Temporomandibular disorders (TMD) are prevalent conditions that can significantly impact function and quality of life. Pain catastrophizing and kinesiophobia contribute to temporomandibular disorder-related disability.

Evaluate the effectiveness of conservative interventions on kinesiophobia and pain catastrophizing in adults with temporomandibular disorders.

PubMed, Embase, CINAHL and Cochrane Central were searched for peer-reviewed interventional studies evaluating the effect of non-pharmacological conservative interventions on kinesiophobia and pain catastrophizing in adults diagnosed with a temporomandibular disorder. Risk of bias was assessed using the Cochrane Risk of Bias (version 2) tool and data were synthesised narratively according to outcomes and interventions. Overall certainty of evidence was evaluated using a modified GRADE approach.

Twelve studies were included, comprising 815 participants (mean age = 42.2 years, 85 % female, most with myofascial/pain-related temporomandibular disorders). Interventions included cognitive behavioural therapy, pain neuroscience education ± exercise, manual therapy, occlusal splinting and hypnosis. There was low to very low confidence that cognitive behavioural therapy, pain neuroscience education plus exercise, and manual therapy may reduce pain catastrophizing in individuals with temporomandibular disorders, and low to very low confidence that pain neuroscience education and manual therapy may improve kinesiophobia. There was very low confidence that hypnosis and occlusal splinting are ineffective at reducing pain catastrophizing levels compared to other conservative interventions.

Cognitive behavioural therapy, pain neuroscience education and manual therapy may be effective in reducing kinesiophobia and pain catastrophizing in adults with temporomandibular disorders. Further research is needed to improve the quality of this evidence.

Existing literature provides inconclusive evidence regarding the impact of pain on movement patterns, especially in medial meniscus injuries. This study investigated how pain induced by medial meniscus injuries affects walking movement patterns, focusing on the biomechanical mechanisms. The goal was to develop targeted rehabilitation.

Thirty control participants (15 male, 15 female), 23 individuals with medial meniscus injury but no pain (11 male, 12 female), and 51 individuals with medial meniscus injury and pain (24 male, 27 female) were recruited. Gait data was collected using eight inertial measurement units and a video camera. Pain characteristics were assessed using the Visual Analog Scale (VAS) score, Tampa Scale for Kinesiophobia (TSK), Pain Catastrophizing Scale, and pain duration score. Statistical analyses were conducted using a one-way ANOVA to compare movement patterns among the three groups. Bivariate correlation analyses were performed within the pain group to examine the relationship between pain characteristics and movement patterns. The p was set at 0.05.

(1) ANOVA among the groups revealed significant differences (p < 0.05) in several parameters: a shorter swing phase, reduced hip and knee angles, increased variability index, increased calf-foot mean absolute relative phase (MARP) during the support phase, and decreased calf-foot MARP during the swing phase were associated with pain. (2) Within the pain group, pain in knee extension (PKE) was negatively correlated with hip and ankle angles, stride length, and thigh-calf MARP during the support phase (p < 0.05). The VAS exhibited a negative correlation with knee angle and stride length, and a positive correlation with shock attenuation (p < 0.05). The TSK showed a positive correlation with hip and knee angles, and calf-foot MARP during the swing phase, while it was negatively correlated with stride length (p < 0.05).

Medial meniscus injury-induced pain has several adverse effects, including prolonged walking swing periods, reduced angulation, and increased variability while positively influencing coordination and shock attenuation. Pain intensity, kinesiophobia, and pain freedom contribute to these changes. Therapists should focus on pain management and movement pattern retraining to develop personalized rehabilitation. The angle of the swing phase should be emphasized during retraining.

https://www.chictr.org.cn/showproj.html?proj=65961, identifier ChiCTR2000041087.

The cerebellum is a structure in the suprasegmental nervous system classically known for its involvement in motor functions such as motor planning, coordination, and motor learning. However, with scientific advances, other functions of the cerebellum, such as cognitive, emotional, and autonomic processing, have been discovered. Currently, there is a body of evidence demonstrating the involvement of the cerebellum in nociception and pain processing. The aim of this review is to present the current literature on the anatomical, physiological, and functional aspects of the cerebellum in pain processing and suggest functional mechanisms of pain processing based on the cerebellum and its connections with other brain structures. To achieve this, searches were conducted in databases to identify relevant studies on the topic. Studies with relevant data and information were collected and summarized. Current literature demonstrates that the cerebellum receives nociceptive afferents from different pathways and exhibits activity in different regions including the vermis, hemispheres, and deep cerebellar nuclei in pain processing. Through its connections with different brain regions, it is possible that the cerebellum participates in the multidimensional processing of pain, which may make it a potential therapeutic target for pain treatment.

ObjectiveThe purpose of this study was to evaluate the effects of the threshold value of Fear-Avoidance Beliefs Subscales on quantified movement as a function of gender.Design studyRetrospective cohort study.SettingsSingle center study.ParticipantsOne hundred forty patients (aged 38.4) with chronic low back pain and referred to functional restauration program.InterventionPatients participated in a five-week multidisciplinary Functional Restoration Program between 1 April 2013 and 1 April 2019, evaluated with clinical scales, psychosocial care and objective gait analysis. This study was a noninterventional retrospective study.Main measuresObjective gait analysis with the Vicon Motion Systems (Ltd, Oxford, UK), Fear-Avoidance Belief Scale, Visual Analog Scale, the DALLAS Pain Questionnaire, and the Hospital Anxiety and Depression Scale.ResultsData from 131 patients were studied. Patients with significant Fear-Avoidance Beliefs scores walked with significantly higher cadence. Patients with higher work subscale values presented significantly lower cadence, without effects on step length and self-selected speed. Women with significant fear-avoidance belief score walked with higher step length (0.58 m (0.05)) than men with significant fear-avoidance belief score (0.61 m (0.05). Correlations between Fear Avoidance Beliefs Questionnaire and spatiotemporal parameters were gender-dependent but nonsignificant or low.ConclusionsThe threshold values depicted in the literature on psychometric analysis reveal low but quantitative effect of fear-avoidance on spatiotemporal parameters. These threshold values can be used by clinicians to evaluate the significance of the clinical scale. Considering gait, cadence should help the clinician to assess the fear-avoidance, particularly for patients are not able to complete all clinical scale items.

Since objective stifness measures are not consistent with the patients' perception and its correlation with the clinical severity of neck pain is not clear, novel studies assessing the clinical relevance of muscle stiffness are needed.

To analyze the correlation among psychological factors, clinical severity indicators, and muscle stiffness in neck muscles in patients with chronic mechanical neck pain, and compare these factors with asymptomatic controls.

A cross-sectional observational study was conducted. Participants included cases with chronic neck pain and asymptomatic controls, assessed for muscle stiffness using shear wave elastography, psychological health (anxiety and kinesiophobia), and clinical severity. Data analysis involved correlation matrices and comparison between groups.

Although no significant differences in levator scapulae stiffness were observed between groups (p > 0.05), patients exhibited significantly increased stiffness in the anterior scalene and cervical multifidus muscles (p = 0.009 and p = 0.040, respectively). STAI scores were significantly higher in patients for both subscales (STAI-S p = 0.002 and STAI-T p < 0.001), but no kinesiophobic behaviors differences were found (p > 0.05). Significant correlations between pain chronicity, intensity, disability, and psychological factors were confirmed. Notably, the levator scapulae stiffness was positively associated with disability, anxiety, and kinesiophobia (all p < 0.01). However, the anterior scalene and cervical multifidus stiffness, even if significantly associated with demographic factors (p < 0.05), were not associated with clinical or psychological outcomes.

The findings underscore the intertwined nature of psychological factors and muscle stiffness in chronic neck pain, suggesting the need for integrated approaches in treatment that consider both physical and psychological dimensions.

Chronic Pelvic Pain Syndrome causes psychological distress, worsened by kinesiophobia and pain catastrophizing. This study assesses whether combining capacitive-resistive monopolar radiofrequency with myofascial techniques is more effective than myofascial techniques alone for improving psychological outcomes such as kinesiophobia and catastrophizing.

This double-blind, randomized controlled trial enrolled 81 chronic pelvic pain syndrome patients (67.9% female, mean age 43.6 years) from March 2019 to April 2021. Participants were assigned to either an activated (intervention) or deactivated (control) capacitive-resistive monopolar radiofrequency group, with both groups receiving physiotherapy and pain education over 10 weeks. Outcomes on kinesiophobia and catastrophizing were assessed at weeks 5 and 10, using the Spanish versions of the Tampa Scale (TSK-11) and Pain Catastrophizing Scale (PCS).

At treatment's end, the intervention group showed greater improvement in kinesiophobia (3 points) compared to controls, though nonsignificant (p = .099). The intervention also significantly reduced catastrophizing scores by 8 points versus control (p = .042). No major adverse effects occurred, and adherence was high (86.4%), with no differences between groups.

This study shows that combining capacitive-resistive monopolar radiofrequency with myofascial techniques can improve kinesiophobia and catastrophizing in chronic pelvic pain syndrome patients, such as fear movement and catastrophic thinking related to pain. This marks a potential breakthrough in chronic pain management. Future research should focus on larger, multicenter RCTs with extended follow-up periods to better assess long-term effects.

Clinical trial registration (NCT03797911).

ObjectiveTo explore the status of kinesophobia in patients with osteoporotic vertebral compression fractures and analyze the influencing factors of different kinesophobia profiles.DesignCross-sectional survey studyParticipantsA total of 245 patients with osteoporotic vertebral compression fractures who underwent surgical treatment at our Department of Orthopedics between January 2023 and March 2024 were selectedMain MeasureA general data questionnaire and Tampa Scale for Kinesiophobia were used in the investigation. Latent profile analysis was conducted to categorise kinesophobia in patients with osteoporotic vertebral compression fractures, while univariate logistic regression was performed to identify the factors influencing the latent profiles of kinesophobia.ResultsThe average kinesophobia score of the patients with osteoporotic vertebral compression fractures was 45.38 ± 7.12 points. The patients were divided into three latent profile categories, namely high, medium, and low kinesophobia, with mean probabilities of 0.958, 0.966, and 0.970, respectively. Furthermore, age, gender, pain score, injury cause, and other injuries were significant influencing factors in the kinesophobia groups (P < 0.05).ConclusionKinesophobia in patients with osteoporotic vertebral compression fractures is heterogeneous and affected by age, gender, pain score, injury cause, and other injuries. Clinical staff should recognise the characteristics of patients in different kinesophobia categories and actively adopt appropriate measures for those in the high kinesophobia group to enhance the alleviation of their fear status and mitigate the occurrence of fear-induced adverse outcomes, such as disability and weakness.

Fear of movement in patients with traumatic hand-arm injuries can negatively affect functional outcomes. Therefore, it is important to evaluate fear of movement in this patient population. The aim of this study was to investigate the validity and reliability of the Tampa Scale for Kinesiophobia in patients with traumatic hand-forearm injuries.

Cross-sectional.

Hand rehabilitation unit in a university hospital.

The study included 170 patients with traumatic hand-arm injuries and a mean age of 37.57 (11.85) years.

Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, Beck Anxiety Inventory and pain severity rating (via Visual Analog Scale) were completed by interview in the first session. In addition, Modified Hand Injury Scoring System was used to determine severity of the injury. Tampa Scale for Kinesiophobia was re-administered 15 days after the first session. Test-retest reliability, internal consistency, and construct validity of the Tampa Scale for Kinesiophobia were evaluated. In addition, exploratory factor analysis was completed using baseline data.

Cronbach's alpha for the scale was 0.604, and test-retest reliability was acceptable (ICC = 0.646). Tampa Scale for Kinesiophobia had a significant relationship with Beck Anxiety Inventory (r = 0.269, p < 0.001), Pain Catastrophizing Scale (r = 0.457, p < 0.001) and pain severity at rest (r = 0.168, p = 0.029). Factor analysis estimated the scale represented five subsections in this population.

Psychometric properties of the Tampa Scale for Kinesiophobia were acceptable in patients with hand-forearm injuries. However, since our results were weaker than those in the literature, this should be considered when interpreting the results.

The purpose of this study is to investigate the influence of kinesiophobia following Total Knee Arthroplasty (TKA) on the rehabilitation outcomes of patients during hospitalization, includes examining the trends in resting pain levels at various time points post-surgery, the trends in active flexion of the knee at various time points post-surgery, and the effects of kinesiophobia on the timing of first postoperative ambulation, the duration of postoperative hospital stay, and the results of the two-minute walk test on the day of discharge. Postoperative kinesiophobia in patients was identified using the Tampa Scale for Kinesiophobia (TSK), with 33 patients scoring >37 points and 35 patients scoring ≤37 points. Resting Pain levels were assessed using the Numerical Rating Scale (NRS) at various time points, including upon return to the ward (T1), the first (T2), second (T3), third (T4), fifth(T5) postoperative days, and the day of discharge (T6). Furthermore, active flexion of the knee joint was measured at different time points for both groups, including the first (T1*), third (T2*), and fifth (T3*) postoperative days, and the day of discharge (T4*). The first time out of bed activities of the two groups of patients were compared, along with the results of the 2-Minute Walk Test (2-MWT) on the day of discharge. The pain scores of patients in the kinesiophobia group at different time points after surgery were worse than those in the non-kinesiophobia group (P<0.05). There were significant time effects (F = 131.297;P<0.01), inter-group effects (F = 15.016; P<0.01), and interaction effects (F = 5.116; P<0.05). The active knee flexion of patients in the kinesiophobia group at different time points after surgery were worse than those in the non-kinesiophobia group (P<0.05).There were significant time effects (F = 628.258;P<0.01), inter-group effects (F = 16.546; P<0.01), and interaction effects (F = 66.025; P<0.01). Patients in the kinesiophobia group delayed getting out of bed for the first time (35.39±9.82vs28.77±9.81hours; P<0.01), had shorter activity time (4.12±1.36vs5.80±1.96minutes; P<0.01) and distance (19.12±3.36vs30.17±5.64meters;P<0.01), and experienced higher pain scores during activity (6.30±1.10vs5.48±0.95scoresP<0.05). Additionally, patients in the kinesiophobia group walked shorter distances in the 2-MWT test on the day of discharge compared to the non-kinesiophobia group (37.60±5.76vs50.68±5.37meters;P<0.05), and had longer hospitalization time (8.11±1.31vs50.68±5.37days; P<0.05). In short, compared to patients without kinesiophobia, the presence of kinesiophobia after TKA surgery significantly impacts the efficacy of early rehabilitation exercises during hospitalization. This impact is observed in pain perception, knee joint mobility, the 2-minute walk test, etc. Early identification of patients with kinesiophobia after TKA and timely intervention are necessary and beneficial.

To summarize complication rates, reoperation rates, length-of-stay (LOS), patient-reported outcome measures (PROMs), and range of motion following total shoulder arthroplasty (TSA) in patients with preexisting psychiatric disorders (PDs) compared to controls.

Three databases (MEDLINE, PubMed, and EMBASE) were searched from inception to 4 March 2024 to identify studies comparing outcomes between patients undergoing anatomic (aTSA) or reverse TSA (rTSA) with or without a preexisting psychiatric condition. The authors adhered to the preferred reporting items for systematic reviews and meta-analyses and revised assessment of multiple systematic review guidelines. Data on demographics, as well as postoperative complication rates, reoperation rates, LOS, PROMs, and range of motion were extracted from included studies. PROMs included the American Shoulder and Elbow Surgeons (ASESs) score, and visual analogue scale (VAS) pain score. Meta-analyses were conducted for outcomes reported by multiple studies, with odds ratios (ORs) and mean differences (MDs) as effect measures for continuous and dichotomous outcomes, respectively.

Thirteen studies were included in this review, comprising a total of 820,831 TSA patients. The PD group (71.0% female) consisted of 150,432 patients (mean age: 67.6 ± 9.9) with a mean follow-up time of 34.1 ± 30.1 months. The control group (58.1% female) consisted of 670,399 patients (mean age: 69.4 ± 10.7) with a mean follow-up time of 39.1 ± 36.0 months. The PD group had significantly higher rates of complications and reoperation. The PD group also reported significantly lower postoperative ASES scores, higher postoperative VAS scores, and inferior postoperative abduction. There were no significant differences in postoperative LOS, forward flexion, internal rotation, or external rotation.

Patients with preexisting PDs may have a one-and-a-half times higher odds of postoperative complication or reoperation, as well as significantly worse postoperative pain and PROMs. Identification of at-risk individuals with preexisting psychiatric conditions and preoperative referral to a mental health specialist to optimize psychiatric conditions may benefit this patient cohort ahead of their shoulder arthroplasty procedure.

IV.

One possible factor contributing to low back pain is hip range of motion (ROM). However, there is inconstancy in published studies, which may be due to the heterogeneity of patients. Therefore, the present study focuses on the relationship between hip ROM and lower lumbar disc herniation (LLDH).

A cross-sectional study involved 52 participants between 18 and 65 years old. Two digital inclinometers were utilized to measure the ROM of the lumbar and hip joints in all study participants. For each outcome, 2 measurements were conducted, and the mean of the 2 measurements was utilized for analysis. The level of statistical significance was established at P ≤ .05.

The difference in all ROM between the 2 groups is significant except for dominant hip flexion (P < .05). Lumbar flexion was reduced in LLDH compared with healthy individuals (P = .003). The findings manifested a significant correlation between right lumbar rotation and nondominant hip abduction (P = .05, R = .388) and between left lumbar lateral bending and nondominant hip flexion (P = .008, R = .510).

Patients with LLDH have reduced hip ROM and lumbar flexion compared with healthy individuals. The study showed correlations between hip and lumbar ROM and emphasized the significance of evaluating hip ROM in LLDH for assessment and treatment planning.

Kinesiophobia has a major health impact on patients with Musculoskeletal disorders (MSDs) in their functional and physical activities, which leads to poor outcomes, loss of motivation, loss of mobility, and decreased quality of life. Despite the burden of kinesiophobia among MSDs, there is limited evidence about the burden of kinesiophobia in Ethiopia. Thus, this study aimed to assess the prevalence and its associated factors of kinesiophobia among MSD patients attending physiotherapy outpatient clinics.

An institutional multi-center cross-sectional study was conducted from February to April 2023 with a sample size of 424. A systematic random sampling technique and face-to-face interviews using a structured questionnaire and chart review were used. The collected data was entered into Epi-data version 4.6.0.6 and analyzed using SPSS version 25. Binary logistic regression analysis was employed to identify the potential candidates for multivariable logistic regression with a p-value less than 0.25. Finally, multivariate logistic regression analysis was employed and variables at p < 0.05 with 95% CI were considered statistically significant contributors to kinesiophobia.

The overall prevalence of kinesiophobia among MSD patients was 48.3% (95% CI, 43.3-53.3). Being overweight and obese BMI value (AOR = 3.98; 95% CI, 2.17-7.29), having moderate pain level (AOR = 3.31; 95% CI, 1.51-7.26), having severe pain level (AOR = 9.29; 95% CI, 3.79-22.77), physical inactivity (AOR = 3.00; 95% CI = 1.84-4.89), anxiety (AOR = 2.57; 95% CI = 1.57-4.19), and depression (AOR = 8.21; 95% CI = 3.47-19.46) were significantly associated with kinesiophobia among musculoskeletal disorder patients.

kinesiophobia is a public health burden among patients with MSDs. Nearly half of the people with MSDs had reported kinesiophobia. Being overweight and obese BMI value, pain severity level, physical inactivity, anxiety, and depressive symptoms were significantly associated with kinesiophobia. Thus, we suggest screening for kinesiophobia, be physically active, avoiding being overweight and obese, and managing depression, anxiety and pain will help to reduce the occurrence of kinesiophobia.

Several factors such as acute symptom severity, premorbid anxiety, and depression have been associated with concussion recovery. Elevated kinesiophobia has been associated with recovery from musculoskeletal conditions, as well as increased reaction time and vestibular-ocular motor dysfunction following concussion. However, kinesiophobia has yet to be evaluated as a modifier of concussion recovery time.

This study was designed to evaluate the role of acute kinesiophobia levels on days until clinical recovery in collegiate athletes with concussion. We hypothesized that collegiate athletes with elevated Tampa Scale of Kinesiophobia (TSK) scores would take a greater number of days to achieve clinical recovery compared with athletes with lower values.

Division I collegiate athletes diagnosed with a concussion (N = 113, 19.9 ± 1.5 years, 42% female) participated in this descriptive laboratory study. Participants were assigned to high [≥ 37 (H-TSK, n = 54)] or low [< 37 (L-TSK, n = 59)] TSK groups on the basis of the first TSK values recorded within 72 h of their concussion. Participants were also administered the Revised Head Injury Scale (HIS-r) to assess symptom severity within 72 h of injury. The Immediate Postconcussion and Cognitive Test (ImPACT) battery was administered at baseline and used to gather demographic variables such as biological sex, age, history of anxiety/depression, and concussion history, and as part of the athletes' symptom-free assessment. Days until clinical recovery between H-TSK and L-TSK groups were compared using a Mann-Whitney U test. Spearman's rank correlation coefficients were calculated to determine the relationship between TSK and days until clinical recovery in addition to other modifiers of recovery. Multiple linear regression was used to evaluate days until clinical recovery as a function of the TSK total score, controlling for the HIS-r and ImPACT variables.

Days until clinical recovery was significantly longer in the H-TSK group (median difference = 2.5 days, p < 0.001) compared with the L-TSK group. A significant, moderate positive correlation between the TSK score and days to clinical recovery (ρ = 0.45, p < 0.001) was observed, which was also the strongest correlation among all variables. Our regression model demonstrated that for every point increase on the TSK, days until clinical recovery increased by 0.23 while controlling for total symptom severity, age, concussion history, psychiatric history, and biological sex (β = 0.23, p = 0.018). All other variables entered into the regression were not statistically significant.

Our data suggest that athletes with TSK scores above 37 within 72 h of a concussion had a greater number of days until clinical recovery when compared with athletes with TSK values below 37. The TSK score had the highest correlation with days until clinical recovery when compared with other known modifiers of recovery, including total symptom severity. The TSK score was also the strongest predictor of days until clinical recovery. Collectively, these findings suggest that the TSK score should be considered by healthcare professionals to help inform effective management strategies for collegiate athletes with concussion.

Exercise is a vital adjunct therapy for patients with hypertension comorbidities. However, medical personnel and patients face significant obstacles in implementing exercise prescription recommendations. AI has been developed as a beneficial tool in the healthcare field. The performance of intelligent tools such as ChatGPT 4.0 and Intelligent Health Promotion Systems (IHPS) in issuing exercise prescriptions for patients with hypertension comorbidities remains to be verified.

After collecting patient information through IHPS hardware and questionnaire systems, the data were input into the software terminals of ChatGPT 4.0 and IHPS according to the five stages of the Transtheoretical Model, resulting in exercise prescriptions. Subsequently, experts from various fields scored the accuracy, comprehensiveness, and applicability of each prescription, along with providing professional recommendations based on their expertise. By comparing the performance of both systems, their capability to serve this specific group was evaluated.

In most cases, ChatGPT scored significantly higher than IHPS in terms of accuracy, comprehensiveness, and applicability. However, when patients exhibited certain functional movement disorders, GPT's exercise prescriptions involved higher health risks, whereas the more conservative approach of IHPS was advantageous.

The path of generating exercise prescriptions using artificial intelligence, whether via ChatGPT or IHPS, cannot achieve a completely satisfactory state.But can serve as a supplementary tool for professionals issuing exercise prescriptions to patients with hypertension comorbidities, especially in alleviating the financial burden of consulting costs. Future research could further explore the performance of AI in issuing exercise prescriptions, harmonize it with physiological indicators and phased feedback, and develop an interactive user experience.

Kinesiophobia, the fear of movement, can significantly impede an individual's ability to engage in daily activities. This fear often stems from past traumatic experiences or witnessing others in pain, leading to an increased fear of injury. This study aimed to evaluate the psychometric properties of the Persian version of the Tampa Scale for Kinesiophobia among Iranian post-surgery patients. A methodological study conducted in 2023 involved a sample of 400 post-surgery patients selected through convenience sampling. The translated scale underwent psychometric evaluation, including network analysis, exploratory and confirmatory factor analysis for construct validity, as well as assessments for convergent and discriminant validity. Internal consistency of the scale was also assessed. The mean age of the participants was 44.38 (SD = 13.49) years and the majority of them (77.8%) were women. Exploratory factor analysis with Promax rotation identified two factors explaining 60.28% of the variance, comprising 17 items. The final model was confirmed after necessary adjustments in confirmatory factor analysis. Both convergent and discriminant validity were established, and alpha and omega coefficients of the subscales were above 0.7. The Persian version of the Tampa Scale for Kinesiophobia showed robust psychometric properties among Iranian post-surgery patients, serving as a valuable tool for evaluating and addressing kinesiophobia in this population. These findings enhance the understanding and management of kinesiophobia within the Iranian healthcare context.

(1) To examine if a more accessible built environment (BE) is significantly associated with better knee function outcomes in knee osteoarthritis (OA) patients. (2) To assess if the relationship between BE and knee function is mediated by fear of movement and self-efficacy.

Cross-sectional study.

Two tertiary hospitals in Singapore.

212 knee OA patients (mean: 63.81±8.27 years old), majority female (69.8%).

(i) meets National Institute for Health and Care Excellence criteria for knee OA, (ii) independent community ambulant.

(i) alternative diagnosis to knee OA, (ii) secondary osteoarthritis, (iii) severe medical and/or cognitive comorbidity impairing activities of daily living, (iv) previous knee arthroplasty, (v) wheelchair bound, or (vi) pregnant. PRIMARY AND SECONDARY OUTCOME MEASURES; STATISTICS: How self-efficacy (Arthritis Self-Efficacy Scale-8 (ASES-8)) and fear of movement (Brief Fear of Movement (BFOM)) mediates impact of overall BE (IPAQ-Environment module: Access to Destinations) and five item-specific domains of BE accessibility on knee function (Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12)). For variables significantly correlated with BE and KOOS-12 in bivariate Pearson correlation tests, mediation analysis was performed with confounders adjusted.

Total BE (r=0.142, p=0.038) and accessibility to transit station (r=0.161, p=0.019) were positively correlated with KOOS-12. Structural barriers (r=-0.138, p=0.045) were negatively correlated with KOOS-12. ASES-8 was a significant mediator in the relationship between accessibility to transit station and KOOS-12 (coeff=0.87, 95% CI=(0.24, 1.69), p=0.005) and between total BE and KOOS-12 (coeff=0.25, 95% CI=(0.10, 0.45), p=0.004). BFOM was a marginally significant mediator between structural barriers and KOOS-12 (coeff=-0.36, 95% CI=(-0.86, -0.02); p=0.054).

More accessible BE and lesser structural barriers in the BE are associated with better knee function. Self-efficacy mediates the relationship between overall BE accessibility and knee function. Fear of movement mediates the negative association between barriers in the BE and knee function.Applications include assessing BE barriers and psychosocial mediators in clinician consultations, developing multidisciplinary integrated care models and urban designers planning mobility friendly BEs.

The study has been registered under clinicaltrials.gov registry (Identifier: NCT04942236).

Knee osteoarthritis (KOA) is a prevalent degenerative joint disease associated with pain, disability, and functional limitations. Kinesiophobia, the fear of movement, has been linked to disability and pain in KOA patients. This study aimed to analyze the relationship between kinesiophobia and symptoms of KOA. A comprehensive literature search was conducted in four electronic databases (PubMed/Medline, Web of Science, Scopus and Science Direct) with the following inclusion criteria: 1) recruited participants with diagnostic of knee osteoarthritis; 2) measures of pain, disability and/or functional limitation through questionnaires or physical tests; 3) articles exploring the correlation between kinesiophobia, and pain, disability, and/or functional limitation as principal or secondary outcome; 4) primary data studies (observational and experimental). A total of 17 studies involving 1,574 participants (mean age 61.04 ± 5.79 years) were included in the corresponding meta-analyses. Results showed a moderate correlation between kinesiophobia and disability (r = 0.519; p-value=0.004), and fair correlations of kinesiophobia with pain (r = 0.362; p-value<0.001), and functional limitation (r = 0.270; p-value<0.001). Despite high heterogeneity (I2: 89.4% for pain, 94.6% for disability, and 90.4% for functional limitation), 52% of studies displayed low risk of bias. In conclusion, kinesiophobia positively correlates with pain, disability, and functional limitation in KOA patients.

The efficacy of various supervision methods for stabilization exercises in patients with chronic low back pain (CLBP) remains uncertain.

To evaluate the impact of supervised and unsupervised stabilization exercises in patients with CLBP.

Sixty-six participants were assigned to the in-person-supervised, tele-supervised, or unsupervised groups. All participants received a 20-30-minute exercise program three times a week for 4 weeks. We assessed functionality (Oswestry Disability Index), pain intensity (Numeric Rating Scale), and kinesiophobia (Tampa Scale of Kinesiophobia) before and after the 4 weeks. The outcomes were analyzed using effect size, minimum clinically important difference (MCID), minimal detectable change (MDC), Wilcoxon test, and post hoc analyses.

While the unsupervised group improved in all measures (p < .05) both the tele-supervised (p = .001) and in-person-supervised (p < .001) groups achieved superior functionality exceeding MDC. The in-person-supervised group demonstrated greater functionality (p < .001) than the tele-supervised group, exceeding MCID. Pain intensity decreased in the tele-supervised (p = .011) and in-person-supervised groups (p < .001) compared to the unsupervised group, exceeding MCID and MDC. No significant difference was found in post-treatment NRS score changes between the supervised groups (p = .071). The in-person-supervised group displayed a greater reduction in kinesiophobia than the tele-supervised (p < .001) and unsupervised groups (p < .001) but not exceeding MCID or MDC. Effect sizes were large within and between groups except for a small effect size between the tele-supervised and unsupervised groups in kinesiophobia.

While tele-supervised stabilization exercises alleviate pain and enhance functionality, in-person-supervised exercises may be more effective in improving functionality and reducing kinesiophobia in patients with CLBP.

To explore the trajectory and influencing factors of kinetophobia in elderly patients with limb fracture during the rehabilitation period.

In this retrospective study, we retrieved the follow-up records of 150 elderly patients with limb fractures from our hospital's electronic medical record system. We collected the demographic data and Tampa Scale for Kinesiophobia (TSK) scores of patients at postoperative day 1 (T0), 1 week (T1), 3 weeks (T2), 6 weeks (T3), and 12 weeks (T4) to track changes in kinesiophobia over time. We used Mplus 8.3 software to fit the development trajectory types of kinesiophobia based on TSK scores at time points T0 to T4 using a Latent Class Growth Model (LCGM). After selecting the best fitting model, logistic regression analysis was performed to identify the risk factors for kinesiophobia in different types. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to compare the predictive value of relevant influencing factors for kinetophobia in elderly patients recovering from limb fracture.

The TSK scores decreased steadily from T0 to T4 [(46.03±7.88) at T0, (41.14±8.89) at T1, (34.61±5.64) at T2, (29.95±6.79) at T3, and (26.71±5.03) at T4], [F (4, 745) = 193.1, P < 0.001]. We identified the trajectory of changes in kinesiophobia symptoms through LCGM, gradually establishing models with 1 to 5 categories. By integrating the results of relevant fit indices, we ultimately selected the best fitting model with 2 categories. Among them, 119 patients in Class 1 (79.3%) showed a slow and continuous decline in kinesiophobia symptoms from T0 to T4, while 31 patients in Class 2 (20.7%) exhibited rapid decline followed by rebound in kinesiophobia symptoms. Logistic regression showed that older the age (OR = 1.219), per capita monthly income < 3000 yuan (OR = 12.657), numeric rating scale (NRS), patients with higher NRS (OR = 2.401) and higher self-efficacy (OR = 1.212) were more likely to be in Class 1. The ROC curve results show that the combined above indicators have a higher predictive value for the changes in fear of movement in elderly patients with lower limb fractures during the rehabilitation period (AUC = 0.934), compared to age (AUC = 0.694), per capita monthly income (AUC = 0.654), NRS score (AUC = 0.812), and self-efficacy (AUC = 0.811) as individual indicators.

As the recovery time progresses for elderly patients with limb fractures, the overall trend of kinesiophobia scores decreases. Kinesiophobia presents with two different trajectories, with age, average monthly income, NRS score, and self-efficacy being important factors influencing the trajectory categories of kinesiophobia changes.

This paper reviews the scope of research on kinesiophobia in patients after cardiac surgery. Further, it reviews the current situation, evaluation tools, risk factors, adverse effects, and intervention methods of kinesiophobia to provide a reference for promoting early rehabilitation of patients after cardiac surgery.

Guided by the scoping methodology, the Web of Science, PubMed, CINAHL, Cochrane Library, China Biomedical Literature Database, VIP Database, Wanfang Database, CNKI, and other databases were searched from database inception until July 31, 2024. The studies obtained were screened, summarised and systematically analysed by two researchers.

Eighteen studies (16 cross-sectional studies, one qualitative study, and one randomised controlled trial) were included. The incidence of kinesiophobia in patients after cardiac surgery was 39.20-82.57%, and the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) was used to evaluate this incidence. The influencing factors of kinesiophobia in patients after cardiac surgery included demographic characteristics, pain severity, frailty, exercise self-efficacy, disease-related factors, and psychosocial factors. Kinesiophobia led to adverse health outcomes such as reduced recovery, prolonged hospital stays, and decreased quality of life in patients after cardiac surgery, and there were few studies on intervention methods for postoperative kinesiophobia.

The kinesiophobia assessment tools suitable for patients after cardiac surgery should be improved, and intervention methods to promote the early recovery of patients after major clinical surgery and those with difficult and critical diseases should be actively researched.

Knowledge of the factors affecting pain intensity and pain sensitivity can inform treatment targets and strategies aimed at personalizing the intervention, conceivably increasing its positive impact on patients. Therefore, this study aimed to investigate the association between demographic factors (sex and age), body mass index (BMI), psychological factors (anxiety and depression, kinesiophobia and catastrophizing), self-reported physical activity, pain phenotype (symptoms of central sensitization, and nociceptive or neuropathic pain), history of COVID-19 and pain intensity and sensitivity in patients with chronic non-specific low back pain (LBP).

This was a cross-sectional secondary analysis with 83 participants with chronic non-specific LBP recruited from the community between August 2021 and April 2022. BMI, pain intensity (Visual Analog Scale), pain sensitivity at the lower back and at a distant point [pressure pain threshold], catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale), pain phenotype (Central Sensitization Inventory and PainDetect Questionnaire), physical activity (International Physical Activity Questionnaire), and disability (Roland Morris Disability Questionnaire) were assessed. Multiple linear regression analyses with pain intensity and sensitivity as the dependent variables were used.

The model for pain intensity explained 34% of its variance (Adjusted R2 = -0.343, p < 0.001), with depression and anxiety (p = 0.008) and disability (p = 0.035) reaching statistical significance. The model for pain sensitivity at the lower back, also explained 34% of its variance (Adjusted R2 = 0.344, p < 0.001) at the lower back with sex, BMI, and kinesiophobia reaching statistical significance (p < 0.05) and 15% of the variance at a distant body site (Adjusted R2 = 0.148, p = 0.018) with sex and BMI reaching statistical significance (p < 0.05).

This study found that different factors are associated with pain intensity and pain sensitivity in individuals with LBP. Increased pain intensity was associated with higher levels of anxiety and depression and disability and increased pain sensitivity was associated with being a female, higher kinesiophobia, and lower BMI.

Chronic low back pain patients often experience recurrent episodes due to various peripheral and central factors, leading to physical and mental impairments, affecting their daily life and work, and increasing the healthcare burden. With the continuous advancement of neuropathological research, changes in brain structure and function in chronic low back pain patients have been revealed. Neuroplasticity is an important mechanism of self-regulation in the brain and plays a key role in neural injury repair. Targeting neuroplasticity and regulating the central nervous system to improve functional impairments has become a research focus in rehabilitation medicine. Recent studies have shown that exercise can have beneficial effects on the body, such as improving cognition, combating depression, and enhancing athletic performance. Exercise-induced neuroplasticity may be a potential mechanism through which exercise affects the brain. This article systematically introduces the theory of exercise-induced neuroplasticity, explores the central effects mechanism of exercise on patients with chronic low back pain, and further looks forward to new directions in targeted neuroplasticity-based rehabilitation treatment for chronic low back pain.

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

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

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

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

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

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

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

Low physical activity (PA) levels and low physical fitness (PF) have been reported in subjects with temporality-based chronic pain; however, it is unknown whether there are differences in subjects with nociplastic pain (NP) compared with subjects with non-nociplastic pain (NNP).

The aim was to compare the levels of PA and PF in patients with chronic, nociplastic, and non-nociplastic musculoskeletal pain.

This is an analytical, cross-sectional study. The sample comprised 30 patients receiving ambulatory physiotherapy treatment. Pain was classified as NP or NNP according to the International Association for the Study of Pain categorization system. The PA level was measured with the International Physical Activity Questionnaire-Short Form, and the PF level was measured with the hand grip strength test (HGS) to assess upper limb strength, the five Repetition Sit-to-Stand Test (5R-SRTS) to assess lower limb strength and power, and the YMCA 3 Min Step Test (YMCA-3MST) to estimate peak VO2. The results were compared with independent samples t-tests (with p < 0.05 considered significant). Cohen's d was calculated to determine the effect size.

The NP group reported a significantly lower PA level than the NNP group, specifically the vigorous PA (p = 0.0009), moderate PA (p = 0.0002), and total PA (p = 0.005) dimensions. The NP group also showed significantly lower 5R-STS (p = 0.000) and HGS (p = 0.002) results compared with the NNP group. There were no significant differences in the YMCA-3MST between the NP and NNP groups (p = 0.635).

It is possible that the neurophysiological and neuromuscular changes related to NP are associated with a reduced ability to perform vigorous PA. Clinicians should identify the presence of NP comorbidities in conjunction with the diagnosis when establishing the therapeutic goals.

Breast cancer-related lymphedema (BCRL) significantly impacts the quality of life (QoL) of breast cancer survivors following treatment. This study explores the association between kinesiophobia (fear of pain caused by movement) and QoL in postsurgical BCRL survivors and examines whether self-care and compliance with functional exercise act as mediators between these variables.

This cross-sectional study surveyed 274 BCRL patients at three tertiary hospitals in Shenyang City, China, from May 2020 to October 2022. The participants completed self-reported questionnaires on self-care, functional exercise compliance, kinesiophobia, and QoL. Medication analysis was conducted using the PROCESS macro (Model 6).

Kinesiophobia was found to have negative association with self-care (P < 0.001), functional exercise compliance (P < 0.001), and QoL (P < 0.001). Kinesiophobia indirectly affected QoL through three mediating pathways: self-care (effect = -0.132), functional exercise compliance (effect = -0.390), and a combination of self-care and functional exercise compliance (effect = -0.220), collectively accounting for 7.9%, 23.3%, and 13.1% of the total effect, respectively.

This study highlights the substantial chain-mediating role of self-care and functional exercise compliance in the relationship between kinesiophobia and QoL. It provides valuable evidence supporting the protective effects of self-care and functional exercise compliance in mitigating kinesiophobia and enhancing the QoL of BCRL survivors.

Kinesiophobia is an excessive, irrational, debilitating fear of physical movement and activity caused by a sense of vulnerability to pain or re-injury, which can have a direct impact on physical functioning and mental well-being of patients. This paper aims to provide reliable support for future in-depth research on kinesiophobia through scientometrics and historical review. Studies on kinesiophobia published from 2002 to 2022 were retrieved from the Web of Science Core Collection. CiteSpace and VOSviewer were used to conduct bibliometric analysis of the included studies and map knowledge domains. Keywords were manually clustered, and the results were analyzed and summarized in combination with a literature review. A total of 4157 original research articles and reviews were included. Research on kinesiophobia is developing steadily and has received more attention from scholars in recent years. There are regional differences in the distribution of research. Chronic pain is the focus of research in this field. A multidisciplinary model of pain neuroscience education combined with physical therapy based on cognitive-behavioral therapy and the introduction and development of virtual reality may be the frontier of research. There is a large space for the study of kinesiophobia. In the future, to improve regional academic exchanges and cooperation, more attention should be given to the clinical applicability and translation of scientific work, which will be conducive to improving the quality of life and physical and mental health outcomes of kinesiophobia patients.

To assess content validity and to modify the Tampa Scale of Kinesiophobia (TSK) to make it suitable for application in patients with anterior shoulder instability.

A four-round Delphi method was performed to establish expert consensus on developing the Tampa Scale of Kinesiophobia for patients with anterior shoulder instability (TSK-SI) using an expert group of Dutch shoulder-specialized orthopedic surgeons and physiotherapists. During round 1, experts were asked to score the 17 items of the original TSK on relevance and construction using the COSMIN guidelines. With this feedback, questions were reviewed and modified. During round 2, experts were asked to score the modified items. This process was repeated until consensus was established. Then, patients were asked to participate in a moderator-guided, three-step-test interview using a Web-based platform to assess the modified scale. Sessions were recorded and evaluated by the working group. The modified scale was finally adjusted on the basis of the input of these patients.

Thirty Dutch shoulder experts were included, of which 25 completed all 4 rounds, after which consensus was established. One question was added to the modified scale based on feedback in round 1, establishing the 18-item TSK-SI. Sixteen patients with shoulder instability were included, which all completed the three-step test interview. Following this, question 4 (changed to present tense) and question 7 (hypothetical component added) were adjusted, resulting in the final TSK-SI.

This consensus modification of the TSK to TSK-SI can support the content validity of the instrument to assess kinesiophobia in patients with anterior shoulder instability. These modifications may improve the responsiveness and validity of the TSK-SI, as it does not match all the items of the original TSK.

Level V, consensus statement.

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

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

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

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

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