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

Abstract

Objective 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 If you have Achilles tendon rupture, your level of motivation, psychological readiness for return to sport, and fear of movement can affect your rehabilitation outcome. Your physical therapist can help you recognize these factors.

Kinesiophobia in Injured Athletes: A Systematic Review

“…The level of sport participation varied in the 14 studies included in the review. In one study, the authors examined adolescent athletes [ 20 ], three examined high-school and/or collegiate athletes [ 21 , 22 , 23 ], one examined professional athletes [ 24 ], two examined recreational athletes [ 5 , 25 ], and seven examined a combination of levels [ 11 , 16 , 26 , 27 , 28 , 29 , 30 ], such as recreational and collegiate athletes. The athletes played diverse sports, including running [ 25 ], football and lacrosse [ 21 ], alpine skiing [ 24 ], and various college sports, including baseball, basketball, futsal, gymnastics, lacrosse, soccer, softball, table tennis, tennis, and track and field [ 23 ].…”

“…The athletes played diverse sports, including running [ 25 ], football and lacrosse [ 21 ], alpine skiing [ 24 ], and various college sports, including baseball, basketball, futsal, gymnastics, lacrosse, soccer, softball, table tennis, tennis, and track and field [ 23 ]. Most studies examined athletes who had anterior cruciate ligament or other knee injuries [ 16 , 24 , 25 , 26 , 27 , 28 , 29 ], or ankle injuries [ 5 , 21 , 23 , 30 ].…”

“…The authors used several tests (see Table 5 ) and objective physical measures to assess Kinesiophobia (see Table 6 ) including joint-position sense [ 5 ], postural control [ 5 ], strength [ 11 , 29 ], joint laxity [ 21 , 29 ], muscle activity [ 29 ], and performance-based functions [ 11 , 16 , 20 , 26 , 29 , 30 ]. We found that authors commonly use performance-based functions, often via horizontal hops tests for distance (single leg or double leg), side to side hops, heel raises, and/or by examining peak vertical ground reaction forces.…”

“…Finally, Paterno et al found that patients who had higher TSK-11 scores were more likely to have a quadricep muscle strength symmetry and a hop limb symmetry lower than 90% [ 11 ]. Kinesiophobia had a high correlation with a fear of reinjury [ 11 , 21 , 22 , 28 , 29 , 30 ], fear of movement [ 5 , 21 , 23 , 26 ], and confidence levels [ 16 , 23 , 24 , 26 , 30 ] in lower limb movement. Other objective outcome measures previously used to assess Kinesiophobia include activity level [ 11 ], injury tracking [ 11 ], and reliability and validity of the TSK [ 27 ].…”

Multispectral Optoacoustic Tomography Enables In Vivo Anatomical and Functional Assessment of Human Tendons

“…Recently, it has been shown that increasing patient motivation during rehabilitation leads to the reduction of kinesiophobia, and positively affects recovery outcome. [ 32 ] MSOT's sensitivity could provide visualization of tendon neovascularisation, a precursor in the tendon healing process, and this positive feedback on the effectiveness of the treatment protocol could encourage patients and increase rehabilitation incentives. In the future, MSOT could even drive the development of patient‐specific treatments for the alleviation of chronic pain.…”