Kinesiophobia in patients with non-traumatic arm, neck and shoulder complaints: a prospective cohort study in general practice.
BACKGROUND
Complaints of arm, neck and shoulder are common in Western societies. Of those consulting a general practitioner (GP) with non-traumatic arm, neck or shoulder complaints, about 50% do not recover within 6 months. Kinesiophobia (also known as fear of movement/(re)injury) may also play a role in these complaints, as it may lead to avoidance behaviour resulting in hypervigilance to bodily sensations, followed by disability, disuse and depression. However, in relation to arm, neck and shoulder complaints little is known about kinesiophobia and its associated variables. Therefore this study aimed to: describe the degree of kinesiophobia in patients with non-traumatic complaints of arm, neck and shoulder in general practice; to determine whether mean scores of kinesiophobia change over time in non-recovered patients; and to evaluate variables associated with kinesiophobia at baseline.


METHODS
In this prospective cohort study set in general practice, consulters with a first or new episode of non-traumatic arm, neck or shoulder complaints (aged 18-64 years) entered the cohort. Baseline data were collected on kinesiophobia using the Tampa Scale for Kinesiophobia, the 13-item adjusted version: TSK-AV, and on patient-, complaint-, and psychosocial variables using self-administered questionnaires. The mean TSK-AV score was calculated. In non-recovered patients the follow-up TSK-AV scores at 6 and 12 months were analyzed with the general linear mixed model. Variables associated with kinesiophobia at baseline were evaluated using multivariate linear regression analyses.


RESULTS
The mean TSK-AV score at baseline was 24.8 [SD: 6.2]. Among non-recovered patients the mean TSK-AV score at baseline was 26.1 [SD: 6.6], which remained unchanged over 12- months follow-up period. The strongest associations with kinesiophobia were catastrophizing, disability, and comorbidity of musculoskeletal complaints. Additionally, having a shoulder complaint, low social support, high somatization and high distress contributed to the kinesiophobia score.


CONCLUSIONS
The mean TSK-AV score in our population seems comparable to those in other populations in primary care. In patients who did not recover during the 12- month follow-up, the degree of kinesiophobia remained unchanged during this time period. The variables associated with kinesiophobia at baseline appear to be in line with the fear-avoidance model.
Feleus
Anita
A
Department of General Practice, Erasmus MC, Rotterdam, The Netherlands. a.feleus@erasmusmc.nl
van Dalen
Tineke
T
Bierma-Zeinstra
Sita M A
SM
Bernsen
Roos M D
RM
Verhaar
Jan A N
JA
Koes
Bart W
BW
Miedema
Harald S
HS
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications / Q000523:psychology*; D019547:Neck Pain / Q000523:psychology*; D010698:Phobic Disorders / Q000209:etiology*; D011446:Prospective Studies; D020069:Shoulder Pain / Q000523:psychology*; D013997:Time Factors; D034941:Upper Extremity