“Overcoming the Fear of Movement: Unraveling the Mystery of Kinesiophobia”

According to studies (Vlaeyen, Crombez, & Linton, 2016; Vlaeyen, Haazen, Schuerman, Kole-Snijders, & van Eek, 1995; Waddell, Newton, Henderson, Somerville, & Main, 1993), pain-related fear is more likely to predict continued disability in people with persistent pain than pain intensity or structural findings.

This was initially brought up by Lethem and colleagues (1983), who attempted to explain why some patients respond to pain more intensely than others using the “fear-avoidance” concept. According to Larsson, Ekvall Hansson, Sundquist, and Jakobsson (2016), the Fear-Avoidance Model shows that when a painful experience is seen as dangerous, it might lead to catastrophizing ideas that movement and activity would cause further pain and reinjury. As this goes on, it develops into an avoidance behavior that results in impairment, deconditioning, and depression as well as a vicious cycle of anxiety and unending suffering (Larsson et al., 2016).

Miller and colleagues (1990) initially used the term “kinesiophobia” to describe a component of the fear-avoidance paradigm. “A condition where a patient has an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury,” according to Kinesiophobia (1990, p. 36). As a result of the fear of re-injury, it is now understood to be a fear of movement (Lundberg, Larsson, Ostlund, & Styf, 2006; Vlaeyen et al., 1995). People who are highly fear-averse believe that pain is a sign of bodily harm and that any activity that causes pain should be avoided (Hapidou et al., 2012).

⇒Relationship to gender difference

Chronic neck and low back pain are the two diseases with the largest illness burden in Australia, and persistent pain is growing more and more frequent (Hoy et al., 2014). Kinesiophobia, as already noted, is a better indicator of chronic pain than pain intensity or radiological findings.

So, kinesiophobia is a marker for when pain will stick around.So, should we check for kinesiophobia in each patient?
Do certain individuals have a higher propensity for developing kinesiophobia and, therefore, prolonged pain?

Women are more likely than men to have persistent musculoskeletal pain, both in the general population and among those seeking therapy (Stubbs et al., 2010), and treatment outcomes vary by gender (Wijnhoven, de Vet, & Picavet, 2006). According to research (Popescu, LeResche, Truelove, & Drangsholt, 2010), women are more sensitive to pain, describe greater pain intensities, and experience broad pain more often than men. According to Munce and Stewart (2007), women consume more analgesics and had twice as many cases of depression as men. However, according to Rovner et al. (2017), men usually exhibit poorer levels of quality of life and score higher on tests of kinesiophobia. Males and females were given the identical painful stimulation in Rovner and colleagues’ (2017) investigation, and they noted variations between the sexes. Surprisingly, both sexes claimed to be suffering the same amount of pain, but men showed more kinesiophobia, mood disruption, and lower levels of activity, while women reported greater social support, acceptance of pain, and higher levels of activity.

Based on this, it seems that men are more prone to exhibit kinesiophobia, while females are more likely to exhibit sadness, despite the fact that females are more likely to acquire prolonged pain. While screening every patient may not be essential, it seems more pertinent to test men for kinesiophobia and women for depression and anxiety (Rovner et al., 2017).

⇒Surgical intervention

IS THERE A DIFFERENCE BETWEEN PATIENTS WHO RECEIVE CONSERVATIVE MANAGEMENT AND THOSE WHO UNDERGO SURGICAL INTERVENTION? KINESISOPHOBIA IS A KEY PREDICTOR OF PERSISTENT LOW BACK PAIN.

After discectomy surgery, kinesiophobia was studied by Svensson and colleagues (2011). Following surgical intervention, patients filled out questionnaires measuring kinesiophobia, quality of life, pain levels, disability, function, and patient satisfaction. All other data (age, gender, location of herniation, and place of birth) were similar across groups, however almost half of the patients scored highly on the Tampa Scale for Kinesiophobia (TSK) (Svensson et al., 2011). According to Svensson et al. (2011), those with high levels of kinesiophobia had worse results across the board, including higher levels of pain, disability, and depressive symptoms as well as worse self-efficacy and more catastrophizing thoughts. Nearly 50% of people still showed kinesiophobia in the follow-up surveys, which were conducted 10 to 34 months after surgery (Svensson et al., 2011).

Since pain and sadness are strongly related, patients with kinesiophobia often experience higher levels of depression. According to the research (Jansson, Nemeth, Granath, Jonsson, & Blomqvist, 2005; Silverplats et al., 2011), more than 50% of individuals who reported pre-surgery anxiety or sadness also had it post-surgery. According to Svensson et al. (2011), depression also seems to independently predict poor post-operative results. According to Vlaeyen’s fear-avoidance paradigm (Vlaeyen & Linton, 2012), kinesiophobia may contribute to depression, hence avoiding it may lessen depression symptoms.

Following discectomy, it seems essential to test all patients for kinesiophobia. It seems that virtually every second patient will exhibit fear avoidance, given that approximately half of the individuals showed kinesiophobia. It is anticipated that if their kinesiphobia is not treated, they would have more severe pain, more impairment, and a reduced quality of life.
Fortunately, Sullivan and colleagues’ (2009) research revealed that treating psychological issues before to surgery reduced post-operative impairment and pain levels. Although knee surgery was the primary topic of this research, it would seem reasonable to apply the results to low back discomfort.

Physiotherapists should be able to lower pain levels and impairment after lumbar discectomy surgery by regularly evaluating people for depression and kinesiophobia before and after lumbar surgery and treating those who exhibit high levels of despair and kinesiophobia.

⇒Tampa scale kinesiophobia ratings

Miller and colleagues created the Tampa Scale for Kinesiophobia (TSK) in 1991 in an effort to measure the severity of kinesiophobia in people.
There are 17 questions in the survey, with an 11-question abbreviated version also accessible.

The patient should circle the number that most accurately describes each statement on the entire form, which is seen below. Then, the therapist must reverse the answers to questions 4, 8, 12, and 16. For instance, if a patient answers “1” to question 4, then the therapist must count this as a score of 4. Or if a patient answers “2” to question 8, they must get a 3 instead. The final score will be quite different if these scores are not flipped.

The distinction between high and low kinesiophobia cutoff scores is not well understood. Most people agree, nonetheless, that a score of more than 37 indicates severe kinesiophobia (Vlaeyen et al., 2016). Regarding cut-off scores, there also seems to be a variation between the sexes. Women with higher TSK scores tended to be younger than those with lower levels, according to a 2008 study by Branstrom and colleagues. Additionally, their level of discomfort and impairment was greater.
Interestingly, there was no obvious association between impairment and the percentage of males with chronic pain who had a high TSK score (>37) (Branstrom & Fahlstrom, 2008). The Rovner paper, which was previously mentioned, had a female average age of 45, so it’s possible that it missed the subgroup of young females, who showed alarmingly high levels of pain, impairment, and kinesiophobia.

The authors propose utilizing alternative cut-off scores, with potentially a somewhat lower cut-off for young girls, since they claim that there are disparities between genders. Perhaps a cut-off score of 33 is more suitable in identifying at-risk young girls as this group of young females who scored strongly on TSK had larger negative outcomes, more acute pain, and greater impairment (Branstrom & Fahlstrom, 2008).

Kinesiophobia is a key component of chronic pain, and people who score higher on the TSK report more severe pain, more disability, and more injury recurrence. A score of >37 on the Tampa Scale for Kinesiophobia is generally regarded as indicating significant levels of kinesiophobia. According to studies by Branstrom and Fahlstrom (2008) and Rovner et al. (2017), older females (>40) are at a decreased risk of developing kinesiophobia, but both young girls and men must be evaluated for the condition. Following lumbar discectomy surgery, all patients should have a regular TSK to identify those who have kinesiophobia and are more likely to experience chronic pain. Kinesiophobia assessment and treatment are essential for treating people with chronic pain; a subsequent blog post will describe management techniques.

 

References:

• Hapidou, E. G., O’Brien, M. A., Pierrynowski, M. R., de Las Heras, E., Patel, M., & Patla, T. (2012). Fear and Avoidance of Movement in People with Chronic Pain: Psychometric Properties of the 11-Item Tampa Scale for Kinesiophobia (TSK-11). Physiother Can, 64(3), 235-241.
• Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., . . . Buchbinder, R. (2014). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis, 73(6), 968-974.
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• Silverplats, K., Lind, B., Zoega, B., Halldin, K., Gellerstedt, M., Rutberg, L., & Brisby, H. (2011). Health-related quality of life in patients with surgically treated lumbar disc herniation: 2- and 7-year follow-up of 117 patients. Acta Orthop, 82(2), 198-203.
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