The relationships between kinesiophobia and clinical outcomes after ACL reconstruction differ by self-reported physical activity engagement

Norte, Grant E.; Solaas, Haley; Saliba, Susan A.; Goetschius, John; Slater, Lindsay V.; Hart, Joseph M.

doi:10.1016/j.ptsp.2019.08.002

Cited by 29 publications

(38 citation statements)

References 40 publications

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“…36 The lower self-reported current activity level among the ACLR group could partially explain the observation of objectively measured impairments, although these relationships are unclear in the literature. 10 However, the observed relationships were negligible to low in magnitude, suggesting that each instrument of knee function may explain unique information about individuals recovering from ACLR that is distinct from objective measures of quadriceps and lower extremity function. This appears to indicate that perceived function differs from measured function, and supports the utility of including each in the RTS decision-making process.…”

Section: Discussionmentioning

confidence: 95%

“…8 Moreover, the relationships between subjective and objective knee function have been widely reported. 9,10 For example, higher subjective knee function has been associated with several critical functional measures among individuals with ACLR, including greater unilateral and symmetric knee extensor torque, 9 better single-leg hop (SLH) performance, 11 quadriceps strength symmetry, 12 and overall successful performance on RTS tests with high sensitivity. 13 These data suggest the IKDC may be a useful clinical indicator of functional recovery after ACLR, and may have utility as a screening tool when incorporated in a battery of tests aimed at assessing overall patient health status.…”

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confidence: 99%

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Rationale for a Parsimonious Measure of Subjective Knee Function Among Individuals With Anterior Cruciate Ligament Reconstruction: A Rasch Analysis

Duckett

Fox

Hart

et al. 2021

Journal of Athletic Training

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Context: The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation is the most frequently used patient-reported measure of subjective knee function among individuals with ACL reconstruction (ACLR). Yet, limitations with traditional validation approaches leave it unclear whether the IKDC measures knee function as intended. Rasch analysis offers a robust validation approach, which may enhance clinical interpretation of the IKDC. Objective: 1) To assess the psychometric properties, 2) ability to classify health status, and 3) relationships between the IKDC and objective measures of strength and functional performance relative to a newly proposed reduced-item instrument. Design: Cross-sectional. Setting: Laboratory. Patients or other Participants: Seventy-seven individuals with primary, unilateral ACLR (21.9±7.8 years, 6.2±1.0 months post-surgery), and seventy-six age-matched controls. Main Outcome Measure(s): Rasch analysis was used to assess the psychometric properties of the IKDC. Receiver-operator-characteristic curves and logistic regression were used to assess the accuracy of classifying ACLR versus control participants. Correlations (Pearson and Spearman) were used to assess relationships between subjective knee function, quadriceps torque, and single-limb hop performance. Results: Rasch analysis aided the development of a reduced 8-item instrument (IKDC-8), which yielded improved psychometric properties in misfit analysis, percent of variance accounted for by one dimension (IKDC-8=71.5%; IKDC=56.7%), and item reliability. The IKDC was an outstanding diagnostic tool and the IKDC-8 was excellent, correctly classifying 87.2% and 82.7% of cases, respectively. The Hanley-McNeil formula found that there was no significant difference in the areas under the respective ROC curves. Equivalent associations between subjective and objective knee function were observed regardless of instrument used. Conclusions: We observed evidence of enhanced reliability and validity for a parsimonious measure of subjective knee function. The proposed instrument reduces the number of items, increases score interpretability as measuring a single construct, and improves the rating scale functioning, while not significantly diminishing its ability to classify ACLR versus control participants or changing existing relationships with objective measures of recovery. We suggest the IKDC-8 may enhance clinical use by reducing administration time, improving the interpretation of the subjective knee function score, and clarifying functional ability.

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Rationale for a Parsimonious Measure of Subjective Knee Function Among Individuals With Anterior Cruciate Ligament Reconstruction: A Rasch Analysis

Duckett

Fox

Hart

et al. 2021

Journal of Athletic Training

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“…59 The same results were seen in previous ACLR research reporting that lower levels of kinesiophobia were associated with higher functional outcome scores. 60,61 Although reported motivation levels were high throughout rehabilitation, interventions like setting short-and long-term rehabilitation goals could be beneficial for patients with slightly lower motivation levels in order to enhance motivation and adherence to rehabilitation exercises. 51…”

Section: [H3]course Of Psychological Factors and Associations With Function And Participationmentioning

confidence: 99%

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

et al. 2021

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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.

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“…The prediction of harm causes the body to protect the knee in an effort to reduce the risk for re-injury (Vlaeyen and Linton, 2000). Despite growing evidence reporting an association between higher FoH and lower rate of return-to-play (Paterno et al, 2018;Tjong et al, 2014), increased risk for second ACL-injury (Paterno et al, 2018), asymmetric hop performance (Norte et al, 2019), lower peak knee, hip and trunk flexion during jump landing (Trigsted et al, 2018), and asymmetric quadriceps- (Lentz et al, 2015) and hamstring strength (Norte et al, 2019), to our knowledge, there is no evidence of the relation between FoH and lowerlimb motor-flexibility in ACLR-patients.…”

Section: Introductionmentioning

confidence: 99%

Changes in motor-flexibility following anterior cruciate ligament reconstruction as measured by means of a leg-amplitude differentiation task with haptic and visual feedback

Roelofsen

Cingel

Staal

et al. 2020

Clinical Biomechanics

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Background: In the current study changes in lower-limb motor flexibility of patients undergoing Anterior Cruciate Ligament Reconstruction were evaluated in relation to fear of harm. Methods: Fourteen patients were measured pre-and post-surgery, and data were compared to those of a single measurement in fifteen controls. Lower-limb motor-flexibility was assessed in treadmill-walking and a cyclic legamplitude differentiation task augmented with haptic or visual feedback. Flexibility was captured by determining the between-leg coordination-variability (SD of relative phase) and each leg's temporal variability (sample entropy). Patients were post hoc divided into a higher-fear-group (pre-surgery: n = 6, post-surgery: n = 7) and a lower-fear-group (pre-surgery: n = 6, post-surgery: n = 7) by means of a median split of their scores on a self-reported fear of harm scale. Differences in flexibility-measures between the higher-fear-group and the lowerfear-group were also assessed. Findings: No pre-and post-surgery differences, nor differences with the control group, were found in motorflexibility during treadmill-walking but the post-surgery higher-fear-group did show lower values of SD relative phase. In the leg-amplitude differentiation task the SD of the relative phase decreased but sample entropy increased post-surgery towards levels of the control-group. The pre-surgery higher-fear-group showed lower values of sample entropy in visual conditions. Interpretation: While gait kinematics may not show motor-flexibility changes following anterior cruciate ligament reconstruction, a leg-amplitude differentiation task does show such changes. Differentiating patients on a fear-ofharm scale revealed subtle differences in motor-flexibility. Challenging patients with non-preferred movements such as amplitude differentiation may be a promising tool to evaluate motor-flexibility following ACLR.

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The relationships between kinesiophobia and clinical outcomes after ACL reconstruction differ by self-reported physical activity engagement

Cited by 29 publications

References 40 publications

Rationale for a Parsimonious Measure of Subjective Knee Function Among Individuals With Anterior Cruciate Ligament Reconstruction: A Rasch Analysis

Rationale for a Parsimonious Measure of Subjective Knee Function Among Individuals With Anterior Cruciate Ligament Reconstruction: A Rasch Analysis

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

Changes in motor-flexibility following anterior cruciate ligament reconstruction as measured by means of a leg-amplitude differentiation task with haptic and visual feedback

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