Kinesiophobia vs. Task-Specific Fear: Defining Movement-Related Fear in ACL Reconstruction Patients

Official title

Kinesiophophia or Task-specific Fear of Movement? What Are we Talking About in Patients Post Anterior Cruciate Ligament Reconstruction?

Overview

Kinesiophobia, defined as an excessive and irrational fear of physical movement due to perceived vulnerability to injury, has gained significant attention in clinical and scientific communities. This condition can act as a barrier to physical activity, negatively impacting patients' disability, quality of life, and the implementation of rehabilitation programs. It is particularly prevalent after anterior cruciate ligament reconstruction (ACLR), affecting physical function, return to sport rates, and patient performance. While the Tampa Scale for Kinesiophobia (TSK) is considered a gold standard for assessing kinesiophobia, recent studies have raised concerns about its validity, especially in ACLR patients. The TSK may not adequately capture fear of specific sports activities, which is more common in ACLR patients than a general phobia of movement. Some researchers argue for an assessment approach similar to that used for pain experiences, emphasizing the subjective nature of fear. Based on the specific phobia model, assessing kinesiophobia in the presence of a trigger, such as visualizing or confronting the movement associated with the injury, may be more relevant. This approach is supported by evidence showing that sports situations evoking the greatest fear after ACLR are cutting, jumping, and contact. Further research is needed to investigate alternative methodologies for assessing fear of movement in ACLR patients, considering the prevalence and repercussions of kinesiophobia in this population. The objectives of this study are threefold: * To compare the magnitude of kinesiophobia through the TSK, the subjective feeling of fear when visualising feared movements, and the subjective feeling of fear in anticipation of the feared situation. * Evaluate the impact of focusing on feared activities on motor behavior and Autonomic Nervous System (ANS) markers. * To assess the relation between the three methods of assessing fear of movement and indicators of motor behaviour, ANS activity, fear-avoidance beliefs, anxiety, avoidance behaviour, and physical function.

Interventions

• Other Exposure to neutral images visualization
  The patient will have to walk on a treadmill at their preferential walking speed for 10 minutes while visualizing neutral images (landscapes, monuments...)
• Other Exposure to nocive images visualisation
  The patient will have to walk on a treadmill at their preferential walking speed for 10 minutes while visualizing images interpreted as nocive (cutting, jumping, contact...)
• Other Exposure to anticipated realisation of a feared movement
  Before the start of the experimental condition, the patient will be asked to think about their willingness to perform the first movement visualised in the video, while a researcher places a jumping platform inside the laboratory. During the test, the patient will have to walk on a treadmill at their preferred speed for 10 minutes, while watching a video showing a drop jump followed by images interpreted as nocive for the rest of the time.

Primary outcome measures

• Fractal scaling exponent (α) [Time frame: Day 0 (during intervention)]
• Heart rate variability [Time frame: Day 0 (during intervention)]
• Skin conductance [Time frame: Day 0 (during intervention)]
• Blood pressure variability [Time frame: Day 0 (during intervention)]

Secondary outcome measures (7)

• Physical Function in Sports and Leisure Activities subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-Sport/Rec) [Time frame: Day 0 (Before experiment)]
• Physical Activity subscale of the Fear-Avoidance Beliefs Questionnaire (FABQ-PA) [Time frame: Day 0 (Before experiment)]
• Tampa Scale for Kinesiophobia 13 items version (TSK-13) [Time frame: Day 0 (Before experiment)]
• Hospital Anxiety and Depression Scale (HADS) [Time frame: Day 0 (Before experiment)]
• Subjective feeling of fear (SFoM) [Time frame: Day 0 : After walking with visualization of neutral images; after walking with visualization of feared movements; after walking with visualization of feared movement and in the anticipation of realizing a feared movement.]
• Avoidance behaviour related to specific feared activities [Time frame: Day 0: after walking with visualization of feared movement and in anticipation of realizing a feared movement.]
• Coefficient of Variation (CV) [Time frame: Day 0 (during intervention)]

Eligibility criteria

Inclusion criteria

• The patient must have given their informed consent and signed the consent form.
• The patient must have enough comprehension of the Portuguese language to complete the written questionnaires.
• The patient must have suffered an ACL injury, with or without a history of concomitant meniscal pathology, while playing or training for sport (recreational or organized).
• The patient must have undergone anterior cruciate ligament reconstruction surgery.
• The patient must be between 18 and 35 years old.
• The patient must still be under medical care/rehabilitation due to the ACL injury.
• The patient must have started jump landing tasks.

Exclusion criteria

• The subject has a history of repeated ACLR.
• The subject has not injured the ACL while playing sports.
• The subject presents a concurrent psychiatric disorder
• The subject has a history of heart disease and/or peripheral vascular disease and/or metabolic disease and/or Raynaud´s Syndrome.
• The subject is taking any medications known to affect heart rate or blood pressure
• The subject is currently a smoker.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Crossover

Masking

Double blind

Primary purpose

Basic science

Study locations

Portugal · 2 centers

• Clínica de Fisioterapia Egas Moniz — Caparica
• Egas Moniz School of Health & Science — Almada

Identifiers

NCT: NCT07190456 · 1476

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗