More Physical Activity Is Correlated With Reduction in Kinesiophobia for Adolescents With Persistent Symptoms After Concussion

Abstract

Context: The relationship between physical activity (PA) and fear of pain with movement (ie, kinesiophobia) during concussion recovery is unknown. Kinesiophobia may limit PA, while PA after concussion may reduce kinesiophobia. Our purpose was to examine the correlation between PA and self-reported kinesiophobia during concussion recovery for adolescents with and without persistent symptoms. Design: Prospective cohort study of children ages 10–18 years within 14 days of concussion. Methods: Participants rated kinesiophobia using the Tampa Scale of Kinesiophobia (TSK) at initial (≤14 d postconcussion) and return to play (RTP) assessments, and wore activity monitors between assessments. Our primary outcome was TSK score change from initial to RTP assessments. We grouped participants based on whether they experienced persistent symptoms (symptoms ≥28 days) or not (symptoms <28 days) and calculated correlation coefficients (Pearson r for normally distributed and Spearman rho for nonnormally distributed variables) between PA variables and TSK change scores. Results: Among the 41 participants enrolled, 44% developed persistent symptoms (n = 18; age = 14.5 [2.0] y; 50% female; symptom duration = 57.3 [6.2] d; RTP = 66.8 [6.4] d) and 56% did not (n = 23; age = 14.9 [1.8] y; 48% female; symptom duration = 15.2 [1.5] d; RTP = 21.7 [1.9] d). For the persistent symptoms group, greater TSK change scores (mean = −2.5 [5.7] point change) were significantly and moderately correlated with higher daily step count (r = −.60, P = .008) and exercise frequency (r = −.63, P = .005), but were not correlated with exercise duration (ρ = −.12, P = .65). Among the no persistent symptoms group, TSK change scores (mean = −6.0 [5.0] point change) were not correlated with step count (r = −.18, P = .41) or exercise duration (ρ = .10, P = .67), and the correlation with frequency was low and not significant (r = −.34, P = .12). Conclusions: Regular PA during concussion recovery, regardless of duration or intensity, may help reduce kinesiophobia for those experiencing persistent symptoms.

Kinesiophobia and physical activity: A systematic review and meta-analysis

“…Most studies that employed accelerometer-based measures used the ActiGraph (Actigraph, LLC, Pensacola, FL, USA) GT3X+ (n = 4) 120,137,150,151 , wGT3X-BT (n = 2) 138,148 or GT9X Link (n = 2) 78,132 . The other accelerometers were the RT3 (Stayhealthy Inc., Monrovia, CA, USA; n = 3) 117,118,124 , the SenseWear Pro3 Armband (BodyMedia, Pittsburgh, PA, USA; n = 3) 74,144,146 , the Activity Sensory Move II (movisens GmbH, Karlsruhe, Germany; n = 1) 129 , the LifeShirt (Vivometrics, Inc., Ventura, CA, USA; n = 1) 122 , the ActiWatch (Mini Mitter Co., Inc., Bend, OR, USA; n = 1) 111 , AX3 (Axtivity, Newcastle upon Tyne, UK; n = 1) 65 , FitBit (FitBit Inc., San Francisco, CA) Charge HR (n = 1) 126 , Charge 3 (n = 1) 143 , and the Activ8 (2M Engineering, North Brabant, Netherland, n = 1) 66 . The type of accelerometer was not reported in one study 113 .…”

“…These devices were worn for 5 days (n = 1) 111 , 6 days (n = 1 129 ), 7 days (n = 16) 63,65,75,88,91,113,117,118,120,124,132,137,144,148,150,151 , or 14 days (n = 1) 126 . The remaining 7 studies did not specify the number of days the device was worn 66,74,78,122,128,143,145 . All studies provided the accelerometer or pedometer on the day kinesiophobia was assessed (n = 18) 63,65,66,75,78,88,89,111,113,120,122,126,132,137,143,148,150 .…”

“…The remaining 7 studies did not specify the number of days the device was worn 66,74,78,122,128,143,145 . All studies provided the accelerometer or pedometer on the day kinesiophobia was assessed (n = 18) 63,65,66,75,78,88,89,111,113,120,122,126,132,137,143,148,150 . The remaining studies did not specify whether kinesiophobia was measured the day the device was provide or the last day of physical activity assessment (n = 7) 74,118,124,128,144,146,151 .…”

“…Among the 74 articles included in the systematic review, 42 reported correlation coefficients of the association between physical activity and kinesiophobia. Specifically, 32 articles reported at least one Pearson’s r correlation coefficient and 12 articles reported at least one Spearman’s rho 87,89,91,113,116,124,127,132,135,143,149,151 . When a correlation coefficient was not reported, but the exact p-value (or t value) and sample size were available and it was possible to know the sign of the correlation, which was the case for 7 studies 83,111,115,120,125,133,144 , the Pearson’s r estimate was computed using an ad-hoc R code (Supplemental Code 1A).…”

“…The 74 articles identified by the systematic review included a total of 13388 participants aged 11 to 85 years, including 7308 women, 4729 men, and 1351 participants whose gender and sex was not reported. The studies investigated populations with pain (n = 37) 62,64–71,73,76–81,83,88,89,111–128 cardiac conditions (n = 6) 86,87,104,129–131 , surgery (n = 8) 63,131–137 , arthritis (n = 10) 75,82,84,85,91,138–142 , neurologic conditions (n = 3) 90,143,144 , pulmonary conditions (n = 3) 145–147 , cancer (n = 1) 74 , women health conditions (n = 2) 72,148 , as well as healthy adults (n = 6) 29,85,107,149–151 (Table 1).…”