title: Patient kinesiophobia affects both recovery time and final outcome after total knee arthroplasty.
abstract: OBJECTIVE
  To evaluate the effects of kinesiophobia on both phases immediately after surgery and the final results after total knee arthroplasty (TKA).
  
  
  METHODS
  This study evaluated prospectively 101 patients (mean age 66 ± 8.0 years, 70 women and 31 men), 5 days after surgery, at 1, 6, 12 months, and at a mean final follow-up of 3.2 ± 0.7 years (2.0-4.2 years). Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK: Activity Avoidance-TSK1 and Harm-TSK2 subscales), and results were evaluated with range of motion, pain and function on 0-10 numeric rating scales, WOMAC and SF-12 (Physical and Mental subscales) scores.
  
  
  RESULTS
  TSK1 was correlated with the acute postoperative pain measured at 5 days (p = 0.031), pain measured at 12 months (p = 0.018), patient perceived function at 12 months (p = 0.025), SF-12P at 6 months (p < 0.001), SF-12P and SF-12M at 12 months (p = 0.001 and p = 0.005, respectively), and WOMAC at both 6 and 12 months of follow-up (p = 0.005 and p = 0.001). The effect of TSK 1 on the final WOMAC score was significant when corrected by age and sex (p = 0.049, η2= 0.041): the youngest female patients were affected even by moderate kinesiophobia levels.
  
  
  CONCLUSIONS
  Fear of pain and even more avoidance of movement are strongly correlated both with the acute postoperative pain perception and recovery after surgery up to 1 year, thus presenting a relevant clinical impact on the outcome after TKA. Moreover, this study showed that even though at longer follow-up its impact decreases, patients with higher levels of kinesiophobia may present a poorer final outcome, especially women.
  
  
  METHODS
  IV.
authors.affiliation: Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Filardo
authors.affiliation: Laboratory of NanoBiotechnology (NABI), Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy. a.roffi@biomec.ior.it.
authors.forename: A
authors.initials: A
authors.lastname: Roffi
authors.affiliation: Laboratory of NanoBiotechnology (NABI), Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Merli
authors.affiliation: Mood, Centro per lo studio e la cura dei disturbi emotivi, Bologna, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Marcacci
authors.affiliation: Mood, Centro per lo studio e la cura dei disturbi emotivi, Bologna, Italy.
authors.forename: F Berti
authors.initials: FB
authors.lastname: Ceroni
authors.affiliation: Mood, Centro per lo studio e la cura dei disturbi emotivi, Bologna, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Raboni
authors.affiliation: Mental Health Department, AUSL Bologna, Bologna, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Bortolotti
authors.affiliation: Mood, Centro per lo studio e la cura dei disturbi emotivi, Bologna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: De Pasqual
authors.affiliation: Laboratory of Biomechanics and Technology Innovation/2nd Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Marcacci
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000502:physiology / Q000503:physiopathology; D008297:Male; D010149:Postoperative Pain / Q000523:psychology*; D010698:Phobic Disorders; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Catastrophizing; Kinesiophobia; TKA; TKR; Total knee arthroplasty; Total knee replacement