The Association of Pain and Fear of Movement/Reinjury With Function During Anterior Cruciate Ligament Reconstruction Rehabilitation

Chmielewski, Terese L.; Jones, Debi; Day, Tim; Tillman, Susan M.; Lentz, Trevor A.; George, Steven Z.

doi:10.2519/jospt.2008.2887

Cited by 229 publications

(245 citation statements)

References 35 publications

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“…22 Fear of pain and reinjury was associated with function for patients in the return-to-sports phase of rehabilitation following anterior cruciate ligament reconstruction, 3 and also with self-report of disability in patients with foot and ankle pain. 23 In other studies for lower extremity conditions, fear-avoidance beliefs were associated with selfreport of knee function in patients with knee osteoarthritis 32 and were predictive of pain and function outcomes in patients with patellofemoral pain.…”

Section: T T Resultsmentioning

confidence: 99%

Fear-Avoidance Beliefs and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain Conditions

George¹,

Stryker²

2011

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Prospective cohort. Objective To investigate fear-avoidance eliefs across different anatomical regions for patients with musculoskeletal pain. Background Fear-avoidance beliefs were first widely studied in patients with low back pain. The early results of studies involving patients with cervical spine, knee, and shoulder disorders suggest that fear-avoidance beliefs have the potential to influence pain and function in different anatomical regions. However, very few prospective studies of fear-avoidance beliefs involve multiple anatomical regions. Methods The sample of this study consisted of 313 patients (mean age, 45.5 years; 115 males, 198 females) seeking outpatient physical therapy for cervical spine (n = 63), upper extremity (n = 58), lumbar spine (n = 79), or lower extremity (n = 113) complaints. During the intake session, patients completed the Fear-Avoidance Beliefs Questionnaire physical activity scale (FABQ-PA), modified for the appropriate anatomical location. Patients also rated pain intensity and function on the Therapeutic Associates Outcomes System (TAOS) Functional Index at intake and discharge. The collection of treatment-related parameters included the number of visits, calendar days of physical therapy, and treatment received. FABQ-PA scores were compared across anatomical regions. Elevated FABQ-PA scores and anatomical regions were also investigated for association with intake pain and function, clinical outcomes, and treatment utility parameters. Results Similar FABQ-PA levels were observed across the 4 anatomical regions (P>.05). Number of visits, calendar days of physical therapy, and treatment received did not differ between elevated and lower fear-avoidance belief levels (P>.05). Findings for pain intensity and function were similar for each anatomical region. Patients with elevated fear-avoidance beliefs had higher intake scores (P<.05), larger improvements (P<.05), but similar discharge scores (P>.05), compared to those with lower fear-avoidance beliefs. Conclusions These data suggest that, in patients with cervical, upper extremity, lumbar, or lower extremity complaints, fear-avoidance beliefs may have a similar influence on intake and change scores for pain intensity and function. General assessment of fear-avoidance beliefs using the FABQ-PA, especially to predict change scores, may be appropriate for use in patients with various musculoskeletal pain conditions. J Orthop Sports Phys Ther 2011;41(4):249–259, Epub 18 February 2011. doi:10.2519/jospt.2011.3488

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Section: T T Resultsmentioning

confidence: 99%

Fear-Avoidance Beliefs and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain Conditions

George¹,

Stryker²

2011

Journal of Orthopaedic & Sports Physical Therapy

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“…Our results agree with findings in other populations, such as individuals with patellofemoral pain 20 and patients after anterior cruciate ligament reconstruction. 34 These findings highlight the need to evaluate function local to the ankle, as well as globally, to fully understand the scope of HRQOL changes in patients with CAI.…”

Section: Discussionmentioning

confidence: 99%

Health-Related Quality of Life in Individuals With Chronic Ankle Instability

Houston

Lunen

Hoch

2014

Journal of Athletic Training

157

104

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Context: Individuals with chronic ankle instability (CAI) have reported decreased global and regional function. Despite the identification of functional deficits in those with CAI, more research is required to determine the extent to which CAI influences the multidimensional profile of health-related quality of life.Objective: To determine whether global, regional, and psychological health-related outcomes differ between individuals with and without CAI.Design: Case-control study. Setting: Laboratory.Patients or Other Participants: Twenty-five participants with CAI (age ¼ 21.9 6 2.5 years, height ¼ 170.8 6 8.6 cm, mass ¼ 69.8.0 6 11.7 kg) were sex-and limb-matched to 25 healthy participants (age ¼ 22.0 6 2.1 years, height ¼ 167.4 6 9.1 cm, mass ¼ 64.8 6 11.2 kg).Main Outcome Measure(s): Both groups completed the Disablement in the Physically Active Scale, the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport, the Tampa Scale of Kinesiophobia-11, and the Fear-Avoidance Beliefs Questionnaire. Dependent variables were scores on these instruments, and the independent variable was group.Results: Compared with healthy individuals, those with CAI reported decreased function on the Disablement in the Physically Active Scale, FAAM, and FAAM-Sport (P , .001) and increased fear of reinjury on the Tampa Scale of Kinesiophobia-11 and Fear-Avoidance Beliefs Questionnaire (P , .001). In the CAI group, the FAAM and FAAM-Sport demonstrated a significant relationship (r ¼ 0.774, P , .01).Conclusions: Individuals with CAI reported decreased function and increased fear of reinjury compared with healthy control participants. Also, within the CAI group, there was a strong relationship between FAAM and FAAM-Sport scores but not between any other instruments. These findings suggest that health-related quality of life should be examined during the rehabilitation process of individuals with CAI.Key Words: ankle sprains, impairment, fear of reinjury, psychology Key PointsIndividuals with chronic ankle instability reported global, regional, and psychological health-related quality-of-life deficits compared with healthy control participants. Functional deficits and psychological barriers reported by the patient should be taken into consideration when clinicians treat individuals with chronic ankle instability.

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“…29,94,95,173 This trend is due in part to the documented improved outcomes with more aggressive rehabilitation. 151 Howe et al 77 also reported improved outcomes-greater motion, improved muscular strength, and enhanced earlier function-with formal, supervised rehabilitation compared to no supervised rehabilitation.…”

Section: T T Abstract: Acl Knee Neuromuscular Training Propriocepmentioning

confidence: 97%

“…The athlete must also demonstrate sufficient confidence in the affected extremity to successfully return to sport without any fears or limitations. 29,170 Finally, we only return the athlete to sport participation once the knee has returned to its normal FIGURE 7. Double-leg plyometric jumping drills in the lateral direction, in which the patient is instructed to land on the box and flat ground with the knee in a flexed position.…”

Section: Progress To Sport-specific Trainingmentioning

confidence: 99%

“…It has been our experience that, following a serious knee injury, patients may become afraid of reinjury and returning to high-level function. 29 We believe that restoring neuromuscular control and, in particular, perturbation skill, significantly improves the patient's confidence in the injured knee. [ clinical commentary ]…”

Section: Restore Neuromuscular Controlmentioning

confidence: 99%

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Recent Advances in the Rehabilitation of Anterior Cruciate Ligament Injuries

Wilk¹,

Macrina²,

Cain³

et al. 2012

Journal of Orthopaedic & Sports Physical Therapy

138

124

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Synopsis Rehabilitation following anterior cruciate ligament surgery continues to change, with the current emphasis being on immediate weight bearing and range of motion, and progressive muscular strengthening, proprioception, dynamic stability, and neuromuscular control drills. The rehabilitation program should be based on scientific and clinical research and focus on specific drills and exercises designed to return the patient to the desired functional goals. The goal is to return the patient's knee to homeostasis and the patient to his or her sport or activity as safely as possible. Unique rehabilitation techniques and special considerations for the female athlete will also be discussed. The purpose of this article is to provide the reader with a thorough scientific basis for anterior cruciate ligament rehabilitation based on graft selection, patient population, and concomitant injuries. J Orthop Sports Phys Ther 2012;42(3):153–171. doi:10.2519/jospt.2012.3741

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The Association of Pain and Fear of Movement/Reinjury With Function During Anterior Cruciate Ligament Reconstruction Rehabilitation

Cited by 229 publications

References 35 publications

Fear-Avoidance Beliefs and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain Conditions

Fear-Avoidance Beliefs and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain Conditions

Health-Related Quality of Life in Individuals With Chronic Ankle Instability

Recent Advances in the Rehabilitation of Anterior Cruciate Ligament Injuries

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