Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain- A case-control study

Praveen Kumar Kandakurti; Arthur de Sá Ferreira; Leandro Alberto Calazans Nogueira; Watson Arulsingh; Mr. Sharad Patil

doi:10.12688/f1000research.152751.1

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Research Article

Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain- A case-control study

[version 1; peer review: 1 not approved]

Praveen Kumar Kandakurti ¹, Arthur de Sá Ferreira², Leandro Alberto Calazans Nogueira², Watson Arulsingh¹, Mr. Sharad Patil³

Praveen Kumar Kandakurti ¹, Arthur de Sá Ferreira², [...] Leandro Alberto Calazans Nogueira², Watson Arulsingh¹, Mr. Sharad Patil³

PUBLISHED 06 Sep 2024

Author details Author details

¹ Physiotherapy, Gulf Medical University, Ajman, United Arab Emirates
² Rehabilitation Sciences, Centro Universitário Augusto, Rio de Janeiro, Brazil
³ Physiotherapy, Thumbay Physical Therapy & Rehabilitation Hospital, Ajman, United Arab Emirates

Praveen Kumar Kandakurti
Roles: Conceptualization, Data Curation, Formal Analysis

Arthur de Sá Ferreira
Roles: Supervision, Validation, Writing – Review & Editing

Leandro Alberto Calazans Nogueira
Roles: Formal Analysis, Methodology, Project Administration, Software, Writing – Review & Editing

Watson Arulsingh
Roles: Investigation, Visualization, Writing – Original Draft Preparation

Mr. Sharad Patil
Roles: Investigation, Project Administration, Resources

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Patients with chronic low back pain (CLBP) frequently present with kinesiophobia. Although kinesiophobia is found to affect outcomes such as affect pain and quality of life in patients with CLBP, it is unclear whether kinesiophobia is linked to reduction of muscle endurance in these patients. The primary aim of the study was to analyze the impact of kinesiophobia on lumbar extensor endurance in patients with CLBP and asymptomatic individuals.

Methods

This case-control study was proceeded with 200 patients with CLBP and 400 controls. Kinesiophobia, lumbar endurance and Pain intensity were assessed with Tampa Scale, Soren’s lumbar extensor test and visual analog scale respectively. Regression model was administered to explore the relationship between kinesiophobia and lumbar extensor endurance.

Results

Prevalence of kinesiophobia was found to be higher in patients with CLBP (30%) than in controls (11%) which is (6.49 ± 0.52, d= 1.07) more in CLBP than controls. Lumbar endurance was significantly lower in CLBP than controls (-20.5±6.84), further affected by the presence of kinesiophobia as lumbar endurance was negatively correlated (r = - 0.09) to Kinesiophobia. Moreover, VAS (r = 0.2) was positively correlated with kinesiophobia in patients with CLBP.

Discussion and conclusion

A high prevalence of kinesiophobia was reported by patients with CLBP. The presence of kinesiophobia exhibited strong linear relationship with lumbar endurance, and pain intensity among patients with CLBP. Hence management of CLBP should comprise of an assessment of kinesiophobia and appropriate treatment strategies to address it in preventing persistent CLBP.

ClinicalTrials.gov Identifier

NCT05079893 Registered on 14/10/2021.

Keywords

Low back pain; Kinesiophobia; pain; Endurance; Chronic pain.

Corresponding author: Praveen Kumar Kandakurti

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Kumar Kandakurti P et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Kumar Kandakurti P, Ferreira AdS, Nogueira LAC et al. Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain- A case-control study [version 1; peer review: 1 not approved]. F1000Research 2024, 13:1016 (https://doi.org/10.12688/f1000research.152751.1) First published: 06 Sep 2024, 13:1016 (https://doi.org/10.12688/f1000research.152751.1) Latest published: 06 Sep 2024, 13:1016 (https://doi.org/10.12688/f1000research.152751.1)

Background

CLBP (Chronic Low Back Pain) is a leading cause of disability among working age adults.¹ In fact, worldwide, the number of years spent with disability due to low back pain rose by 54% from 1990 to 2015.² CLBP is defined as pain between the bottom of the lower rib margin and the buttocks that persists for over 12 weeks.³

As for specific causes of low back pain (LBP) are concerned, only 15% of the total back pain due to a pathophysiological mechanism, e.g., Herniated nuclei pulposus (HNP), Infection, Osteoporosis (Olympic), Rheumatoid Arthritis, Fracture, or Tumor.⁴^–⁷ The remaining patients are classified as NSLBP (Nonspecific Low Back Pain). As NSLBP has no pathophysiological cause, treatment is focused on pain-related intervention.⁸

Kinesiophobia is described as an excessive, irrational, and debilitating fear of performing physical movements due to susceptibility to painful injury or reinjury.⁹ Although there are many biological factors that contribute to LBP, psychological factors may play an unexpectedly large role in some chronic LBP patients.¹⁰ Clinical studies have shown that an exaggerated negative cognitive response to actual pain, known as fear of catastrophic pain and movement/(re) injury (kinesiophobia), is important in the pathogenesis of CLBP and related disorders.¹¹

The prevalence of kinesiophobia in chronic pain varies between 50 and 70%.¹² Therefore, kinesiophobia is correlated with pain-related disorders, causing changes in motor activity that affect pain-related activities and the coping pain-related disorders.¹³ Thus, studies in the past have shown that patients with lower back pain develop more severe Kinesiophobia, regardless of pain severity. Patients with Kinesiophobia also had higher pain perception and decreased physical activity levels. Kinesiophobia has been shown to negatively impact quality of life for patients with chronic low back pain (CLBP).¹⁴ Higher levels of kinesiophobia correlate with higher levels of perceived pain in all forms of chronic musculoskeletal pain (CMP)¹⁵ and lower return to pre-injury activities.¹⁶

Subgroup and moderation analyses of data in the earlier studies reported a consistent reduced muscle activity among people with higher kinesiophobia.¹⁷^,¹⁸ Recent high-quality studies¹³^,¹⁸ found moderate-to-strong evidence of associations between higher degree of kinesiophobia, disability, and poorer quality of life among patients with chronic pain conditions. Nevertheless, the consensus not yet reached in this area owing to the presence of heterogeneity among all included studies.

To the best of our knowledge, to date, there is no study assessing the relationship between kinesiophobia, lumbar endurance in patients with CLBP. Moreover, this is case control study which determined sample size for both cases and controls using odds ratio based on prevalence rate of kinesiophobia among CLBP.¹⁴

Therefore, the current study aimed to compare the impact of kinesiophobia on lumbar extensor endurance in patients with CLBP and asymptomatic individuals. Secondarily, we aimed to examine the relationship between kinesiophobia and lumbar extensor endurance, and pain intensity in patients with CLBP. Lumbar endurance is reported to be affected among patient with CLBP. We hypothesized that the presence of kinesiophobia would further add to the detoriation of lumbar extensor endurance in patients with CLBP.

Methods

Study design & setting

This is a case-control study in which CLBP patients and asymptomatic control patients were recruited from Thumbay Physiotherapy and Rehabilitation Hospital and Thumbay University Hospital in Ajman, United Arab Emirates. After obtaining ethical approval, informed consent was taken from all recruited participants. This study involved human subjects for data collections thus sought for Ethical Committee approval. The Institutional Review Board, Gulf Medical University, UAE, reviewed and approved to undertake this research on 21.05.2021 with Ref. no. IRB/COHS/FAC/03/May-2021.

This research was conducted in accordance with the principles embodied in the Declaration of Helsinki and in accordance with local statutory requirements [Link]. Recruitment of participants for this study occurred from January 2022 to January 2023. The preparation of this manuscript was based on the STROBE statement guidelines.¹⁹

Procedures

Initial screening and evaluation of outcomemeasures of people with and without CLBP were performed by four experienced physical therapists (two men and two women) specializing in musculoskeletal and sports physical therapy. To ensure uniformity of data collection, all therapists were oriented with information about the study protocol, including the assessment methods using the various assessment tools relevant to this study.

Screening of participants to confirm their eligibility was conducted by a physical therapist (Researcher 1) at their first physical therapy appointment. Participants were then instructed to complete the Tempa Scale for screening the presence of Kinesiophobia. data set consisted of socio-demographic information of participants including age, gender, weight, height and pain characteristics (location of pain and associated symptoms). Following the physical examination, pain intensity was assessed using self-report questionnaires (visual analogue scale - VAS). The physical therapist (Researcher 2) who was blinded to the cases and controls, performed the lumbar endurance test. Totally, four qualified therapists were involved in the data collection process for this study of which first two were males and the other two were females. Fear of movement/injury or re-injury was measured using the Tampa Scale for Kinesiophobia (TSK), a 17-item self-report scale with scores ranging from 17 (no fear) to 68 (worst fear).²⁰ TAMPA scores were calculated according to the web application [link]. Additionally, the following characteristics of participants such as obesity, lack of exercise, poor diet, and smoking habits are analysed to determine its association with chronic low back pain and disability.²¹^,²²

Participants

Adults aged 18 to 59 years with CLBP, diagnosed and referred by an orthopedic surgeon or general practitioner, and cases with sufficient physical independence to undergo lumbar extensor endurance test²³ were included in the study. Controls were any healthy participants or patients without lower back symptoms reported at Thumbay Physiotherapy and Rehabilitation Hospital and Thumbay University Hospital in Ajman, UAE. Cases and controls were prospectively identified from these on-campus outpatient clinical centres. On the other hand, healthy adults aged between 18 and 59 years of asymptomatic participants and both genders were included in this study. Participants with congenital spine anomalies, vestibular issues, joint instability in lower limbs, cardiorespiratory conditions, and hip arthritis, history of previous lower back injury, inflammatory, infectious disease, and malignancy in the spine and use of antidepressant medication or antihypertensive medication were excluded.

Main outcomes measures

Kinesiophobia, lumbar endurance, and pain intensity were assessed by the Tampa Scale for Kinesiophobia, Soren’s lumbar extensor test and VAS scale, respectively. All these eveluations were conducted in a laboratory setting.

Kinesiophobia

Tampa Scale for Kinesiophobia (TSK), which is a 17 self-report items scale with scores ranging from 17 (no fear) to 68 (highest fear).²⁴ The Tampa Kinesiophobia Scale has been reported to have good reliability in CLBP patients.²⁵ Additionally, Tempa scores were further subclassified, with a scores of 17–48 was labelled as having low-to-moderate kinesiophobia and scores of 48–68 as with severe kinesiophobia.

Lumbar extensor endurance

Participants were tested during a 1-hour session and were asked to perform a weight-dependent isometric back extension test (Sorensen) on a horizontal table.²⁶ The Sørensen test was performed in the prone position with the iliac crest aligned with the edge of the table and the lower extremities secured with ankle and below-knee straps. During the testing procedure, participants were instructed to keep their bodies (head, arms, and torso) horizontal to the floor for as long as possible without support and keep their arms crossed in front of their chest.²⁶ The examiner gave verbal feedback to maintain the horizontal position during the test, and the test ended when the test position could no longer be maintained. Verbal encouragement was provided during this evaluation procedure. Participants were instructed to keep the lumbar lordotic position as stable as possible. Average lumbaruscular endurance was recorded in seconds by the examiner using a stopwatch. A chair with a padded seat was placed in front of the subject so that the subject could support himself if he got tired during the test. The stopwatch was stopped as soon as the subject became tired or unable to maintain the posture.²⁶

Pain

Pain intensity was measured using a visual analogue scale (VAS). The VAS consists of a 10 cm line, with the left end indicating no pain and the right end indicating severe pain.²⁷ Participants were asked to indicate their current pain level on a scale, with higher scores considered to be more severe.²⁸

Sample size

Based on the prevalence of 70% kinesiophobia among CLBP patients,¹⁴ an assumption was made for the prevalence of kinesiophobia among controls was10% and the odds ratio were 2; thus the minimum sample size fixed for this case control study was 600 [200 cases + 400 Controls] and the expected case-to-control ratio was 1:2.

Statistical methods

Data for this study was analyzed using JASP software version 0.18.1. The Shapiro-Wilk test was used to ensure that the data followed a normal distribution. Because there were statistically significant differences in baseline characteristics for both cases and controls, we used age, gender, employment status, alcohol, physical activity, and nutritional level as covariates for further multivariate analysis of kinesiophobia between cases and controls. Pearson correlation test was used to confirm the correlation between kinesiophobia and lumbar endurance. Furthermore, to analyze the association of linear regression of variables such as lumbar endurance and pain intensity with kinesiophobia, we conducted an analysis of variance to distinguish between lumbar endurance and pain in participants with low-to-severe kinesiphobia to examine the effects of kinesiphobia on lumbar endurance.

Results

Table 1 illustrates the characteristic features of all who participated in this study. A total of 200 patients with CLBP and 400 healthy participants participated in this study through the screening procedure mentioned in the methodology. Comparing case group to the control group, most cases were male, cases were older, cases had higher BMI, cases had higher employment rate, cases were reported smoking habits, cases were with higher frequency of alcohol consumption, cases were reported with higher frequency of physical activity level and cases were reported with more consumption of low vegetables with high meat. Cases were found to consume more analgesics and related drugs compared to controls, and a greater number of cases were insured with medical insurance scheme compared against controls. Prevalence of kinesiophobia was found to be higher in patients with CLBP (30%) than in controls (11%) which is (6.49 ± 0.52, d = 1.07) more in CLBP than controls.

Table 1. Participant baseline characteristics using frequency table.

	Cases (n = 200)	Controls (n = 400)	Comparison P value
Participant characteristics
Sex (Male)	66.0%	63.5%	0.5
Age (years)	39.9±11.5	23.9±9.0	<0.001
BMI (kg/m²)	27.5±5.4	23.9±3.8	<0.001
Currently employed (Yes)	76.0%	10.8%	<0.001
Smoking
Non-smoker	25.5%	77.5%	<0.001
Second-hand smoking	53%	6.7%
Currently smoking	21%	15.8%
Alcohol
None	32.5%	97.5%	<0.001
≤ 1 glass/week	3%	2.5%
2–3 glasses/week	62%	0%
≥ 4 glasses/week	2.5%	0%
Physical activity level
None	14.5%	18.8%	<0.001
≤ 2 h/week	34.5%	49.5%
3–6 h/week	37%	25%
≥ 7 h/week	14%	6.7%
Diet level
Intake of no or low vegetables with high meat	31%	10.3%	0.1
Intake of moderate vegetables with moderate meat	53%	87.2%
Intake of high vegetables with no or low meat	16%	2.5%
Current Medicine use
Simple analgesics (Yes)	50%	2.7%	<0.001
Strong opioid analgesics (Yes)	16%	0%	<0.001
Combination opioid analgesics (Yes)	9.5%	0%	<0.001
Occupation
Manager	9%	1.8%	<0.001
Technician and Trade Worker	2%	9.6%	<0.001
Clerical and Administrative Worker	24%	47.2%	<0.001
Driver	5%	11.5%	<0.001
Machinery Operator	0%	4.3%	<0.001
Professional	57%	23.8%	<0.001
Health insurance (Yes)	76.5%	6.2%	<0.001
Kinesiophobia
Low-moderate	140 (70%)	355 (88.7%)	Odds ratio = - 1.22 (p < 0.001)
High	60 (30%)	45 (11.3%)	Odds ratio = - 1.22 (p < 0.001)

As shown in Table 2, The presence of kinesiophobia was found to be significantly more in patient with CLBP compared against controls. Similarly, lumbar endurance, and pain intensity were significantly impaired in case group compared to control group.

Table 2. Highlights comparison of outcome measures between cases and controls.

	P	Mean difference	SE Difference	Effect size
Kinesiophobia	<.001	6.49	0.521	1.079
Lumbar endurance score	0.003	−20.500	6.841	−0.260
VAS score	<.001	6.183	0.096	5.562

Furthermore, Pearson correlation analysis revealed a positive and negative correlation between Kinesiophobia with VAS score and lumbar extensor endurance respectively among the participants with CLBP as shown in (Table 3).

Table 3. Pearson's Correlation test to analyse kinesiophobia with lumbar endurance.

Variables	Kinesiophobia	P value
Lumbar endurance score	-0.09*	0.031
VAS score	0.2***	<.001

On the basis of logistic and linear analyses (Tables 4-6), factors such as age, alcohol consumption, duration of lower back pain, physical activity, and type of job influenced the presence of Kinesiophobia, and lumbar endurance of participants involved in this case-control study.

Table 4. Logistic regression table analyzing independent variable on Kinesiophobia in CLBP.

Variable	Estimate	Standard Error	Odds Ratio	Z	Wald Statistic	df	p
(Intercept)	0.179	1.241	1.196	0.144	0.021	1	0.885
Age (years)	−0.029	0.014	0.971	−2.040	4.162	1	0.041
BMI (kg/m²)	0.010	0.030	1.011	0.348	0.121	1	0.728

Table 5. Linear regression for analyzing various factors on the presence of Kinesiophobia in CLBP condition.

Variables	Unstandardized	Standard Error	T	P (95% CI)	Lower	Upper
Smoking (second hand)	-019	0.67	-0.26	0.78	-1.51	0.78
Alcohol (= 1 glass/week)	−6.445	1.158	−5.567	<0.001	−8.719	−4.171
Alcohol (2–3 glasses/week)	3.265	0.985	3.313	<0.001	1.329	5.200
Alcohol (= 4 glasses/week)	7.475	2.429	3.078	0.002	2.705	12.245
Physical activity levels (= 2 h/week)	1.630	0.486	3.353	<0.001	0.675	2.584
Physical activity levels (3–6 h/week)	1.614	0.595	2.715	0.007	0.447	2.782
Physical activity levels (= 7 h/week)	1.035	0.851	1.216	0.224	−0.636	2.706
Diet levels (intake of moderate vegetables with moderate meat)	−1.136	0.584	−1.945	0.052	−2.283	0.011
Diet levels (intake of high vegetables with no or low meat)	−1.006	0.822	−1.224	0.221	−2.621	0.609
Duration of CLBP (years) (2)	−0.526	0.578	−0.910	0.363	−1.661	0.609
Duration of CLBP (years) (3)	−2.561	0.597	−4.293	<0.001	−3.733	−1.389
Duration of CLBP (years) (4)	−2.262	0.579	−3.910	<0.001	−3.399	−1.126
Duration of CLBP (years) (5)	−3.521	1.003	−3.510	<0.001	−5.492	−1.551
Duration of CLBP (years) (6)	−1.164	1.187	−0.981	0.327	−3.495	1.167
Presence of leg pain (No)	−1.127	0.751	−1.500	0.134	−2.602	0.349
Simple analgesics (No)	0.599	0.748	0.801	0.423	−0.870	2.067
Strong analgesics (No)	1.788	0.945	1.893	0.059	−0.068	3.643
Combined analgesics (No)	−0.475	1.187	-0.400	0.689	−2.807	1.856
Work type (Technician)	1.564	1.214	1.288	0.198	−0.821	3.950
Work type (Clerk)	−0.361	1.194	−0.302	0.763	−2.707	1.985
Work type (Driver)	−2.845	1.865	−1.525	0.128	−6.509	0.819
Work type (Machinery technician)	−1.935	1.336	-1.448	0.148	−4.560	0.689
Work type (Trade worker)	-5.892	1.168	-5.043	0.01	-8.187	-3.597
Work type (Professionals)	_3.27	1.14	-2.87	0.004	-5.51	-1.02
Health insurance (No)	0.703	0.775	0.907	0.365	−0.819	2.226

Table 6. Linear regression for analyzing relevant factors on lumbar endurance in CLBP condition.

Variables	Unstandardized	Standard Error	T	P (95% CI)	Lower	Upper
Alcohol (2–3 glasses/week)	0.261	15.897	0.016	0.987	-30.964	31.486
Alcohol (≥ 4 glasses/week)	11.304	39.179	0.289	0.773	-65.651	88.259
Physical activity levels (≤ 2 h/week)	37.404	7.682	4.869	<0.001	22.316	52.492
Physical activity levels (3–6 h/week)	61.554	9.234	6.666	<0.001	43.417	79.691
Physical activity levels (≥ 7 h/week)	68.305	13.420	5.090	<0.001	41.945	94.664
Diet levels (intake of moderate vegetables with moderate meat)	1.195	9.421	0.127	0.899	-17.310	19.700
Diet levels (intake of high vegetables with no or low meat)	1.107	13.263	0.083	0.933	-24.943	27.158
Presence of leg pain (No)	42.704	11.986	3.563	<0.001	19.162	66.247
Simple analgesics (No)	-58.426	11.808	-4.948	<0.001	-81.620	-35.232
Strong analgesics (No)	8.284	15.235	0.544	0.587	-21.640	38.208
Combined analgesics (No)	19.814	19.134	1.036	0.301	-17.769	57.398
Work type (Technician)	-9.258	19.590	-0.473	0.637	-47.736	29.220
Work type (Trade worker)	1.709	18.851	0.091	0.928	-35.318	38.736
Work type (Clerk)	-18.235	19.256	-0.947	0.344	-56.057	19.588
Work type (Driver)	-5.532	30.095	-0.184	0.854	-64.644	53.580
Work type (Machinery technician)	-59.505	21.411	-2.779	0.006	-101.561	-17.449
Work type (Professional)	-25.854	18.386	-1.406	0.160	-61.967	10.260
Health insurance (No)	29.809	12.443	2.396	0.017	5.369	54.249
Kinesiophobia grade/code (High)	-2.396	8.552	-0.280	0.779	-19.193	14.401

Discussion

The primary aim of this study was to analyze the impact of kinesiophobia on lumbar extensor endurance in patients with CLBP. Based on the current findings, case group was found with high incident of kinesiophobia and showed impaired lumbar endurance compared to controls. The presence of Kinesiophobia has highly correlated with the lumbar endurance and, pain intensity in patient with CLBP.

The strength of this study is that it analyzed the impact of kinesiophobia on lumbar endurance among cases and controls. Further, the study was distinct in finding out the impact of kinesiophobia on Lumbar extensor endurance among cases with CLBP in comparison with earlier studies which reported only a deterioration of lumbar extensor endurance amongcases with CLBP.²⁹^,³⁰ Thus, no studies have explored the impact of Kinesiophobia on lumbar muscle endurance in patients with CLBP against asymptomatic subjects.

This study further used multi-variate analysis to determine the relationship of other relevant factors that might interfere with the primary outcome of the study which other studies omitted while associating kinesiophobia. Beside this, the physiotherapist who measured the lumbar endurance and pain was blinded to the cases and control group.

On the other hand, the weakness of the study is its own design as a case control study.

The current study reported a significant difference in the presence of kinesiophobia between the cases and control where cases with severe kinesiophobia exhibited strong association with lumbar extensor endurance among cases with CLBP.

This case study result shows that the presence of kinesiophobia has strong linear correlation with lumbar extensor endurance, pain in patients with CLBP in a negative way which added to the fact that why lumbar endurance was compromised in patient with CLBP.³¹ This findings support the earlier hypothesis that the presence of kinesiophobia may deteriorate or influence lumbar extensor endurance.¹⁸

This study finding reports a significantly higher incidence of Kinesiophobia among cases with CLBP which is indeed in line with the prevalence rate of 50 to 70% Kinesiophobia among chronic pain conditions.¹² These findings further call for the inclusion of cognitive behavior therapy in conjunction with other physical therapy for a better prognostic value in case of a chronic musculoskeletal pain conditions.³²

However, there is limited researches done to prove the efficacy of Cognitive Therapy on Chronic Low Back Pain Hence future study should focus on an integrated Physiotherapy approach with various cognitive therapy approaches to ifacilitate the prognostic value of LBP.³³

Furthermore, based on multivariate analysis of the data, this study identified that age has shown a protective response to the occurrence of Kinesiophobia. This is contrary to the earlier finding that reported a higher levels of Kinesiophobia among frailer and older people, predominantly who are living in care homes.³⁴ Besides this, alcohol consumption, duration of lower back pain, physical activity, and type of job have shown association with the presence of Kinesiophobia and CLBP in this case-control study.

Previous studies pointed out the presence of neuropathic pain due to excessive alcohol intake among chronic pain conditions,³⁵^,³⁶ and a moderate drinking habit has shown to exert analgesic effects.²⁴^,²⁵ This study also found a close relationship between physical activity level and the presence of kinesiophobia in the participants. This finding is in line with previous report that states that past sports or lack thereof equally determine the level of kinesiophobia in men and women in the later decades of life.³⁷

The current study findings may be helpful to guide healthcare professionals to rule out the presence of kinesiophobia as part of the clinical evaluation for patients with CLBP. This would assist them in the selection of appropriate strategical treatment plan to acheive a better prognostic value. This result of this study may encourage health care professionals and policy makers for carrying out more extensive prospective researches and amendment of health care policy guidelines. The protocol of this study is published elsewhere.³⁸ Future high-quality studies should focus on comparing different types of cogntive therapy approaches on different outcome of patients with CLBP.

Conclusion

On the basis of the study findings, it may be concluded that higher Kinesiophobia has been reported patients with CLBP compared to controls. The presence of kinesiophobia had shown to have linear correlation with on lumbar endurance, and pain intensity among patients with CLBP. Factors such as age, duration of condition, alcohol consumption, physical activity, and type of job also to be taken to account for deciding the most appropriate treatment plan to achieve the overall clinical outcome of patients with CLBP.

Trial status

ClinicalTrials.gov Identifier: NCT05079893 Registered on 14/10/2021

Supplementary information

All data sheet associated with this study is provided in the extended data section.

Authors’ contributions

Dr. Praveen Kumar is the principal investigator and this study is conducted as a part of Post Doctoral studies.

Dr. Arthur de Sá Ferreira, Coordenador, Prof Leo Programa de Pós-graduação em Ciências da Reabilitação – PPGCR Centro Universitário Augusto Motta.Pós-graduação em Ciências da Reabilitação – PPGCR Centro Universitario Augusto Motta

Dr. Watson Arulsingh D. R contributed to analysis, interpretation of data, and drafted the work. Mr. Shard Patil contributed toward data acquisition and entry. All authors have agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

Declarations

Ethics approval and consent to participate in study was taken to acocunt while Institutional Review Board approved the study protocol; Thumbay Hospital Gulf Medical University, IRB/COHS/FAC/03/May-2021 Informed consent to participate in study was obtained from all participants in this study.

Consent for publication

A completed informed consent form was formed and signed by participants as per the norms of the International Declaration of Helsinki to upholds the safety of those participating in research as well as seeking treatment in the practice. However, the consent for publishing the data was not required as the data has been anonymised), this alterations have not distorted scientific meaning.

Data availability and statement on data sharing

Underlying data

This project contains the following underlying data:

Figshare: Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain- A case-control study, https://doi.org/10.6084/m9.figshare.25965535.v1.³⁹

The project contains the following data:

• Jasp_4 Kinesiophobia Dr Praveen.xlsx

Extended data

Figshare: Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain- A case-control study. Dataset, https://doi.org/10.6084/m9.figshare.26130055.v1.⁴⁰

The projet contains the following extended data:

• Extended data file-Dr.praveen kumar kandakurti

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

Not applicable.

References

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2. Buchbinder R, van Tulder M , Öberg B, et al.: Low back pain: a call for action. Lancet. 2018; 391: 2384–2388. Publisher Full Text
3. Deyo RA, Weinstein JN: Low back pain. N. Engl. J. Med. 2001; 344: 363–370. Publisher Full Text
4. Vadalà G, Russo F, Musumeci M, et al.: Clinically relevant hydrogel-based on hyaluronic acid and platelet rich plasma as a carrier for mesenchymal stem cells: rheological and biological characterization. J. Orthop. Res. 2017; 35: 2109–2116. PubMed Abstract | Publisher Full Text
5. Amirdelfan K, McRoberts P, Deer TR: The differential diagnosis of low back pain: a primer on the evolving paradigm. Neuromodulation Technol. Neural Interface. 2014; 17: 11–17. PubMed Abstract | Publisher Full Text
6. Koes BW, van Tulder MW , Thomas S: Diagnosis and treatment of low back pain. Br. Med. J. 2006; 332: 1430–1434. PubMed Abstract | Publisher Full Text | Free Full Text
7. Maher C, Underwood M, Buchbinder R: Non-specific low back pain. Lancet. 2017; 389(10070): 736–747. Publisher Full Text
8. Negrini S, Zaina F: The chimera of low back pain etiology: a clinical rehabilitation perspective. Am. J. Phys. Med. Rehabil. 2013; 92(1): 93–97. PubMed Abstract | Publisher Full Text
9. Hoy D, Brooks P, Blyth F, et al.: The epidemiology of low back pain. Best Pract. Res. Clin. Rheumatol. 2010; 24(6): 769–781. Publisher Full Text
10. Kori SH, Miller RP, Todd DD: Kinisophobia: a new view of chronic pain behavior. Pain Manag. 1990; 3: 35–43.
11. Fritz JM, George SZ, Delitto A: The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain. 2001; 94(1): 7–15. PubMed Abstract | Publisher Full Text
12. Larsson C, Hansson EE, Sundquist K, et al.: Psychometric properties of the Tampa Scale of Kinesiophobia (TSK-11) among older people with chronic pain. Physiother. Theory Pract. 2014; 30(6): 421–428. PubMed Abstract | Publisher Full Text
13. Luque-Suarez A, Martinez-Calderon J, Falla D: Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br. J. Sports Med. 2019; 53(9): 554–559. PubMed Abstract | Publisher Full Text
14. Uluğ N, Yakut Y, Alemdaroğlu İ, et al.: Comparison of pain, kinesiophobia and quality of life in patients with low back and neck pain. J. Phys. Ther. Sci. 2016; 28(2): 665–670. PubMed Abstract | Publisher Full Text | Free Full Text
15. Palomo-López P, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, et al.: Kinesiophobia and pain intensity are increased by a greater hallux valgus deformity degree-kinesiophobia and pain intensity in hallux valgus. Int. J. Environ. Res. Public Health. 2020; 17(2): 626. PubMed Abstract | Publisher Full Text | Free Full Text
16. Chmielewski TL, Jones D, Day T, et al.: The association of pain and fear of movement/reinjury with function during anterior cruciate ligament reconstruction rehabilitation. J. Orthop. Sports Phys. Ther. 2008; 38(12): 746–753. PubMed Abstract | Publisher Full Text
17. Ishak NA, Zahari Z, Justine M: Kinesiophobia, pain, muscle functions, and functional performances among older persons with low back pain. Pain Res. Treat. 2017; 2017: 1–10. PubMed Abstract | Publisher Full Text | Free Full Text
18. Christe G, Crombez G, Edd S, et al.: Relationship between psychological factors and spinal motor behaviour in low back pain: a systematic review and meta-analysis. Pain. 2021; 162(3): 672–686. PubMed Abstract | Publisher Full Text
19. Von Elm E, Altman DG, Egger M, et al.: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J. Clin. Epidemiol. 2008 Apr; 61(4): 344–349. PubMed Abstract | Publisher Full Text
20. Rosenbloom BN, Pagé MG, Isaac L, et al.: Fear of movement in children and adolescents undergoing major surgery: a psychometric evaluation of the Tampa Scale for Kinesiophobia. Eur. J. Pain. 2020; 24: 1999–2014. PubMed Abstract | Publisher Full Text
21. Robson EK, Kamper SJ, Davidson S, et al.: Healthy Lifestyle Program (HeLP) for low back pain: protocol for a randomised controlled trial. BMJ Open. 2019; 9(9): e029290. PubMed Abstract | Publisher Full Text | Free Full Text
22. Muga MA, Owili PO, Hsu CY, et al.: Association of lifestyle factors with blood lipids and inflammation in adults aged 40 years and above: a population-based cross-sectional study in Taiwan. BMC Public Health. 2019; 19: 1346. PubMed Abstract | Publisher Full Text | Free Full Text
23. Meucci RD, Fassa AG, Faria NM: Prevalence of chronic low back pain: systematic review. Rev. Saude Publica. 2015; 49: 1. PubMed Abstract | Publisher Full Text | Free Full Text
24. Robins MT, Heinricher MM, Ryabinin AE: From Pleasure to Pain, and Back Again: The Intricate Relationship Between Alcohol and Nociception. Alcohol Alcohol. 2019; 54: 625–638. PubMed Abstract | Publisher Full Text | Free Full Text
25. Zhou Y, Liu P, Rui J, et al.: The Associated Factors and Clinical Features of Neuropathic Pain after Brachial Plexus Injuries: A cross-sectional study. Clin. J. Pain. 2017; 33: 1030–1036. PubMed Abstract | Publisher Full Text
26. Behennah J, Conway R, Fisher J, et al.: The relationship between balance performance, lumbar extension strength, trunk extension endurance, and pain in participants with chronic low back pain, and those without. Clin. Biomech. 2018; 53: 22–30. PubMed Abstract | Publisher Full Text
27. Couper M, Tourangeau R, Conrad F, et al.: Evaluating the effectiveness of visual analog scales: a web experiment. Soc. Sci. Comput. Rev. 2006; 24: 227–245. Publisher Full Text
28. Mikhail H, Reda N, Shahaly M, et al.: Predictors of fear-avoidance belief, pain, and disability index in patients with chronic low back pain attending rheumatology outpatient clinics. J. Public Health. 2022; 30: 417–422. Publisher Full Text
29. Suuden E, Ereline J, Gapeyeva H, et al.: Low back muscle fatigue during Sorensen endurance test in patients with chronic low back pain: relationship between electromyographic spectral compression and anthropometric characteristics. Electromyogr. Clin. Neurophysiol. 2008; 48: 185–192. PubMed Abstract
30. Boyce RO, Boone E, Stallings J, et al.: A multidisciplinary approach to a time efficient low back exercise intervention in a small manufacturing plant: a case study. J Exerc Physiol. 2008; 11: 12–24.
31. Aydoğdu O, Zübeyir S: The association between kinesiophobia and proprioception, postural stability, activity level, knee function, and quality of life following anterior cruciate ligament reconstruction. J. Exerc. Ther. Rehabil. 2020; 7(3): 247–252.
32. Monticone M, Ferrante S, Rocca B, et al.: Effect of a long-lasting multidisciplinary program on disability and fear-avoidance behaviors in patients with chronic low back pain: results of a randomized controlled trial. Clin. J. Pain. 2013 Nov 1; 29(11): 929–938. PubMed Abstract | Publisher Full Text
33. Miki T, Kondo Y, Kurakata H, et al.: The effect of cognitive functional therapy for chronic nonspecific low back pain: a systematic review and meta-analysis. BioPsychoSocial Med. 2022; 16: 12. PubMed Abstract | Publisher Full Text | Free Full Text
34. Alpalhão V, Cordeiro N, Pezarat-Correia P: Kinesiophobia and Fear Avoidance in Older Adults: A Scoping Review on the State of Research Activity. J. Aging Phys. Act. 2022 Mar 18; 30(6): 1075–1084. PubMed Abstract | Publisher Full Text
35. Yang YJ: An Overview of Current Physical Activity Recommendations in Primary Care. Korean J. Fam. Med. 2019 May; 40(3): 135–142. Epub 2019 May 20. PubMed Abstract | Publisher Full Text | Free Full Text
36. Guacel I, Miguel-Berges ML, Gómez-Bruton A, et al.: Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis. Nutr. Rev. 2019 Jan 1; 77(1): 1–18. PubMed Abstract | Publisher Full Text
37. Saulicz E, Knapik A, Saulicz M, et al.: Physical activity in youth and level of kinesiophobia in older adults. Balt J. Health Phys. Act. 2016; 8(2): 64–77. Publisher Full Text
38. Kandakurti PK, Arulsingh W, Patil SS: Influence of kinesiophobia on pain intensity, disability, muscle endurance, and position sense in patients with chronic low back pain—a case-control study. Trials. 2022; 23: 469. PubMed Abstract | Publisher Full Text | Free Full Text
39. Kandakurti PK: Jasp_4 Kinesiophobia Dr Praveen.xlsx. Dataset. figshare. 2024. Publisher Full Text
40. Kandakurti PK: Extended data file-Dr.Praveen kumar kandakurti. Dataset. figshare. 2024. Publisher Full Text

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Author details Author details

¹ Physiotherapy, Gulf Medical University, Ajman, United Arab Emirates
² Rehabilitation Sciences, Centro Universitário Augusto, Rio de Janeiro, Brazil
³ Physiotherapy, Thumbay Physical Therapy & Rehabilitation Hospital, Ajman, United Arab Emirates

Praveen Kumar Kandakurti
Roles: Conceptualization, Data Curation, Formal Analysis

Arthur de Sá Ferreira
Roles: Supervision, Validation, Writing – Review & Editing

Leandro Alberto Calazans Nogueira
Roles: Formal Analysis, Methodology, Project Administration, Software, Writing – Review & Editing

Watson Arulsingh
Roles: Investigation, Visualization, Writing – Original Draft Preparation

Mr. Sharad Patil
Roles: Investigation, Project Administration, Resources

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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Kumar Kandakurti P, Ferreira AdS, Nogueira LAC et al. Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain- A case-control study [version 1; peer review: 1 not approved]. F1000Research 2024, 13:1016 (https://doi.org/10.12688/f1000research.152751.1)

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Reviewer Report 14 Nov 2024

Søren O'Neill, University of Southern Denmark, Odense M, Denmark; Medical Spinal Research Unit, University Hospital of Southern Denmark, Kolding, Denmark

Not Approved

https://doi.org/10.5256/f1000research.167548.r335964

Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain - A case-control study

Thank you for the opportunity to review this paper. The authors have undertaken a lot of work in collecting data ... Continue reading

Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain - A case-control study

Thank you for the opportunity to review this paper. The authors have undertaken a lot of work in collecting data from a large population of study participants. Unfortunately, the paper suffers from a number of serious shortcomings.

The paper reports the findings of what seems to be a cross-sectional study. It is reported however, as being a case-control study, which by my reckoning is not the case. For a brief overview of study types and difference, I refer the authors to : https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/what-clinical-trials-are/types-of-clinical-trials

The authors state the aim of the study to be "to compare the impact of kinesiophobia on lumbar extensor endurance in patients with
CLBP and asymptomatic individuals". However, a cross-sectional study is not suited to elucidate a causal relationship (impact). At most, the study design permits examination of correlation between variables, which does not speak to which (if any) variable impacts the other.

The study enrolled a large number of chronic low back pain patients (n=200) and controls/healthy participants (n=400). It is unclear to the reader what constituted the control group: Controls are reported as "healthy participants" or "patients without lower back pain" (recruited from Thumbay Physiotherapy and Rehabilitation Hospital and Thumbay University Hospital) and further that "healthy adults [..] of asymptomatic participants [..] were included in this study. What types of 'patients without lower back pain' were enrolled as healthy controls? Were controls other types of hospital patients and/or staff and/or students and/or a background population sample?

Table 1 in the paper lists a number of baseline characteristics of the two groups, many of which are significantly different. For instance, 76% of the chronic low back pain group are reported as "Currently employed", compared to only 10.8% of the control group ('Healthy participants'). It seems unlikely that a control group of healthy controls should have such a low level of employment, which leads me to think, that the control group is somehow fundamentally different to the cLBP group. In other words, the study compared two groups which appear to differ significantly in a number of ways apart from their low-back pain status, but it is unclear what the control group actually consists of. Also in Table 1, the occupation category of "Controls (n=400)" is listed as percentages (e.g. 1.8% 'Manager'), but is this 1.8% of the 10.8% "Currently employed"?

The authors conclude in the Abstract that "The presence of kinesiophobia exhibited [a] strong linear relationship with lumbar endurance, and pain intensity among patients with CLBP.". This is misleading and not supported by their results: The correlation between kinesiophobia and lumbar endurance is reported as -0.09 (Pearson correlation coefficient), which is a very weak correlation. The corresponding P value was significant at 0.03, but this only demonstrates that the weak correlation is unlikely to be a random finding. Similarly, the correlation between pain intensity (VAS) and kinesiophobia is reported as 0.2 -- also a weak correlation, and significantly so at P<0.001. The linear regression analyses do not contradict this.

In brief, the methods and results are unclear, making the results questionable and the conclusions are not supported by the data.

Throughout, the paper suffers from poor or incorrect wording and spelling. For instance, in the Abstract alone: 1) 'affect' twice in Background, 2) 'proceeded' in Methods should probably be 'conducted', 3) one of the main outcome measures (Biering-Sørensen test) is referred to as 'Soren's test' in Methods and elsewhere as Sorenson's and Sørensen's test, 4) in Methods, a regression model is not 'administered', but 'used' or 'employed', 5) in Results, numbers are presented (e.g. "6.49 +/- 0.52, d=1.07") without explanation, 6) in Discussion, it is not the presence but degree of kinesiophobia that is examined for correlation to lumbar endurance. All in all, the paper bears the hallmarks of not having undergone sufficient scrutiny, leading to an accumulation of errors and spelling mistakes that suggest a lack of thorough editing.

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

No
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Primarily, experimental pain research in clinical populations.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Søren O'Neill, University of Southern Denmark, Odense M, Denmark; University Hospital of Southern Denmark, Kolding, Denmark

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14 Nov 2024 | for Version 1

Søren O'Neill, University of Southern Denmark, Odense M, Denmark; Medical Spinal Research Unit, University Hospital of Southern Denmark, Kolding, Denmark

11 Views Cite this report Responses(0)

Not Approved

Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain - A case-control study

Thank you for the opportunity to review this paper. The authors have undertaken a lot of work in collecting data from a large population of study participants. Unfortunately, the paper suffers from a number of serious shortcomings.

The paper reports the findings of what seems to be a cross-sectional study. It is reported however, as being a case-control study, which by my reckoning is not the case. For a brief overview of study types and difference, I refer the authors to : https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/what-clinical-trials-are/types-of-clinical-trials

The authors state the aim of the study to be "to compare the impact of kinesiophobia on lumbar extensor endurance in patients with
CLBP and asymptomatic individuals". However, a cross-sectional study is not suited to elucidate a causal relationship (impact). At most, the study design permits examination of correlation between variables, which does not speak to which (if any) variable impacts the other.

The study enrolled a large number of chronic low back pain patients (n=200) and controls/healthy participants (n=400). It is unclear to the reader what constituted the control group: Controls are reported as "healthy participants" or "patients without lower back pain" (recruited from Thumbay Physiotherapy and Rehabilitation Hospital and Thumbay University Hospital) and further that "healthy adults [..] of asymptomatic participants [..] were included in this study. What types of 'patients without lower back pain' were enrolled as healthy controls? Were controls other types of hospital patients and/or staff and/or students and/or a background population sample?

Table 1 in the paper lists a number of baseline characteristics of the two groups, many of which are significantly different. For instance, 76% of the chronic low back pain group are reported as "Currently employed", compared to only 10.8% of the control group ('Healthy participants'). It seems unlikely that a control group of healthy controls should have such a low level of employment, which leads me to think, that the control group is somehow fundamentally different to the cLBP group. In other words, the study compared two groups which appear to differ significantly in a number of ways apart from their low-back pain status, but it is unclear what the control group actually consists of. Also in Table 1, the occupation category of "Controls (n=400)" is listed as percentages (e.g. 1.8% 'Manager'), but is this 1.8% of the 10.8% "Currently employed"?

The authors conclude in the Abstract that "The presence of kinesiophobia exhibited [a] strong linear relationship with lumbar endurance, and pain intensity among patients with CLBP.". This is misleading and not supported by their results: The correlation between kinesiophobia and lumbar endurance is reported as -0.09 (Pearson correlation coefficient), which is a very weak correlation. The corresponding P value was significant at 0.03, but this only demonstrates that the weak correlation is unlikely to be a random finding. Similarly, the correlation between pain intensity (VAS) and kinesiophobia is reported as 0.2 -- also a weak correlation, and significantly so at P<0.001. The linear regression analyses do not contradict this.

In brief, the methods and results are unclear, making the results questionable and the conclusions are not supported by the data.

Throughout, the paper suffers from poor or incorrect wording and spelling. For instance, in the Abstract alone: 1) 'affect' twice in Background, 2) 'proceeded' in Methods should probably be 'conducted', 3) one of the main outcome measures (Biering-Sørensen test) is referred to as 'Soren's test' in Methods and elsewhere as Sorenson's and Sørensen's test, 4) in Methods, a regression model is not 'administered', but 'used' or 'employed', 5) in Results, numbers are presented (e.g. "6.49 +/- 0.52, d=1.07") without explanation, 6) in Discussion, it is not the presence but degree of kinesiophobia that is examined for correlation to lumbar endurance. All in all, the paper bears the hallmarks of not having undergone sufficient scrutiny, leading to an accumulation of errors and spelling mistakes that suggest a lack of thorough editing.

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

No
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Primarily, experimental pain research in clinical populations.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Respond to this report

Responses (0)

[1] 1. Murray CJL, Atkinson C, Bhalla K, et al.: The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013; 310: 591–608. PubMed Abstract | Publisher Full Text | Free Full Text

[2] 2. Buchbinder R, van Tulder M , Öberg B, et al.: Low back pain: a call for action. Lancet. 2018; 391: 2384–2388. Publisher Full Text

[3] 3. Deyo RA, Weinstein JN: Low back pain. N. Engl. J. Med. 2001; 344: 363–370. Publisher Full Text

[4] 4. Vadalà G, Russo F, Musumeci M, et al.: Clinically relevant hydrogel-based on hyaluronic acid and platelet rich plasma as a carrier for mesenchymal stem cells: rheological and biological characterization. J. Orthop. Res. 2017; 35: 2109–2116. PubMed Abstract | Publisher Full Text

[5] 5. Amirdelfan K, McRoberts P, Deer TR: The differential diagnosis of low back pain: a primer on the evolving paradigm. Neuromodulation Technol. Neural Interface. 2014; 17: 11–17. PubMed Abstract | Publisher Full Text

[6] 6. Koes BW, van Tulder MW , Thomas S: Diagnosis and treatment of low back pain. Br. Med. J. 2006; 332: 1430–1434. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. Maher C, Underwood M, Buchbinder R: Non-specific low back pain. Lancet. 2017; 389(10070): 736–747. Publisher Full Text

[8] 8. Negrini S, Zaina F: The chimera of low back pain etiology: a clinical rehabilitation perspective. Am. J. Phys. Med. Rehabil. 2013; 92(1): 93–97. PubMed Abstract | Publisher Full Text

[9] 9. Hoy D, Brooks P, Blyth F, et al.: The epidemiology of low back pain. Best Pract. Res. Clin. Rheumatol. 2010; 24(6): 769–781. Publisher Full Text

[10] 10. Kori SH, Miller RP, Todd DD: Kinisophobia: a new view of chronic pain behavior. Pain Manag. 1990; 3: 35–43.

[11] 11. Fritz JM, George SZ, Delitto A: The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status. Pain. 2001; 94(1): 7–15. PubMed Abstract | Publisher Full Text

[12] 12. Larsson C, Hansson EE, Sundquist K, et al.: Psychometric properties of the Tampa Scale of Kinesiophobia (TSK-11) among older people with chronic pain. Physiother. Theory Pract. 2014; 30(6): 421–428. PubMed Abstract | Publisher Full Text

[13] 13. Luque-Suarez A, Martinez-Calderon J, Falla D: Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br. J. Sports Med. 2019; 53(9): 554–559. PubMed Abstract | Publisher Full Text

[14] 14. Uluğ N, Yakut Y, Alemdaroğlu İ, et al.: Comparison of pain, kinesiophobia and quality of life in patients with low back and neck pain. J. Phys. Ther. Sci. 2016; 28(2): 665–670. PubMed Abstract | Publisher Full Text | Free Full Text

[15] 15. Palomo-López P, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, et al.: Kinesiophobia and pain intensity are increased by a greater hallux valgus deformity degree-kinesiophobia and pain intensity in hallux valgus. Int. J. Environ. Res. Public Health. 2020; 17(2): 626. PubMed Abstract | Publisher Full Text | Free Full Text

[16] 16. Chmielewski TL, Jones D, Day T, et al.: The association of pain and fear of movement/reinjury with function during anterior cruciate ligament reconstruction rehabilitation. J. Orthop. Sports Phys. Ther. 2008; 38(12): 746–753. PubMed Abstract | Publisher Full Text

[17] 17. Ishak NA, Zahari Z, Justine M: Kinesiophobia, pain, muscle functions, and functional performances among older persons with low back pain. Pain Res. Treat. 2017; 2017: 1–10. PubMed Abstract | Publisher Full Text | Free Full Text

[18] 18. Christe G, Crombez G, Edd S, et al.: Relationship between psychological factors and spinal motor behaviour in low back pain: a systematic review and meta-analysis. Pain. 2021; 162(3): 672–686. PubMed Abstract | Publisher Full Text

[19] 19. Von Elm E, Altman DG, Egger M, et al.: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J. Clin. Epidemiol. 2008 Apr; 61(4): 344–349. PubMed Abstract | Publisher Full Text

[20] 20. Rosenbloom BN, Pagé MG, Isaac L, et al.: Fear of movement in children and adolescents undergoing major surgery: a psychometric evaluation of the Tampa Scale for Kinesiophobia. Eur. J. Pain. 2020; 24: 1999–2014. PubMed Abstract | Publisher Full Text

[21] 21. Robson EK, Kamper SJ, Davidson S, et al.: Healthy Lifestyle Program (HeLP) for low back pain: protocol for a randomised controlled trial. BMJ Open. 2019; 9(9): e029290. PubMed Abstract | Publisher Full Text | Free Full Text

[22] 22. Muga MA, Owili PO, Hsu CY, et al.: Association of lifestyle factors with blood lipids and inflammation in adults aged 40 years and above: a population-based cross-sectional study in Taiwan. BMC Public Health. 2019; 19: 1346. PubMed Abstract | Publisher Full Text | Free Full Text

[23] 23. Meucci RD, Fassa AG, Faria NM: Prevalence of chronic low back pain: systematic review. Rev. Saude Publica. 2015; 49: 1. PubMed Abstract | Publisher Full Text | Free Full Text

[24] 24. Robins MT, Heinricher MM, Ryabinin AE: From Pleasure to Pain, and Back Again: The Intricate Relationship Between Alcohol and Nociception. Alcohol Alcohol. 2019; 54: 625–638. PubMed Abstract | Publisher Full Text | Free Full Text

[25] 25. Zhou Y, Liu P, Rui J, et al.: The Associated Factors and Clinical Features of Neuropathic Pain after Brachial Plexus Injuries: A cross-sectional study. Clin. J. Pain. 2017; 33: 1030–1036. PubMed Abstract | Publisher Full Text

[26] 26. Behennah J, Conway R, Fisher J, et al.: The relationship between balance performance, lumbar extension strength, trunk extension endurance, and pain in participants with chronic low back pain, and those without. Clin. Biomech. 2018; 53: 22–30. PubMed Abstract | Publisher Full Text

[27] 27. Couper M, Tourangeau R, Conrad F, et al.: Evaluating the effectiveness of visual analog scales: a web experiment. Soc. Sci. Comput. Rev. 2006; 24: 227–245. Publisher Full Text

[28] 28. Mikhail H, Reda N, Shahaly M, et al.: Predictors of fear-avoidance belief, pain, and disability index in patients with chronic low back pain attending rheumatology outpatient clinics. J. Public Health. 2022; 30: 417–422. Publisher Full Text

[29] 29. Suuden E, Ereline J, Gapeyeva H, et al.: Low back muscle fatigue during Sorensen endurance test in patients with chronic low back pain: relationship between electromyographic spectral compression and anthropometric characteristics. Electromyogr. Clin. Neurophysiol. 2008; 48: 185–192. PubMed Abstract

[30] 30. Boyce RO, Boone E, Stallings J, et al.: A multidisciplinary approach to a time efficient low back exercise intervention in a small manufacturing plant: a case study. J Exerc Physiol. 2008; 11: 12–24.

[31] 31. Aydoğdu O, Zübeyir S: The association between kinesiophobia and proprioception, postural stability, activity level, knee function, and quality of life following anterior cruciate ligament reconstruction. J. Exerc. Ther. Rehabil. 2020; 7(3): 247–252.

[32] 32. Monticone M, Ferrante S, Rocca B, et al.: Effect of a long-lasting multidisciplinary program on disability and fear-avoidance behaviors in patients with chronic low back pain: results of a randomized controlled trial. Clin. J. Pain. 2013 Nov 1; 29(11): 929–938. PubMed Abstract | Publisher Full Text

[33] 33. Miki T, Kondo Y, Kurakata H, et al.: The effect of cognitive functional therapy for chronic nonspecific low back pain: a systematic review and meta-analysis. BioPsychoSocial Med. 2022; 16: 12. PubMed Abstract | Publisher Full Text | Free Full Text

[34] 34. Alpalhão V, Cordeiro N, Pezarat-Correia P: Kinesiophobia and Fear Avoidance in Older Adults: A Scoping Review on the State of Research Activity. J. Aging Phys. Act. 2022 Mar 18; 30(6): 1075–1084. PubMed Abstract | Publisher Full Text

[35] 35. Yang YJ: An Overview of Current Physical Activity Recommendations in Primary Care. Korean J. Fam. Med. 2019 May; 40(3): 135–142. Epub 2019 May 20. PubMed Abstract | Publisher Full Text | Free Full Text

[36] 36. Guacel I, Miguel-Berges ML, Gómez-Bruton A, et al.: Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis. Nutr. Rev. 2019 Jan 1; 77(1): 1–18. PubMed Abstract | Publisher Full Text

[37] 37. Saulicz E, Knapik A, Saulicz M, et al.: Physical activity in youth and level of kinesiophobia in older adults. Balt J. Health Phys. Act. 2016; 8(2): 64–77. Publisher Full Text

[38] 38. Kandakurti PK, Arulsingh W, Patil SS: Influence of kinesiophobia on pain intensity, disability, muscle endurance, and position sense in patients with chronic low back pain—a case-control study. Trials. 2022; 23: 469. PubMed Abstract | Publisher Full Text | Free Full Text

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Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain- A case-control study

Abstract

Background

Methods

Results

Discussion and conclusion

ClinicalTrials.gov Identifier

Keywords

Background

Methods

Study design & setting

Procedures

Participants

Main outcomes measures

Kinesiophobia

Lumbar extensor endurance

Pain

Sample size

Statistical methods

Results

Table 1. Participant baseline characteristics using frequency table.

Table 2. Highlights comparison of outcome measures between cases and controls.

Table 3. Pearson's Correlation test to analyse kinesiophobia with lumbar endurance.

Table 4. Logistic regression table analyzing independent variable on Kinesiophobia in CLBP.

Table 5. Linear regression for analyzing various factors on the presence of Kinesiophobia in CLBP condition.

Table 6. Linear regression for analyzing relevant factors on lumbar endurance in CLBP condition.

Discussion

Conclusion

Trial status

Supplementary information

Authors’ contributions

Declarations

Consent for publication

Data availability and statement on data sharing

Underlying data

Extended data

Acknowledgements

References

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