KINESIOPHOBIA AMONG PATIENTS WITH MUSCULOSKELETAL PAIN IN PRIMARY HEALTHCARE Mari Lundberg, Maria Larsson, Helene O ¨ stlund and Jorma Styf From the Department of Orthopaedics, Division of Occupational Orthopaedics, Go ¨ teborg University, Sahlgrenska University Hospital, Sweden Objectives: To describe the occurrence of kinesiophobia and to investigate the association between kinesiphobia and pain variables, physical exercise measures and psychological char- acteristics in patients with musculoskeletal pain. Design: A prospective descriptive study involving 2 selected physiotherapy departments within a primary healthcare set- ting in the south-west of Sweden. Patients: Included were 140 of 369 (38%) consecutive patients (aged between 18 and 65 years) with musculoskeletal pain. Methods: Questionnaires including background data, pain variables, physical exercise measures and psychological char- acteristics were sent to the patients prior to their appointment with the physiotherapist. A simple and a multiple logistic regression model were performed to identify associations among the variables where kinesiophobia was defined as the dependent variable. Results: A high degree of kinesiophobia and psychological distress were observed in approximately 50% of the respon- ders. According to the simple logistic regression analysis the factors that seemed to be associated with kinesiophobia were interference, disability, pain severity, pain intensity, life control, affective distress, depressed mood and solicitous response. The multiple logistic regression analysis showed no significant associations. Conclusion: Kinesiophobia is a commonly seen factor among patients with musculoskeletal pain, which ought to be taken into consideration when designing and performing rehabilita- tion programmes. Key words: primary healthcare, physical therapy, psycho- logical stress. J Rehabil Med 2006; 38: 37  /43 Correspondence address: Mari K. E. Lundberg, Department of Orthopaedics, Division of Occupational Orthopaedics, Go ¨ teborg University, Sahlgrenska University Hospital, SE- 413 45 Go ¨ teborg, Sweden. E-mail: mari.lundberg@orthop. gu.se Submitted September 9, 2004; accepted May 6, 2005 INTRODUCTION Pain-related fear has been shown to be a very salient predictor of pain disability in a chronic pain population and is even more predictive than biomedical status and pain intensity (1, 2). It has been stated that pain-related fear is more disabling than pain itself (3). Pain-related fear predicts future disability and health status in the general population (4). There are different terms for describing pain-related fear. In 1983, Lethem et al. (5) introduced the ‘‘fear-avoidance’’ model. The model is an attempt to explain how and why some individuals develop a stronger psychological reaction to their pain problems than others. Kori, Miller and Todd subsequently applied the ideas about fear-avoidance to chronic pain and physical movement, with the introduction of the term ‘‘kinesio- phobia’’ in 1990 (6). Kinesiophobia is ‘‘a condition in which a patient has an excessive, irrational and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury’’. Vlaeyen et al. (2) elaborated on the kinesiophobia phenomenon, defining it as a fear of movement/(re)injury, a specific fear believed to cause injury or re-injury. Several questionnaires have been developed to quantify pain-related fears including the Fear Avoidance Beliefs Questionnaire (FABQ) (1); the Pain Anxiety Symptoms Scale (PASS) (7) and the Tampa Scale for Kinesiophobia (TSK) (8). The TSK was designed for the assessment of kinesiophobia. The Swedish version (TSK-SV) has been found reliable and valid for use on a Swedish pain population (9). The TSK-SV is a relatively short questionnaire that can be used easily in a primary healthcare setting. From a psychological perspective it is also important to be able to differentiate between functional disabilities due to a sensory experience of pain and behaviours that are driven by fear-avoidance (5, 10). The association between kinesiophobia, disability and physical performance has been investigated previously (3, 11). The physiotherapist is usually the first person who people suffering from musculoskeletal pain encounter when they seek care. An increase in the use of physiotherapy has been observed in Denmark (12), which is consistent with the increase in the prevalence of musculoskeletal problems in the general popula- tion. Epidemiological studies in Denmark showed that 6% of the Danish population were referred to a physiotherapist each year (13). In Sweden, a program designed by a physiotherapist is the most common method for the treatment of musculoskeletal disorders. Since kinesiophobia is said to have a negative influence on the outcome of rehabilitation it would be of interest to investigate the occurrence in a Swedish pain population. J Rehabil Med 2006; 38: 37  /43 # 2006 Taylor & Francis. ISSN 1650-1977 DOI: 10.1080/16501970510041253 J Rehabil Med 38