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Kinesiophobia Negatively Impacts Functional Task Performance in JIA

“Kinesiophobia plays a major role in the onset, persistence, and exacerbation of chronic disability in a variety of musculoskeletal disorders."

Children with juvenile idiopathic arthritis (JIA) had trouble with tasks related to body transfers. Kinesiophobia, a pain-related fear of movement, significantly contributed to functional task performance and may impact clinical outcomes, according to a study published in Pediatric Rheumatology.1

“Kinesiophobia plays a major role in the onset, persistence, and exacerbation of chronic disability in a variety of musculoskeletal disorders,” investigators explained. “Kinesiophobia can impact pain perception, proprioception, and functional performance across different conditions including frozen shoulder patellofemoral pain, temporomandibular disorders, and low back pain. In patients with rheumatic conditions like arthritis, kinesiophobia predicts worse self-reported disability, physical functioning, efficacy for fall prevention, overall quality of life, and is related to worse objective scores for quadriceps muscle strength and knee flexion.”

A cross-sectional, comparative study of patients with JIA (n = 26) and healthy controls (n = 17) was performed. Patients in the JIA cohort had lower extremity joint involvement. Performance measures included gait speed, chair, and stair navigation. Self-reported measures included the Patient Reported Outcome Measurement Information System (PROMIS) Physical Function Mobility and the Pain Interference and the Pediatric Functional Activity Brief Scale (Pedi-FABS). PROMIS focused on the assessment of physical, mental, and social wellbeing. Fear of movement and re-injury due to pain was analyzed via the Tampa Scale of Kinesiophobia (TSK-11), a reliable, 2-factor, 11-item instrument.

Patients included in the study were aged 7 to 21 years and were diagnosed with JIA per the International League of Associations of Rheumatology (ILAR) with current or previous sacroiliac joint or lower extremity joint involvement. Each patient was assessed for joint swelling, range of motion, and pain on range, as well as a physician global assessment of disease activity. Linear regression models were used to evaluate the correlation between TSK-11 scores and performance tests or Pedi-FABS scores.

For patients with JIA, gait speeds were 11-15% slower, stair ascent and descent times were 26-31% slower, and chair rise repetitions were 28% fewer when compared with controls (p < .05). PROMIS scores were also 10% lower and Pain Interference scores were 2.6 times higher in patients with JIA when compared with healthy controls (p = .003).

TSK-11 scores were higher in patients with JIA when compared with controls (p < .0001). After controlling for covariates, TSK-11 scores justified 11.7%-26.5% of the variance of regression models for the Pedi-FABS scores, stair climb time, and chair rise performance (p < .05).

Kinesiophobia may change as patients grow, mature, and disease activity changes, thus limiting the study. Additionally, there is no standard for evaluating changes to fear of movement and addressing specific constructs of fear of movement, particularly in adolescent patients. Further, the TSK-11 assessment is not validated in children and may benefit from language adaption tailored to the pediatric population. Future studies should narrow the age rage to control for impacts of growth and development on physical function. Lastly, selection bias may play a role in the results as the study excluded patients who had upper limb involvement but not lower limb, thus hindering generalizability. However, the study was strengthened by the reliable testing measures, the thorough measures of physical function, the healthy control group, and including a population of patients that represent JIA.

“Children with JIA generally demonstrate lower self-reported and performance-based scores in areas of mobility and body weight transfer,” investigators concluded. “In this cohort, children with JIA demonstrated kinesiophobia, which contributed directly to performance of body weight transfer motions and to physical activity levels. Kinesiophobia may inform clinical care through the reflection of the patient experience of living with JIA.”

Reference:

Woolnough LU, Lentini L, Sharififar S, Chen C, Vincent HK. The relationships of kinesiophobia and physical function and physical activity level in juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2022;20(1):73. Published 2022 Sep 1. doi:10.1186/s12969-022-00734-2