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Le CY1,2, Kennedy J3, Whittaker JL1
1University of Alberta, Physical Therapy, Edmonton, Canada, 2Glen Sather Sports Medicine Clinic, Edmonton, Canada, 3University of Alberta, Kinesiology, Sport, and Recreation, Edmonton, Canada
Background: Kinesiophobia (fear of movement) is associated with physical inactivity and is the most common reason for quitting sports following a serious knee injury. The combination of joint injury, kinesiophobia, and physical inactivity contribute to injured youth having an increased risk for negative long-term health states. In relation to an injured knee joint, kinesiophobia is typically assessed during the later stages of rehabilitation when an individual is considering returning to sport or activity. Currently, little is known about kinesiophobia in the acute injury stage and whether it manifests beyond the injured joint. A better understanding of the onset and reach of kinesiophobia post-injury may lead to modified treatment approaches.
Purpose: To assess the relationship between self-reported kinesiophobia and bilateral knee strength or dynamic knee balance between youth within three-months of a sport-related knee injury and uninjured age-, sex-, and sport-matched controls.
Methods: Participants included 21youth (11-19 years) who suffered a sport-related knee injury within the previous three-months and 21 uninjured age-, sex-, and sport-matched controls. Outcomes included: Tampa Scale for Kinesiophobia (TSK), normalized bilateral knee extensor and flexor isokinetic strength (Nm/kg; isokinetic dynamometer), bilateral triple single leg hop (TSLH), and bilateral Y-balance (YBT) test scores. Descriptive statistics [median (range), proportion or mean within-pair difference (95%CI)] were calculated for all participant characteristics and outcomes by study group. Unadjusted conditional (matched-pair) logistic regression was used to assess the odds of TSK score >37 by study group (odds ratio; 95%CI) and multivariable regression (95%CI) was used to examine the association between TSK score and each outcome, adjusting for injury history.
Results: The median age of participants was 17 years (range 16-20) and 57% were female. The median time between injury and testing was 1.5 months (range 0.3-3.4). The injured group scored higher on the TSK [mean within-pair difference (95%CI); 8 (3,13)], demonstrated weaker index (injured) leg knee extensor [-0.99 Nm/kg (-1.97,-0.02] and flexor strength [-0.96 Nm/kg (-1.85,-0.06)], and had a 10-fold (95%CI 1.3,78.1) greater odds of a TSK score >37 compared to the uninjured group. A significant association was demonstrated between TSK score and index knee extensor strength [β=-0.1 (95%CI -0.2,-0.04), r2=0.278, p=0.01], non-index knee extensor strength [β=-0.1 (95%CI -0.2,-0.01), r2=0.210, p=0.04], index knee flexor strength [β=-0.08 (95%CI -0.1,-0.01), r2=0.287, p 0.01], and non-index knee flexor strength [β=-0.07 (95%CI -0.1,-0.01), r2=0.243, p=0.03], regardless of injury group. No associations were found between TSK and TLSH or YBT scores.
Conclusion(s): These preliminary findings suggest that kinesiophobia may be present as early as three-months following a youth, sport-related knee injury. Additionally, kinesiophobia (as measured by the TSK) seems to manifest beyond the injured joint as the observed by the reduction in bilateral knee extensor and flexor strength. Further investigation is required to confirm these findings and understand the mechanisms underlying kinesiophobia to inform treatment strategies following a youth, sport-related knee injury.
Implications: It is important to screen for kinesiophobia early after a knee injury and, if present, adjust interventions accordingly. Prompt management of kinesiophobia may mitigate the negative long-term consequences associated with injury.
Keywords: Fear of Movement, Strength, Rehabilitation
Funding acknowledgements: Canadian MSK Rehab Research Network, University of Alberta Undergraduate Research Initiative Studentship, and Arthritis Society Young Investigator Operating Grant.
Purpose: To assess the relationship between self-reported kinesiophobia and bilateral knee strength or dynamic knee balance between youth within three-months of a sport-related knee injury and uninjured age-, sex-, and sport-matched controls.
Methods: Participants included 21youth (11-19 years) who suffered a sport-related knee injury within the previous three-months and 21 uninjured age-, sex-, and sport-matched controls. Outcomes included: Tampa Scale for Kinesiophobia (TSK), normalized bilateral knee extensor and flexor isokinetic strength (Nm/kg; isokinetic dynamometer), bilateral triple single leg hop (TSLH), and bilateral Y-balance (YBT) test scores. Descriptive statistics [median (range), proportion or mean within-pair difference (95%CI)] were calculated for all participant characteristics and outcomes by study group. Unadjusted conditional (matched-pair) logistic regression was used to assess the odds of TSK score >37 by study group (odds ratio; 95%CI) and multivariable regression (95%CI) was used to examine the association between TSK score and each outcome, adjusting for injury history.
Results: The median age of participants was 17 years (range 16-20) and 57% were female. The median time between injury and testing was 1.5 months (range 0.3-3.4). The injured group scored higher on the TSK [mean within-pair difference (95%CI); 8 (3,13)], demonstrated weaker index (injured) leg knee extensor [-0.99 Nm/kg (-1.97,-0.02] and flexor strength [-0.96 Nm/kg (-1.85,-0.06)], and had a 10-fold (95%CI 1.3,78.1) greater odds of a TSK score >37 compared to the uninjured group. A significant association was demonstrated between TSK score and index knee extensor strength [β=-0.1 (95%CI -0.2,-0.04), r2=0.278, p=0.01], non-index knee extensor strength [β=-0.1 (95%CI -0.2,-0.01), r2=0.210, p=0.04], index knee flexor strength [β=-0.08 (95%CI -0.1,-0.01), r2=0.287, p 0.01], and non-index knee flexor strength [β=-0.07 (95%CI -0.1,-0.01), r2=0.243, p=0.03], regardless of injury group. No associations were found between TSK and TLSH or YBT scores.
Conclusion(s): These preliminary findings suggest that kinesiophobia may be present as early as three-months following a youth, sport-related knee injury. Additionally, kinesiophobia (as measured by the TSK) seems to manifest beyond the injured joint as the observed by the reduction in bilateral knee extensor and flexor strength. Further investigation is required to confirm these findings and understand the mechanisms underlying kinesiophobia to inform treatment strategies following a youth, sport-related knee injury.
Implications: It is important to screen for kinesiophobia early after a knee injury and, if present, adjust interventions accordingly. Prompt management of kinesiophobia may mitigate the negative long-term consequences associated with injury.
Keywords: Fear of Movement, Strength, Rehabilitation
Funding acknowledgements: Canadian MSK Rehab Research Network, University of Alberta Undergraduate Research Initiative Studentship, and Arthritis Society Young Investigator Operating Grant.
Topic: Sport & sports injuries; Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: University of Alberta
Ethics committee: Health Research Ethics Board
Ethics number: Ethics ID Pro00063773
All authors, affiliations and abstracts have been published as submitted.
