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

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

DOI: 10.2519/jospt.2008.2887

STUDY DESIGN: Cross-sectional. OBJECTIVES: To measure fear of movement/reinjury levels and determine the association with function at different timeframes during anterior cruciate ligament (ACL) reconstruction rehabilitation. We hypothesized that fear of movement/reinjury would decrease during rehabilitation and be inversely related with function. BACKGROUND: Fear of movement/reinjury can prevent return to sports after ACL reconstruction, but it has not been studied during rehabilitation. METHODS AND MEASURES: Demographic data and responses on the shortened version of Tampa Scale for Kinesiophobia (TSK-11), 8-Item Short-Form Health Survey (SF-8), and International Knee Documentation Committee (IKDC) subjective form were extracted from a clinical database for 97 patients in the first year after ACL reconstruction. Three groups were formed: group 1, less than or equal to 90 days; group 2, 91 to 180 days; group 3: 181 to 372 days post-ACL reconstruction. Group differences in TSK-11 score, SF-8 bodily pain rating, and IKDC scores were determined. Hierarchical linear regression models were created for each group, with IKDC score as the dependent variable and demographic factors, SF-8 bodily pain rating, and TSK-11 score as independent variables. RESULTS: TSK-11 score was higher in group 1 than in group 3 (P < .05). Across the groups, SF-8 bodily pain rating decreased (P < .001) and IKDC score increased (P < .001). SF-8 bodily pain rating was a significant factor in the regression model for all groups, whereas TSK-11 score only contributed to the regression model in group 3 (partial correlation, -0.529). CONCLUSIONS: Pain was consistently associated with function across the timeframes studied. Fear of movement/reinjury levels appear to decrease during ACL reconstruction rehabilitation and are associated with function in the timeframe when patients return to sports. LEVEL OF EVIDENCE: Prognosis, level 4.

J Orthop Sports Phys Ther. 2008;38(12):746-753, published online 19 September 2008. doi:10.2519/jospt.2008.2887

KEY WORDS: ACL, knee injury, outcomes, psychosocial

The authors measure fear of movement/reinjury levels and determine the association with function at different timeframes during anterior cruciate ligament (ACL) reconstruction rehabilitation, hypothesizing that fear of movement/reinjury would decrease during rehabilitation and be inversely related with function.

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