This study described the characteristics and relationship of KPB and LBD in Veterans receiving physical therapy (PT) for CLBP and identified the influence of PTSD on Veteran KPB and LBD. Secondarily, it aimed to establish the relationship between a KPB instrument and its derivatives in Veterans.
Medical records of 85 Veterans receiving PT for CLBP over a 12-month period were reviewed. Completed Tampa Scale of Kinesiophobia (TSK-17) and Oswestry Disability Index (ODI) questionnaires, demographic data, pain level (VAS), and the presence of PTSD were collected. The 11-item derivative of TSK-17 (TSK-11) and its subscales, activity avoidance (TSK-11AA) and somatic factor (TSK-11SF), were derived. Robust statistical methods were used for data analysis, where ODI was the dependent variable.
The mean±SD ODI was 52.64±16.53%. Thirty-five subjects (41.18%) had severe disability. The mean±SD TSK-17 was 42.41±8.50. Sixty subjects (70.59%) were kinesiophobic and had a poor prognosis for recovery. The mean±SD TSK-11, TSK-11AA, and TSK-11SF were 28.58±6.41, 15.86±3.66, and 12.72±3.33, respectively. VAS, TSK-17, TSK-11, TSK-11AA, and TSK-11SF as single predictors were significantly correlated with ODI (P0.05). When all variables were used as predictors for ODI, VAS (β=2.26) and TSK-11 (β=0.72) were estimated to be the most important (r=0.49, P0.001). The mean±SD ODI of Veterans with PTSD (58.64±17.31%) was significantly (P=0.03) greater than those without PTSD (50.14±15.67%). When controlled for the presence of PTSD, there was a significant difference in ODI when TSK-17 ≥ 52 (P=0.030), TSK-11 ≥ 36 (P=0.024), TSK-11AA ≥16 (P=0.048), and TSK-11SF ≥15 (P=0.005).
The majority of Veterans receiving PT were kinesiophobic and had a poor prognosis for recovery. When each variable was considered separately, KPB and pain were significantly related to LBD. The presence of PTSD increased LBD. Without controlling for PTSD, only pain, but not KPB, was a significant predictor for LBD. When PTSD was considered, the high magnitude of KPB contributed to the severity of LBD. PTSD had a significant influence on KPB, particularly when the KPB was high, thus impacting LBD and possibly increasing the likelihood of poor recovery prognosis. As TSK-17 and TSK-11 had excellent correlations and were significantly correlated with ODI, the use of TSK-11 proved to be pragmatic for obtaining KPB.
Understanding the characteristics of KPB, its relationship with PTSD, and its contribution to LBD allows clinicians to identify tailored interventional strategies necessary to modulate KPB and PTSD, improving Veteran clinical outcomes and disability. TSK-11 can be used to obtain KPB in Veterans with CLBP.
Kinesiophobia
Veterans
