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

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.  

for Discussion: Do you feel that certain injuries may have higher levels of
kinesiophobia than other injuries?

benefits do you think might come from measuring kinesiophobia in patients?

Written by: Lauren Miller
Reviewed by Lisa Chinn and Jeffrey

Related Posts:

Hartigan EH, Lynch AD, Logerstedt DS, Chmielewski TL, & Snyder-Mackler L (2013). Kinesiophobia after anterior cruciate ligament rupture and reconstruction: noncopers versus potential copers. The Journal of Orthopaedic and Sports Physical Therapy, 43 (11), 821-32 PMID: 24175594