Influence of Baseline Kinesiophobia Levels on Treatment Outcome in People With Chronic Spinal Pain

Abstract

Background Pain neuroscience education (PNE) combined with cognition-targeted exercises is an effective treatment for people with chronic spinal pain (CSP). However, it is unclear as to why some patients benefit more from this treatment. We expect that patients with more pronounced maladaptive pain cognitions, such as kinesiophobia, might show poorer treatment responses. Objective The objective of this study was to assess the influence of baseline kinesiophobia levels on the treatment outcomes of PNE combined with cognition-targeted exercises in people with CSP. This study was a secondary analysis of a multicenter, double-blind randomized controlled trial. Methods Outcome measures included a numeric rating scale for pain (NRS), the Pain Disability Index (PDI), quality of life (Medical Outcomes Study 36-Item Health Survey [SF-36]), Pain Catastrophizing Scale (PCS), and Pain Vigilance and Awareness Questionnaire (PVAQ). Regression models were built using treatment (PNE plus cognition-targeted exercises or neck/back school plus general exercises), baseline scores on the Tampa Scale for Kinesiophobia (TSK), and time (in months) as independent variables. Results A significant three-way interaction effect was found for the models of PDI, PCS, PVAQ, and the SF-36 mental domain, with estimates of −0.01, −0.01, −0.01, and 0.07, respectively. A significant effect of baseline TSK scores was found for the physical domain of the SF-36 (estimate = −3.16). For the NRS, no significant effect of baseline TSK scores was found. Conclusions Our findings indicate that PNE plus cognition-targeted exercises can successfully decrease the unfavorable influence of pretreatment kinesiophobia on disability, mental health, pain catastrophizing, and hypervigilance over time in people with CSP. Nevertheless, higher scores in pretreatment kinesiophobia might still be a key factor for the lack of improvement in pain catastrophizing and hypervigilance following treatment. Regardless of the followed treatment program, pretreatment kinesiophobia was also shown to significantly influence physical health in people with CSP. Impact This study provides novel insight into the unfavorable influence of kinesiophobia on treatment outcomes in people with CSP, and how PNE plus cognition-targeted exercises can limit this impact. As this is one of the first studies to research possible predictors of this experimental treatment, its findings motivate further exploration of other possible influencing factors for treatment success of PNE plus cognition-targeted exercises.

Mediating effect of kinesiophobia between self-efficacy and physical activity levels in post-CABG patients: protocol for a prospective, multicentre, cross-sectional study in China

“…However, perceived activity barriers are expressed as a fear of exercise or even kinesiophobia in HPM. Kinesiophobia arises from negative emotions such as worry and anxiety, and may lead to overprotective avoidance of rehabilitation exercises 48. Vigorous physical activities may lead to angina pectoris,49 whereas patients are often forced to stop any movement during heart attack.…”

“…Kinesiophobia arises from negative emotions such as worry and anxiety, and may lead to overprotective avoidance of rehabilitation exercises. 48 Vigorous physical activities may lead to angina pectoris, 49 whereas patients are often forced to stop any movement during heart attack. In addition, incorrect perceptions or advice from healthcare professionals about PA may exert a negative impact on patients.…”

Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain: A systematic review and meta‐analysis of randomized controlled trials

“…Of 787 non‐duplicated citations identified in the literature, 19 were further analysed to confirm their eligibility. Twelve were excluded after full‐text reading: four as they included participants with concurrent low back pain (Bilterys et al, 2022; Malfliet, Kregel, Coppieters, et al, 2018; Malfliet, Kregel, Meeus, Roussel, et al, 2018; Van Bogaert et al, 2021), two for not being RCTs (Jessica Van Oosterwijck et al, 2011; Louw et al, 2022), one for not reporting pain intensity and kinesiophobia (Willaert et al, 2020), two for lacking control groups and not using PNE (Brage et al, 2015; Ris et al, 2016), two for using the bio‐behavioural approach instead of PNE (Beltran‐Alacreu et al, 2015; López‐de‐Uralde‐Villanueva et al, 2018), and one for having participants overlapping with another publication by the author (Neto et al, 2018). The reasons for exclusion are listed in Table S3.…”

What are Brazilian orthopaedists' views on the diagnosis and treatment of patients with chronic nonspecific low back pain? A qualitative investigation

“…Likewise, despite the mounting evidence that supports the importance of social determinants of health for LBP outcomes (Karran et al., 2020), these were neglected in participants' responses. Notably, cognitive factors such as negative beliefs (Lin et al., 2013), pain catastrophizing (Wertli et al., 2014) and hypervigilance (Van Bogaert et al., 2021) were rarely discussed. While it might not be surprising that psychological and social aspects seemed to be considered secondary to biophysical aspects by participants (orthopaedists' training has a strong focus on anatomy, pathology and physiology), it seems plausible to consider that orthopaedists may need to broaden the range of evidence that informs their practices in order to work with people who experience CNLBP.…”