Cohen d) between groups in each study. The Strength of Recommendation Taxonomy grading scale was used for clinical recommendations.

RESULTS

Six articles (4 randomized control studies, 1 nonrandomized study, and 1 case-control study) met inclusion criteria. Exercises paired with BFR training included open kinetic chain, closed kinetic chain, and passive applications. Diverse assessments and time of intervention were observed across studies. ESs ranged from trivial to large in favor of BFR training for muscle morphological (d = 0.06 to 0.81) and strength assessments (d = -0.12 to 1.24) with CIs spanning zero.

CONCLUSION

At this time, grade B or inconsistent and limited-quality patient-oriented evidence exists to support using BFR training to improve or maintain thigh muscle size as well as knee extensor and flexor strength in ACL-reconstructed patients. ESs indicated no consistent clinically meaningful differences when compared with conventional therapy. Subsequent analyses should be repeated as new evidence emerges to update practice guidelines.

The Level of Kinesiophobia and Its Relationship with Physical Activity in People with a History of Ankle Sprain

Introduction: Kinesiophobia is one of the leading clinical factors in recovery from injury. The stressful situation of an ankle joint injury can cause severe withdrawal and fear of the patient to undertake physical activity, resulting in hypokinesia. Aims: The aim of the study was to demonstrate the relationship between the level of daily physical activity reported by the respondent after an ankle sprain and severity of the kinesiophobia phenomenon. Material and methods: The study comprised 78 people (mean age 23.1 years ± 3.3) with a history of ankle sprain injury. This population was divided into 2 groups, taking the given level of physical activity into account. GR1 consisted of 34 patients with an activity level of 0-3 hours a week of sports activity, GR2 was made up of 44 individuals reporting a level of physical activity > 3 hours a week. In order to obtain the necessary results, the respondents filled in their own personal data sheet; and 3 standardised questionnaires translated into Polish: Foot and Ankle Ability Measure (FAAM); Fear-Avoidance Beliefs Questionnaire (FABQ); Tampa Scale of Kinesiophobia (TSK-17). Results: A high level of physical activity helps to avoid limitations in ankle and foot functioning. A relationship was found between functional limitations and the intensity of fear regarding movement according to the FABQ questionnaire. The limitations of the foot function translate into higher results for the FABQ questionnaire. No other statistically significant relationships were found. Conclusions: Kinesiophobia is a protective factor in the acute disease/injury phase. Physiologically, its level should decrease as functional abilities are regained. If the functional limitations remain high, the fear of movement also increases. Regular, high-level physical activity significantly improves the functioning of the ankle and foot, and reduces the level of kinesiophobia.

Reintroduction of running after ACL reconstruction with a hamstring graft: can we predict short-term success?

CONTEXT

Return to running (RTR) after anterior cruciate ligament reconstruction (ACL-R) is a crucial milestone. However, there is uncertainty on how and when to start a running program.

OBJECTIVE

To explore the feasibility of a structured program to reintroduce running after ACL-R and to evaluate the predictive value of potential predictors of short-term success.

DESIGN

Longitudinal cohort study.

SETTING

Local Research Center / participant's home.

PATIENTS

Thirty-five participants were recruited after ACL-R.

INTERVENTION

Program with a progression algorithm to reintroduce running (10 running sessions in 14 days).

MAIN OUTCOME MEASURES

The criterion for short-term success was no exacerbation of symptoms. Potential predictors included: (i) the International Knee Document Committee (IKDC) subjective knee form; (ii) ACL Return to Sport after Injury questionnaire; (iii) quadriceps and hamstring strength; (iv) Step-Down Endurance test; and (v) the modified Star Excursion Balance test. Descriptive statistics were performed to study the feasibility of the RTR program and Poisson regression analysis was used to evaluate predictors of success.

RESULTS

Of the 34 participants included, 33 completed the RTR program. Sixteen participants experienced some temporary exacerbation of symptoms, but only one had to stop the RTR program. Initial IKDC score was the only significant predictor of a successful RTR with an Area under the ROC curve of 80.4%. An ICKD cut-off of 63.7/100 differentiated responders and non-responders with the highest sensitivity and specificity (77.8% and 75.0%, respectively). There was a 3-fold greater chance of success with an IKDC score above this threshold.

CONCLUSIONS

Our results confirm the feasibility of our RTR program and progression algorithm after ACL-R. Clinicians should use an IKDC score of >64 as a criterion to reintroduce running after ACL-R to increase the likelihood of short-term success.

Psychological Factors Change During the Rehabilitation of an Achilles Tendon Rupture: A Multicenter Prospective Cohort Study

OBJECTIVE

The authors sought to gain insight into the changes in psychological factors during rehabilitation after Achilles tendon rupture (ATR) and to explore the association between psychological factors during rehabilitation and functional outcome 12 months after ATR.

METHODS

Fifty patients clinically diagnosed with ATR were invited to visit the hospital 3, 6, and 12 months after injury for data collection. They completed questionnaires assessing psychological factors: psychological readiness to return to sport (Injury Psychological Readiness to Return to Sport Questionnaire); kinesiophobia (Tampa Scale for Kinesiophobia); expectations, motivation, and outcome measures related to symptoms and physical activity (Achilles Tendon Total Rupture Score); and sports participation and performance (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire). To determine whether psychological factors changed over time, generalized estimating equation analyses were performed. Multivariate regression analyses were used to study the association between psychological factors at 3, 6, and 12 months and outcome measures at 12 months after ATR.

RESULTS

Psychological readiness to return to sport improved, and kinesiophobia decreased significantly during rehabilitation. Psychological readiness at 6 and 12 months showed significant associations with sports participation and performance. Kinesiophobia at 6 months was significantly associated with symptoms and physical activity. Motivation remained high during rehabilitation and was highly associated with symptoms and physical activity, sports participation, and performance.

CONCLUSION

Psychological factors change during rehabilitation after ATR. Patients with lower motivation levels during rehabilitation, low psychological readiness to return to sports, and/or high levels of kinesiophobia at 6 months after ATR need to be identified.

IMPACT

According to these results, psychological factors can affect the rehabilitation of patients with ATR. Physical therapists can play an important role in recognizing patients with low motivation levels and low psychological readiness for return to sport and patients with high levels of kinesiophobia at 6 months post-ATR. Physical therapist interventions to enhance motivation and psychological readiness to return to sport and to reduce kinesiophobia need to be developed and studied in the post-ATR population.

LAY SUMMARY

With Achilles tendon rupture, level of motivation, psychological readiness for return to sport, and fear of movement can affect rehabilitation outcome. A physical therapist can help recognize these factors.

Assessing Physical Activity After ACL Injury: Moving Beyond Return to Sport

CONTEXT

Return to sport is widely utilized by sports medicine researchers and clinicians as a primary outcome of interest for successful recovery when working with young patients who have undergone anterior cruciate ligament (ACL) reconstruction (ACLR). While return-to-sport outcomes are effective at tracking progress post-ACLR, they are limited because they do not necessarily capture physical activity (PA) engagement, which is important to maintain knee joint health and reduce the risk of noncommunicable diseases. Therefore, there is a critical need (1) to describe current PA participation and measurement recommendations; (2) to appraise common PA measurement approaches, including patient-reported outcomes and device-based methodologies; and (3) to provide clinical recommendations for future evaluation.

EVIDENCE ACQUISITION

Reports of patient-reported or device-based PA in patients with ACL injury were acquired and summarized based on a PubMed search (2000 through July 2020). Search terms included physical activity OR activity AND anterior cruciate ligament OR ACL.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 5.

RESULTS

We highlight that (1) individuals with ACLR are 2.36 times less likely to meet the US Department of Health and Human Services PA recommendations even when reporting successful return to sport, (2) common patient-reported PA assessments have significant limitations in the data that can be derived, and (3) alternative patient-reported and device-based assessments may provide improved assessment of PA in this patient population.

CONCLUSION

Clinicians and researchers have relied on return to sport status or self-reported PA participation via surveys. These approaches are not consistent with current recommendations for PA assessment and do not allow for comparison with contemporary PA recommendations or guidelines. Return to sport, patient-reported outcome measures, and device-based assessment approaches should be used in complementary manners to comprehensively assess PA participation after ACLR. However, appropriate techniques should be used when assessing PA in adult and adolescent populations.

Rupture, reconstruction, and rehabilitation: A multi-disciplinary review of mechanisms for central nervous system adaptations following anterior cruciate ligament injury

BACKGROUND

Despite surgical reconstruction and extensive rehabilitation, persistent quadriceps inhibition, gait asymmetry, and functional impairment remain prevalent in patients after anterior cruciate ligament (ACL) injury. A combination of reports have suggested underlying central nervous system adaptations in those after injury govern long-term neuromuscular impairments. The classic assumption has been to attribute neurophysiologic deficits to components of injury, but other factors across the continuum of care (e.g. surgery, perioperative analgesia, and rehabilitative strategies) have been largely overlooked.

OBJECTIVE

This review provides a multidisciplinary perspective to 1) provide a narrative review of studies reporting neuroplasticity following ACL injury in order to inform clinicians of the current state of literature and 2) provide a mechanistic framework of neurophysiologic deficits with potential clinical implications across all phases of injury and recovery (injury, surgery, and rehabilitation) RESULTS: Studies using a variety of neurophysiologic modalities have demonstrated peripheral and central nervous system adaptations in those with prior ACL injury. Longitudinal investigations suggest neurophysiologic changes at spinal-reflexive and corticospinal pathways follow a unique timecourse across injury, surgery, and rehabilitation.

CONCLUSION

Clinicians should consider the unique injury, surgery, anesthesia, and rehabilitation on central nervous system adaptations. Therapeutic strategies across the continuum of care may be beneficial to mitigate maladaptive neuroplasticity in those after ACL injury.

Rationale for a Parsimonious Measure of Subjective Knee Function after ACL Reconstruction: A Rasch Analysis

CONTEXT

The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation is the most frequently used patient-reported measure of subjective knee function among individuals with ACL reconstruction (ACLR). Yet, limitations with traditional validation approaches leave it unclear whether the IKDC measures knee function as intended. Rasch analysis offers a robust validation approach, which may enhance clinical interpretation of the IKDC.

OBJECTIVE

1) To assess the psychometric properties, 2) ability to classify health status, and 3) relationships between the IKDC and objective measures of strength and functional performance relative to a newly proposed reduced-item instrument.

DESIGN

Cross-sectional.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Seventy-seven individuals with primary, unilateral ACLR (21.9±7.8 years, 6.2±1.0 months post-surgery), and seventy-six age-matched controls.

MAIN OUTCOME MEASURE(S)

Rasch analysis was used to assess the psychometric properties of the IKDC. Receiver-operator-characteristic curves and logistic regression were used to assess the accuracy of classifying ACLR versus control participants. Correlations (Pearson and Spearman) were used to assess relationships between subjective knee function, quadriceps torque, and single-limb hop performance.

RESULTS

Rasch analysis aided the development of a reduced 8-item instrument (IKDC-8), which yielded improved psychometric properties in misfit analysis, percent of variance accounted for by one dimension (IKDC-8=71.5%; IKDC=56.7%), and item reliability. The IKDC was an outstanding diagnostic tool and the IKDC-8 was excellent, correctly classifying 87.2% and 82.7% of cases, respectively. The Hanley-McNeil formula found that there was no significant difference in the areas under the respective ROC curves. Equivalent associations between subjective and objective knee function were observed regardless of instrument used.

CONCLUSIONS

We observed evidence of enhanced reliability and validity for a parsimonious measure of subjective knee function. The proposed instrument reduces the number of items, increases score interpretability as measuring a single construct, and improves the rating scale functioning, while not significantly diminishing its ability to classify ACLR versus control participants or changing existing relationships with objective measures of recovery. We suggest the IKDC-8 may enhance clinical use by reducing administration time, improving the interpretation of the subjective knee function score, and clarifying functional ability.

Mind-Body Activity Program for Chronic Pain: Exploring Mechanisms of Improvement in Patient-Reported, Performance-Based and Ambulatory Physical Function

BACKGROUND

Improving physical function among patients with chronic pain is critical for reducing disability and healthcare costs. However, mechanisms underlying improvement in patient-reported, performance-based, and ambulatory physical function in chronic pain remain poorly understood.

PURPOSE

To explore psychosocial mediators of improvement in patient-reported, performance-based, and objective/accelerometer-measured physical function among participants in a mind-body activity program.

METHODS

Individuals with chronic pain were randomized to one of two identical 10-week mind-body activity interventions aimed at improving physical function with (GetActive-Fitbit; N=41) or without (GetActive; N=41) a Fitbit device. They completed self-reported (WHODAS 2.0), performance-based (6-minute walk test), and objective (accelerometer-measured step-count) measures of physical function, as well as measures of kinesiophobia (Tampa Kinesiophobia Scale), mindfulness (CAMS-R), and pain resilience (Pain Resilience Scale) before and after the intervention. We conducted secondary data analyses to test mediation via mixed-effects modeline.

RESULTS

Improvements in patient-reported physical function were fully and uniquely mediated by kinesiophobia (Completely Standardized Indirect Effect (CSIE)=.18; CI=0.08, 0.30; medium-large effect size), mindfulness (CSIE=-.14; CI=-25, -.05; medium effect size) and pain resilience (CSIE=-.07; CI=-.16, -.005; small-medium effect size). Improvements in performance-based physical function were mediated only by kinesiophobia (CSIE=-.11; CI=-23, -.008; medium effect size). No measures mediated improvements in objective (accelerometer measured) physical function.

CONCLUSION

Interventions aiming to improve patient-reported physical function in patients with chronic pain may benefit from skills that target kinesiophobia, mindfulness, and pain resilience, while those focused on improving performance-based physical function should target primarily kinesiophobia. More research is needed to understand mechanisms of improvement in objective, accelerometer-measured physical function.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03412916.

Comparison of the lower extremity function of patients with foot problems according to the level of kinesiophobia

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.

Psychological factors are associated with return to pre-injury levels of sport and physical activity after ACL reconstruction

PURPOSE

The impetus of anterior cruciate ligament reconstruction (ACLR) is to allow patients to return to sport and to remain engaged in physical activity. Many patients exhibit deficits in psychological domains of health-related quality of life which may impede return to sport and physical activity participation. Therefore, the purpose of this study was to examine the association of patient-based, specifically psychological, and functional outcomes with return to sport and physical activity.

METHODS

Forty participants, a minimum of 1-year post-ACLR, reported to the laboratory for one-testing session. Participants completed a series of patient-based and functional outcome assessments. Participants were also instructed to wear a pedometer for 1 week to monitor their daily steps.

RESULTS

Twenty-five participants (62%) did not return to sport and 29 participants (72%) did not average 10,000 steps per day. Individuals with elevated levels of self-reported kinesiophobia were 17% less likely to return to sport. Self-reported knee self-efficacy and knee-related quality of life accounted for 27.1% of the variance of average daily step counts.

CONCLUSIONS

Psychological factors, specifically injury-related fear and self-efficacy, were associated more significantly than functional outcomes with return to sport and physical activity levels. Clinicians should examine psychological factors throughout rehabilitation in patients after ACLR. Future research should explore the effectiveness of psychoeducation techniques to decrease injury-related fear and enhance self-efficacy in this population.

LEVEL OF EVIDENCE

III.