Does your patient suffer from kinesiophobia?

A fear of movement or physical activity is prevalent among knee osteoarthritis patients and this fear, not necessarily the disease itself, is responsible for keeping patients down, researchers write in Arthritis Care and Research.

The pain and psychological toll from the trauma of osteoarthritis can be so intense that patients fear that any kind of movement will cause pain, injury or re-injury. But without medically recommended physical activity, patients may suffer from increased pain, poorer physical function, and higher physical and psychological disability.

“Identifying characteristics associated with fear of movement in OA may help clinicians to target those most at risk for pain, disability, and physical inactivity,” researchers wrote. “These patients may benefit from interventions that specifically address fear of movement within the context of other treatments or interventions such as exercise programs.”

This was an exploratory study with no formal hypotheses that is based on a single clinical trial of 350 patients with symptomatic knee osteoarthritis by researchers at the University of North Carolina at Chapel Hill. Researchers measured fear of movement with the Brief Fear of Movement (BFOM) measure finding a relatively high frequency of fear of movement among osteoarthritis patients.

The following characteristics were measured:  age, sex, race, education, pain and activities of daily living (ADL) subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS), knee symptom duration, depressive symptoms (PHQ-8), history of falls and knee injury, family history of knee problems, self-efficacy for exercise (SEE), and a unilateral balance test.

The study participants were randomly assigned to either the standard physical therapy for knee osteoarthritis group, an internet-based exercise program for knee osteoarthritis or a wait list control group.

Researchers found that not only was it common for patients to be fearful of beginning a physical therapy program, but they had more depressive symptoms and lower self-efficacy for exercise. “The relatively high frequency of fear of movement and the association with psychological variables suggest that behavioral and psychological interventions may be important strategies for decreasing fear of movement in order to improve physical activity participation and outcomes in individuals with knee OA,” the researchers wrote.

Additional research is needed to identify effective strategies for delivering targeted interventions to people with osteoarthritis who have a high level of fear of movement.

“These findings are consistent with prior research showing that fear of movement is common among individuals with a variety of chronic pain conditions. Branstrom et al reported that 56% of participants with chronic musculoskeletal pain had a high degree of fear of movement, defined as a score >37 on the Swedish Version of the Tampa Scale of Kinesiophobia. We found that 36% endorsed 3 of the 6 items on the scale, which may indicate a high level of fear,” researchers wrote.

As with prior studies, this study showed that patients experiencing depression were more fearful of movement (1.15 times the odds of having greater fear of movement per unit increase on the PHQ-8). And, participants with greater self-efficacy for exercise had less fear of movement (0.87 times the odds of having greater fear of movement per 10-unit increase in SEE score).

References:

Alexander H. Gunn, Todd A. Schwartz, Liubov S. Arbeeva, et al. “Fear of Movement and Associated Factors among Adults with Symptomatic Knee Osteoarthritis,” Arthritis Care and Research.  Accepted manuscript online: 31 MAR 2017 03:45PM EST, DOI: 10.1002/acr.23226