Kinesiophobia and physical therapy-related pain in musculoskeletal pain: A national multicenter cohort study on patients and their general physicians

Introduction

Physical therapy (PT) represents a major approach in musculoskeletal (MSK) pain. This study aimed to assess kinesiophobia, its impact and management, in patients with MSK pain treated by PT.

Methods

A national multicenter, prospective study was conducted in France in patients with MSK pain referred to PT. Kinesiophobia was scored with the Tampa Scale of Kinesiophobia (TSK). Pain, satisfaction, analgesic intake and acceptability were assessed at the initial visit, at the 5th PT session, and at the end of PT.

Results

A total of 700 consecutive outpatients with MSK pain, 54.5% female, referred to PT were recruited by 186 GPs: 501 had significant levels of kinesiophobia (TSK score > 40). Patients with kinesiophobia were significantly older, with less physical activity, more pain and less acceptability. Patients from GPs presenting with kinesiophobia had both higher pain and kinesiophobia levels. After 5 PT sessions, global satisfaction was significantly higher in patients without kinesiophobia. A significant increase of PT satisfaction was observed in patients who had been given preventive analgesics before PT sessions, in 25.6% of patients. Independent predictors for specific management of PT-induced pain were: patient's kinesiophobia (OR = 2.02 [1.07–3.82]), current analgesics treatment (OR = 2.05 [1.16–3.63]), GP with postgraduate course on pain (OR = 2.65 [1.29–5.43]), GP's independent practice (OR = 1.88 [1.01–3.48]).

Conclusion

Kinesiophobia is frequent in patients with MSK pain, is associated to GPs’ kinesiophobia and decreases satisfaction of physical therapy. Preventive analgesic treatment before PT sessions improves patients’ satisfaction and should be proposed to improve MSK pain management.