Association of Kinesiophobia with Catastrophism and Sensitization-Associated Symptoms in COVID-19 Survivors with Post-COVID Pain

Abstract

Pain symptoms after the acute phase of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are present in almost 50% of COVID-19 survivors. The presence of kinesiophobia is a risk factor which may promote and perpetuate pain. This study aimed to investigate variables associated with the presence of kinesiophobia in a sample of previously hospitalized COVID-19 survivors exhibiting post-COVID pain. An observational study was conducted in three urban hospitals in Spain, including one hundred and forty-six COVID-19 survivors with post-COVID pain. Demographic (age, weight, height), clinical (intensity and duration of pain), psychological (anxiety level, depressive level, sleep quality), cognitive (catastrophizing), sensitization-associated symptoms, and health-related quality of life variables were collected in 146 survivors with post-COVID pain, as well as whether they exhibited kinesiophobia. Stepwise multiple linear regression models were conducted to identify variables significantly associated with kinesiophobia. Patients were assessed a mean of 18.8 (SD 1.8) months after hospital discharge. Kinesiophobia levels were positively associated with anxiety levels (r: 0.356, p < 0.001), depression levels (r: 0.306, p < 0.001), sleep quality (r: 0.288, p < 0.001), catastrophism (r: 0.578, p < 0.001), and sensitization-associated symptoms (r: 0.450, p < 0.001). The stepwise regression analysis revealed that 38.1% of kinesiophobia variance was explained by catastrophism (r2 adj: 0.329, B = 0.416, t = 8.377, p < 0.001) and sensitization-associated symptoms (r2 adj: 0.381, B = 0.130, t = 3.585, p < 0.001). Kinesiophobia levels were associated with catastrophism and sensitization-associated symptoms in previously hospitalized COVID-19 survivors with post-COVID pain. Identification of patients at a higher risk of developing a higher level of kinesiophobia, associated with post-COVID pain symptoms, could lead to better therapeutic strategies.

SMART System in the Assessment of Exercise Tolerance in Adults

“…assessment was made according to standardized criteria [38]. Next, for statistical analyses, the participants were divided into three groups: I-very low or low exercise performance; II-average or good exercise performance; III-very good or highest exercise performance.…”

“…This indirect method of assessing the maximal oxygen uptake uses the established relationship between exercise oxygen uptake and heart rate. The qualitative VO2max assessment was made according to standardized criteria [ 38 ]. Next, for statistical analyses, the participants were divided into three groups: I—very low or low exercise performance; II—average or good exercise performance; III—very good or highest exercise performance.…”

“…The problem of declining PA and failure to return to the former level of physical activity particularly affects individuals who have been diagnosed with COVID-19 [ 35 , 36 , 37 ]. In addition to somatic symptoms, the problem is kinesiophobia [ 38 ]. The fear of undesirable consequences of PA may cause people to avoid exercise, especially its more intense forms.…”

Post-COVID Syndrome: From the Perspective of Physiatrists

“…Kinesiophobia, the fear of movement, contributes to the chronicity, persistence, and exacerbation of pain (33). Herrero-Montes et al (34) reported that nearly 57% of patients with post-COVID pain exhibited potential kinesiophobic behavior. Higher kinesiophobia levels are associated with decreased physical activity (35).…”

Feeling connected to nature: validation of the connectedness to nature scale in the Italian context

“…The mean age of the participants was 34.70 (SD = 13.584), ranging from 18 to 65 years. The sample size was determined following the guidelines proposed by Austin and Steyerberg (2015) , as also observed in other studies conducted by Collister et al (2023) , Herrero-Montes et al (2023) , Huang et al (2023) , Stepovic et al (2023) , and Yamazaki et al (2023) . Table 1 presents the sociodemographic characteristics of the sample.…”