The primary aim of this systematic review was to determine whether psychological factors differ between those with and without tendinopathy.
A systematic search of the literature was performed through seven databases from inception until September 2024.
We included all English language studies which presented data comparing psychological outcomes between those with a clinical diagnosis of tendinopathy and those without tendinopathy. Psychological outcomes included those which aligned with International Scientific Tendinopathy Symposium consensus.
Identified articles were imported into Covidence and screened by title and abstract, followed by full-text screening independently by four reviewers. Extracted data was imported into a Microsoft Excel spreadsheet.
18,992 records were identified, after removing duplicates 10,076 titles and abstracts were screened. 46 studies underwent full-text screening. 22 studies were included following full-text screening encompassing a total of 2,211 participants. 16 studies provided data for meta-analysis.
Meta-analyses were conducted using a random-effects model comparing depression, anxiety, kinesiophobia, pain catastrophization, mental health, self-efficacy and extraversion between those with and without tendinopathy. Psychological factors not included in the meta-analysis were analysed descriptively. These included: fear avoidance beliefs, personality traits, sleep quality, stress, mood state, perfectionism, hope for success, fear of failure, agoraphobia, somatisation, insufficiency, sensitivity and aggression-hostility.
Risk of bias was evaluated using Joanna Briggs Institute critical appraisal tools. Certainty of evidence was assessed using the GRADE framework.
Meta-analysis revealed that people with tendinopathy had higher levels of depression (k=7), anxiety (k=6), kinesiophobia (k=4), pain catastrophization (k=7) and were in poorer mental health (k=2) when compared to those without tendinopathy.
No difference was found between those with tendinopathy and those without tendinopathy for general self-efficacy (k=2) or extraversion (k=2).
Overall, two studies were deemed as having high, seven studies moderate and thirteen studies low risk of bias. The certainty of evidence for all studies included in our meta-analysis was assessed as very low.
This systematic review and meta-analysis provides evidence that those with tendinopathy are more depressed, anxious, more fearful of movement and have more catastrophic thinking than those without tendinopathy. Future research should investigate the efficacy of cognitive care models in tendinopathy.
Clinicians should be cognisant that psychological factors present may be higher in those presenting for care with tendinopathy compared to those without. These characteristics of people with tendinopathy may suggest that biopsychosocial approaches be given consideration. However, further research is required to determine whether interventions in the cognitive domain may be of value in the management of tendinopathy.
Psychological Factors
Pain Cognitions
