Association of psychological variables and outcome in tendinopathy: a systematic review

Abstract

The association of psychological variables and outcome in tendinopathy: a systematic review ABSTRACT Objective: Fear, anxiety, depression, distress and catastrophisation are all factors known to affect pain and disability levels. To date, the association of such psychological factors has yet to be established in tendinopathy. Therefore, the purpose of this paper was to determine if psychological variables are associated with tendinopathy and whether any such variables may be associated with pain and disability outcomes in conservative management of tendinopathy.Design: A systematic review was undertaken and included studies were appraised for risk of bias using the Newcastle Ottawa Scale. Due to heterogeneity of studies, a qualitative synthesis was undertaken.Data sources: An electronic search of MEDLINE, CiNAHL, SPORTDiscus, PsycINFO, EMBASE and PsycARTICLES was undertaken from their inception to April 2016.Eligibility criteria for selecting studies: Any study design that incorporated psychological measures and clinical outcomes using participants with tendinopathy.Results: Ten articles describing nine studies and 1108 participants were included. Conflicting evidence exists regarding the association of anxiety, depression and lateral epicondylalgia (LE). Strong evidence suggests LE is not associated with kinesiophobia. Moderate evidence links catastrophisation and distress with LE. Moderate evidence suggests distress is not associated with rotator cuff tendinopathy, but kinesiophobia and catastrophisation are. Limited evidence suggests patella tendinopathy is not associated with anxiety or depression and kinesiophobia may be linked with suboptimal outcomes in Achilles tendinopathy. Summary/conclusions:Tendinopathy requires an individualised approach to management. Clinicians should consider using validated screening tools for the presence of psychological variables as a part their holistic management. What are the new findings Psychological variables may be associated with tendinopathy and a suboptimal outcome  Multi-dimensional factors influence the development and maintenance of pain and disability in tendinopathy  The underlying factors for the presence of these variables and their amenability to change warrant further investigation How might it impact on clinical practice in the near future  Tendinopathy management should include an individualised, holistic assessment  Management strategies may need to be adapted to address individual psychological variables and any underlying cognitive barriers.

The association of working alliance, outcome expectation, adherence and self‐efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study)

“…Participants were required to be a minimum of 18 years old, have access to the internet, an available email address, proficient with written and spoken English, and identified as having AT as determined by the attending physiotherapist according to established criteria (Adrian Mallows, Debenham, Walker, & Littlewood, ; Martin et al, ): Local Achilles tendon pain reproduced with load‐based activity, for example heel raising, for at least ten days duration Tenderness on palpation of the Achilles tendon Range of movement at the ankle within normal limits To minimize confounding variables for recovery, participants presenting post‐operatively, or with lumbar spine related disorders which may refer directly to the Achilles tendon region were excluded (Mallows et al, ; Martin et al, ). The exclusion criteria were: Tendon rupture Receiving treatment for post‐surgical recovery Reproduction of pain in the Achilles region on movements of the spine …”

“…As current strategies appear incomplete, the need to investigate factors beyond the specific effects of exercise on peripheral tissue appears to be one way of potentially optimising outcomes in AT. In recent times, cognitive and contextual influences such as self‐efficacy, working alliance and expectations have been highlighted as potentially relevant factors that would benefit from investigation in tendinopathy (Mallows, Debenham, Malliaras, et al, ; Mallows, Debenham, Walker, & Littlewood, ). Working alliance, also known as ‘therapeutic alliance’ or ‘patient‐therapist relationship’, can be defined as “the working rapport or positive social connection between the patient and the therapist” (Joyce, Ogrodniczuk, Piper, & McCallum, ).…”

General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care

“…Higher management rates for RCRP were found among patients from most disadvantaged socioeconomic status. A multitude of factors may be associated with RCRP and more prevalent in socioeconomic disadvantaged areas, including rates of metabolic disease and mental health issues such as anxiety and depression [55][56][57]. The higher management rate of RCRP among male GPs than female GPs, identified after adjustment for other GP and patient characteristics, may reflect the higher management rate of musculoskeletal problems (overall) by male GPs in Australia [58,59].…”

Patellar and Achilles tendinopathies are predominantly peripheral pain states: a blinded case control study of somatosensory and psychological profiles

“…Knowledge of psychological characteristics associated with persistent tendinopathies is scarce and inconsistent 19. In LE, some studies have reported higher levels of anxiety and depression,20 21 whereas others have not 9 10.…”