THE BACK PAGE RESEARCH REVIEW Kinesiophobia in Chronic MSK Pain STUDY TITLE: Role of Kinesiophobia on Pain, Disability and Quality of Life in People Suffering from Chronic Musculoskeletal Pain: A Systematic Review AUTHORS: Luque-Suarez A, Martinez-Calderon J & Falla D. PUBLICATION INFORMATION: British Journal of Sports Medicine 2019; 53: 554-559. BY SHAWN THISTLE the inclusion criteria. Because of this, the authors recommend that more longitudinal studies be performed. The authors also acknowledge that kinesiophobia is a known modifiable barrier to rehabilitation adherence in various chronic pain conditions, that when appropriately treated can facili-tate earlier achievement of pain relief and functional recovery. They advise that clinicians identify the presence of kinesiophobia prior to the prescription of any intervention, since its presence may require clinicians to take a holistic biopsychosocial approach to rehabili-tation programming, such as selection of functional goals, education to man-age safe behaviours and graded expo-sure to fearful activities. Pertinent results A total of 63 observational studies with a total of 10,726 participants were in-cluded. The results of the synthesis will be outlined based on the study designs listed below. Cross-Sectional Analyses: • Strong evidence exists demonstrat-ing an association between a greater degree of kinesiophobia and greater levels of pain intensity and disability. • There is moderate evidence for an association between a greater degree of kinesiophobia and greater levels of pain severity. • There is moderate quality evidence for an association between greater levels of kinesiophobia and lower quality of life. baseline predict lower QoL, with limited evidence. • Conflicting evidence was found in support of kinesiophobia as a predic-tor of changes in pain intensity. Clinical application & conclusions This review was conducted in accord-ance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The PECOS (Patient Exposure Com-parator Outcome Study design) frame-Longitudinal Analyses: work was followed to determine which • Moderate quality evidence exists, studies to include in the systematic demonstrating that a greater degree review, based on the following inclu-of kinesiophobia at baseline predicts sion criteria: the progression of disability immedi-• Observational studies (cross-sec-ately post-intervention, and at 3-, tional, case control and longitudinal 6-and 12-month follow-ups, even studies) exploring the predictive role after adjustment for age, gender, of kinesiophobia in people with education level, comorbidities, BMI, chronic MSK pain and their associ-pain severity, baseline disability lev-ation with outcomes. els, work status, marital status and • Studies including adult participants disease severity. with chronic MSK pain, defined in • A greater degree of kinesiophobia at this review as persistent or episodic baseline predicts greater levels of pain in the axial skeleton or periph-pain severity at 6-month follow-up, eral joints, fibromyalgia, chronic with limited evidence. myofascial pain, chronic widespread • Greater levels of kinesiophobia at pain, RA, spondyloarthropathy or OA lasting > 3 months. SHAWN THISTLE, BKIN (HONS), DC, CSCS, practises full time in Toronto. He is the founder and president • Studies measuring kinesiophobia of Research Review Service Inc., an online, subscription-based service designed to help busy practitioners with the TSK questionnaire. integrate current, relevant, scientific evidence into their practice (www.researchreviewservice.com). • English-language studies including 28 Canadian Chiropractor October 2019 www.canadianchiropractor.ca The authors performed a systematic review of cross-sectional and longitu-dinal studies to elucidate the relation-ship between kinesiophobia and pain, disability and quality of life. Specifi-cally, cross-sectional studies showed strong evidence of an association be-tween a greater degree of kinesiophobia and greater levels of pain intensity and disability; moderate evidence for an association between a greater degree of kinesiophobia and greater levels of pain severity; and moderate evidence for an association between greater levels of kinesiophobia and lower quality of life. Longitudinal analysis of the prog-nostic role of kinesiophobia showed that higher baseline values of kineso-phobia are associated with a higher disability over time; are predictive of higher pain severity at 6-month fol-low-up, with limited evidence; are predictive of lower QoL at 6-months, with limited evidence; and that kinesi-ophobia is a predictor of changes in pain intensity, with conflicting evi-dence. Unfortunately, causality could not be firmly demonstrated in the analysis, as there was a low total num-ber of longitudinal studies which met Study methods
Chiropractic + Naturopathic Doctor October 2019: Page 28
