A network analysis reveals the interaction between fear and physical features in people with neck pain

Abstract

Although neck pain is known to be a complex and multifactorial condition characterised by the interplay between physical and psychological domains, a comprehensive investigation examining the interactions across multiple features is still lacking. In this study, we aimed to unravel the structure of associations between physical measures of neuromuscular function and fear of movement in people with a history of neck pain. One hundred participants (mean age 33.3 ± 9.4) were assessed for this cross-sectional study, and the neuromuscular and kinematic features investigated were the range of motion, velocity of neck movement, smoothness of neck movement, neck proprioception (measured as the joint reposition error), and neck flexion and extension strength. The Tampa Scale for Kinesiophobia was used to assess fear of movement. A network analysis was conducted to estimate the associations across features, as well as the role of each feature in the network. The estimated network revealed that fear of movement and neuromuscular/kinematic features were conditionally dependent. Higher fear of movement was associated with a lower range of motion, velocity, smoothness of neck movement, neck muscle strength, and proprioception (partial correlations between − 0.05 and − 0.12). Strong interactions were also found between kinematics features, with partial correlations of 0.39 and 0.58 between the range of motion and velocity, and between velocity and smoothness, respectively. The velocity of neck movement was the most important feature in the network since it showed the highest strength value. Using a novel approach to analysis, this study revealed that fear of movement can be associated with a spectrum of neuromuscular/kinematic adaptations in people with a history of neck pain.

Kinematic analysis of sensorimotor control during the craniocervical flexion movement in patients with neck pain and asymptomatic individuals: a cross-sectional study

“…A recent study by Devecchi et al [28] also observed that kinesiophobia was the most relevant factor associated with the kinematic features of patients with neck pain, supporting the fear-avoidance model, which considers fear of motion as a potential driver for physical deconditioning and a mediator between pain and disability in people with neck pain [46].…”

“…These results agree with previous research that also observed that kinesiophobia showed stronger associations with kinematic measures of neck movement than pain intensity or disability did [ 45 ]. A recent study by Devecchi et al [ 28 ] also observed that kinesiophobia was the most relevant factor associated with the kinematic features of patients with neck pain, supporting the fear-avoidance model, which considers fear of motion as a potential driver for physical deconditioning and a mediator between pain and disability in people with neck pain [ 46 ].…”

“…Previous research has observed alterations in the performance of the CCFT in elderly subjects when compared to young participants [ 27 ]. Also, a recent study of Devecchi et al have highlighted the association between fear of pain and neuromuscular and kinematic adaptations observed in people with a history of neck pain [ 28 ]. Previous research specifically investigated the ROM of the craniocervical flexion, and observed that patients with neck pain or headache had reduced ROM when compared with asymptomatic subjects during full range movement [ 29 ] or during the stages of CFFT [ 21 ].…”

Network analyses reveal the interaction between physical features, fear of movement and neck pain and disability in people with acute and chronic whiplash‐associated disorders

“…Thus, a network analysis has the potential to identify and quantify interactions between various signs and symptoms in people with WAD, better exposing the potential complexity of these interactions. This type of analysis has been implemented to investigate other patient populations, such as those with tension-type headaches or other chronic pain conditions, providing evidence on the interaction between different variables and highlighting potential future targets for pain management (Devecchi et al, 2022; Fernández-de-Las-Peñas Significance: Through two network analyses, we evaluated the interaction between pain-related factors, fear of movement, neck disability and physical factors in people who had experienced a whiplash injury. We demonstrated that physical factors may be involved in the maintenance and development of chronic pain after a whiplash injury.…”

“…The association between single features, typically achieved by assessing simple correlations, may not capture the complexity of spinal pain, including WAD (Falla & Hodges, 2017; Ludvigsson et al, 2016). In contrast, a network analysis is an approach that can be applied to examine the interaction between multiple factors, including psychological features, measures of physical function and patient‐reported outcome measures (PROMs), since it can be used to quantitatively assess and graphically describe multiple interactions (Devecchi et al, 2022). Indeed, the analysis of the interaction between physical and psychological factors has a stronger association with pain intensity and disability than the presence of either factor alone in people with neck pain (Johnston et al, 2010).…”