Kinesiophobia after anterior cruciate ligament rupture and reconstruction: Noncopers versus potential copers
Hartigan E, Lynch A, Logerstedt D, Chmielewski T, Snyder-Mackler L.. J Orthop Sports Phys Ther. 2013; 43(11):821-832
Take Home Message: Non-copers have higher levels of kinesiophobia before an ACL reconstruction and larger overall decreases in kinesiophobia following surgery compared with potential copers. There was no relationship between kinesiophobia and functional ability (e.g., quadriceps strength, hop tests).
Individuals with anterior cruciate ligament (ACL) ruptures may be classified into two categories – potential copers and non-copers – depending on whether they have unimpaired function and can dynamically stabilize their knee. While non-copers have functional impairments it is unclear if they have kinesiophobia – a fear of movement because it may elicit pain or further injury – which is also related to poor outcomes after an ACL injury. If we can gain a better understanding of kinesiophobia among potential copers and non-copers then it may help us promote better outcomes after an ACL injury. The purpose of this study was to compare levels of kinesiophobia among potential copers and non-copers before and after reconstruction and assess the relationship of kinesiophobia with quadriceps strength and overall knee function. This study included 111 patients (potential copers=50, non-copers=61) with a unilateral ACL rupture who also underwent surgical reconstruction and had scores for the Tampa Scale of Kinesiophobia (TSK-11) for at least one time point. Participants completed four evaluations: the initial screening (preoperative), following a pre-operative neuromuscular training program, six months after reconstruction, and a year after reconstruction. At the initial screening visits, the authors classified participants as potential coper or non-coper based on previously established cutoff values for self-reported number of episodes of “giving way” of the knee, scores on timed single leg 6-meter hop test, score on Knee Outcome Survey Activities ofDaily Living Subscale (KOS-ADL), and score on the Global Knee Rating Scale (GRS). At all four time points, the authors collected data for quadriceps strength index, four single leg hop tests during, daily function using the KOS-ADL, global function using the GRS, and kinesiophobia levels using TSK-11. Non-copers had higher kinesiophobia levels than potential copers at both preoperative time points. Following surgery, both groups had a reduction in kinesiophobia scores; however, both groups had similar levels of kinesiophobia after surgery. Among all of the measures of function, only self-reported function was related to kinesiophobia in both groups, which suggested that as self-reported function improved as kinesiophobia decreased, regardless of group.
This study is important because it reminds us to note higher kinesiophobia levels in the weeks prior to an ACL reconstruction surgery, particularly among non-copers, since patients may need additional emotional support and perhaps even additional interventions (e.g., bracing). Therefore, we should evaluate objective and self-perceived physical and emotional progression among patients with an ACL rupture. If we add emotional/psychological components to our rehabilitation then we should set goals to restore the patient’s view of their functional ability or reduce kinesiophobia since these two outcomes are related. This study also illustrates the need to continue to monitor kinesiophobia since the participants had high levels of kinesiophobia at 12 months, which is the time period when many athletes are returning to play. More and more we are seeing studies like this one that remind us that we need to assess psychological outcomes along with objective and self-reported physical outcomes to help better understand deficits that may need to be addressed.
Questions for Discussion: Do you feel that certain injuries may have higher levels of kinesiophobia than other injuries? What benefits do you think might come from measuring kinesiophobia in patients?
Written by: Lauren Miller
Reviewed by Lisa Chinn and Jeffrey Driban