title: Decreased Range of Motion After Total Knee Arthroplasty Is Predicted by the Tampa Scale of Kinesiophobia.
abstract: BACKGROUND
  Range of motion (ROM) is important for functional outcome after total knee arthroplasty (TKA); however, some patients hesitate to maximize their ROM postoperatively. The Tampa Scale of Kinesiophobia (TSK) measures patients' fear of movement. The primary purpose of this investigation was to determine whether TSK scores correlated with decreased ROM after primary TKA. A secondary purpose was to determine whether biofeedback could increase ROM after TKA.
  
  
  METHODS
  Patients were recruited from the senior author's practice between June 2011 and March 2013. A clinical photograph was taken of each patient's knee in maximum passive flexion in the operating room immediately following closure. Patients were randomized to the control or photograph group before incision. A linear mixed model was implemented to determine whether the TSK score and viewing the photo correlated to ROM.
  
  
  RESULTS
  Seventy-nine patients were analyzed for correlation between the TSK score and the knee ROM. Sixty patients were analyzed for correlation between viewing the clinical photograph and the knee ROM. The linear mixed model demonstrated a significant negative correlation between the TSK score and both active (β = -0.47, P < .01) and passive (β = -0.66, P < .001) knee flexions. There was a trend toward decreased knee flexion among patients shown their clinical photograph.
  
  
  CONCLUSIONS
  The TSK was developed as a tool to identify patients at risk for maladaptive responses to painful stimuli. Our data suggest that the TSK may help arthroplasty surgeons identify patients at risk for decreased ROM after TKA. Showing patients a clinical photograph failed to increase ROM after TKA.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Brown
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina.
authors.forename: Johannes F
authors.initials: JF
authors.lastname: Plate
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina.
authors.forename: Sarah
authors.initials: S
authors.lastname: Von Thaer
authors.affiliation: Department of Biostatistical Sciences, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina.
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina.
authors.forename: Beth P
authors.initials: BP
authors.lastname: Smith
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina.
authors.forename: Thorsten M
authors.initials: TM
authors.lastname: Seyler
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Lang
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular
keywords: functional outcome; kinesiophobia; range of motion; total knee arthroplasty