Kinesiophobia Severity Categories and Clinically Meaningful Symptom Change in Persons With Achilles Tendinopathy in a Cross-Sectional Study: Implications for Assessment and Willingness to Exercise

Abstract

Objectives: (1) Validate thresholds for minimal, low, moderate, and high fear of movement on the 11-item Tampa Scale of Kinesiophobia (TSK-11), and (2) Establish a patient-driven minimal clinically important difference (MCID) for Achilles tendinopathy (AT) symptoms of pain with heel raises and tendon stiffness.Methods: Four hundred and forty-two adults with chronic AT responded to an online survey, including psychosocial questionnaires and symptom-related questions (severity and willingness to complete heel raises and hops). Kinesiophobia subgroups (Minimal ≤ 22, Low 23–28, Moderate 29–35, High ≥ 36 scores on the TSK-11), pain MCID subgroups (10-, 20-, 30-, >30-points on a 0- to 100-point scale), and stiffness MCID subgroups (5, 10, 20, >20 min) were described as median [interquartile range] and compared using non-parametric statistics.Results: Subgroups with higher kinesiophobia reported were less likely to complete three heel raises (Minimal = 93%, Low = 74%, Moderate = 58%, High = 24%). Higher kinesiophobia was associated with higher expected pain (Minimal = 20.0 [9.3–40.0], Low = 43.0 [20.0–60.0], Moderate = 50.0 [24.0–64.0], High = 60.5 [41.3–71.0]) yet not with movement-evoked pain (Minimal = 25.0 [5.0–43.0], Low = 31.0 [18.0–59.0], Moderate = 35.0 [20.0–60.0], High = 43.0 [24.0–65.3]). The most common pain MCID was 10 points (39% of respondents). Half of respondents considered a 5-min (35% of sample) or 10-min (16%) decrease in morning stiffness as clinically meaningful.Conclusions: Convergent validity of TSK-11 thresholds was supported by association with pain catastrophizing, severity of expected pain with movement, and willingness to complete tendon loading exercises. Most participants indicated that reducing their pain severity to the mild range would be clinically meaningful.

Psychosocial and individual factors affecting Quality of Life (QoL) in patients suffering from Achilles tendinopathy: a systematic review

“…Moreover, lower QoL was associated with one or more comorbidities, specifically low back pain, high blood pressure, and diabetes [ 20 ]. Chimenti et al [ 40 ] found that patients identified as Hispanic or Latino presented higher kinesiophobia levels compared to the group identified as Caucasian. Weight, height and BMI did not show a significant impact.…”

“…Regarding physical activity, reducing physical activity impacts patients socially, affecting overall health and quality of life [24]. Results also showed that patients feared carrying out specific movements [38,40]. Eccentric exercise has been reported as improving AT [50] due to neuromuscular changes.…”

The effect of combined Action Observation Therapy with eccentric exercises in the treatment of mid-portion Achilles-tendinopathy: a feasibility pilot randomised controlled trial

“…As the numbers included in this study were too small to truly explore the impact of AOT on eccentric exercises in subgroups of participants presenting with low levels of self-efficacy or high levels of kinesiophobia or catastrophisation, analysis of larger numbers in a full-scale RCT would be able to investigate this further. A recent study reported that participants with higher levels of kinesiophobia had higher levels of pain catastrophisation, higher levels of pain in their AT at rest and with activities, along with a decreased willingness to perform Achilles tendon loading activities [ 73 ]. As the reconceptualization of maladaptive fear avoidance beliefs is essential to reduce perceived threat of fear and pain, viewing an individual perform the rehabilitation movements safely could help with this process, altering the patients expectation from the movements they were to perform prior to the execution [ 74 ].…”

The effects of pain science education plus exercise on pain and function in chronic Achilles tendinopathy: a blinded, placebo-controlled, explanatory, randomized trial

“…42,52 Expected pain (visual analog scale, 0-100) during heel raises and hops was assessed after asking the participants to view images or videos of the task. 12 For average stiffness duration, participants were asked, "For how many minutes do you have stiffness in the Achilles tendon region on first getting up" (0 to .100 minutes). For anticipated global rating of change, an online survey at 0 weeks asked participants to, "Please rate the anticipated overall condition of your Achilles tendon by the time that you complete physical therapy 12 weeks from now."…”

“…However, 20% to 50% of individuals with AT continue to have pain following rehabilitation. 41,53,57 The majority of individuals with AT report elevated fear of movement, 11,12,23 which is associated with more severe pain and may interfere with exercise participation and recovery. 12 Given that patient education focusing on pain mechanisms has been shown to reduce fear of movement and pain catastrophizing in other musculoskeletal conditions, 56 the addition of education could potentially enhance the effectiveness of exercise in improving symptoms in individuals with AT.…”