Kinesiophobia, Knee Self-Efficacy, and Fear Avoidance Beliefs in People with ACL Injury: A Systematic Review and Meta-Analysis,Sports Medicine

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Kinesiophobia, Knee Self-Efficacy, and Fear Avoidance Beliefs in People with ACL Injury: A Systematic Review and Meta-Analysis
Sports Medicine ( IF 9.3 ) Pub Date : 2022-08-13 , DOI: 10.1007/s40279-022-01739-3
Garrett S Bullock _{1,

2} , Timothy C Sell ₃ , Ryan Zarega ₃ , Charles Reiter , Victoria King ₃ , Hailey Wrona ₃ , Nilani Mills _{3,

4} , Charlotte Ganderton ₅ , Steven Duhig ₆ , Anu Räisäsen _{7,

8} , Leila Ledbetter ₉ , Gary S Collins _{10,

11} , Joanna Kvist _{12,

13} , Stephanie R Filbay ₁₄

Affiliation

Department of Orthopaedic Surgery, Wake Forest School of Medicine, Charlotte, NC, USA.
Centre for Sport, Exercise and Osteoarthritis Research-Versus Arthritis, University of Oxford, Oxford, UK.
Atrium Health, Charlotte, NC, USA.
University of New South Wales, Sydney, NSW, Australia.
Swinborne University of Technology, Melbourne, VIC, Australia.
Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, Australia.
Department of Physical Therapy, Western University of Health Sciences, Lebanon, OR, USA.
Department of Kinesiology, University of Calgary, Calgary, AB, Canada.
Medical Libraries, Duke School of Medicine, Durham, NC, USA.
Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Unit of Physiotherapy, Department of Health, Medicine, and Caring Medicine, Linkoping University, Linköping, Sweden.
Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
Centre of Health, Exercise, and Sport Medicine, University of Melbourne, Melbourne, VIC, Australia.

Background

To improve the understanding of the psychological impacts of anterior cruciate ligament (ACL) injury, a systematic review synthesizing the evidence on knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury is needed.

Objective

The aim of this systematic review was to investigate knee self-efficacy, fear avoidance beliefs and kinesiophobia following ACL injury, and compare these outcomes following management with rehabilitation alone, early and delayed ACL reconstruction (ACLR).

Methods

Seven databases were searched from inception to April 14, 2022. Articles were included if they assessed Tampa Scale of Kinesiophobia (TSK), Knee Self-Efficacy Scale (KSES), or Fear Avoidance Beliefs Questionnaire (FABQ). Risk of bias (RoB) was assessed using domain-based RoB tools (ROBINS-1, RoB 2, RoBANS), and GRADE-assessed certainty of evidence. Random-effects meta-analyses pooled outcomes, stratified by time post-injury (pre-operative, 3–6 months, 7–12 months, > 1–2 years, > 2–5 years, > 5 years).

Results

Seventy-three studies (70% high RoB) were included (study outcomes: TSK: 55; KSES: 22; FABQ: 5). Meta-analysis demonstrated worse kinesiophobia and self-efficacy pre-operatively (pooled mean [95% CI], TSK-11: 23.8 [22.2–25.3]; KSES: 5.0 [4.4–5.5]) compared with 3–6 months following ACLR (TSK-11: 19.6 [18.7–20.6]; KSES: 19.6 [18.6–20.6]). Meta-analysis suggests similar kinesiophobia > 3–6 months following early ACLR (19.8 [4.9]) versus delayed ACLR (17.2 [5.0]). Only one study assessed outcomes comparing ACLR with rehabilitation only.

Conclusions

Knee self-efficacy and kinesiophobia improved from pre-ACLR to 3–6 months following ACLR, with similar outcomes after 6 months. Since the overall evidence was weak, there is a need for high-quality observational and intervention studies focusing on psychological outcomes following ACL injury.

中文翻译：

ACL 损伤患者的运动恐惧症、膝关节自我效能和恐惧回避信念：系统回顾和荟萃分析

背景

为了提高对前交叉韧带 (ACL) 损伤心理影响的理解，需要对膝关节自我效能、恐惧回避信念和 ACL 损伤后运动恐惧症的证据进行系统评价。

客观的

本系统评价的目的是调查 ACL 损伤后的膝关节自我效能、恐惧回避信念和运动恐惧症，并比较单独康复、早期和延迟 ACL 重建 (ACLR) 管理后的这些结果。

方法

从开始到 2022 年 4 月 14 日，我们搜索了七个数据库。如果他们评估了坦帕运动恐惧症量表 (TSK)、膝关节自我效能量表 (KSES) 或恐惧回避信念问卷 (FABQ)，则会包括文章。使用基于领域的 RoB 工具（ROBINS-1、RoB 2、RoBANS）和 GRADE 评估的证据确定性评估偏倚风险 (RoB)。随机效应荟萃分析汇总结果，按受伤后时间分层（术前、3-6 个月、7-12 个月、> 1-2 年、> 2-5 年、> 5 年）。

结果

包括 73 项研究（70% 高 RoB）（研究结果：TSK：55；KSES：22；FABQ：5）。荟萃分析表明，与 ACLR 后 3-6 个月相比，术前的运动恐惧症和自我效能更差（汇总平均值 [95% CI]，TSK-11：23.8 [22.2-25.3]；KSES：5.0 [4.4-5.5]）（TSK-11：19.6 [18.7–20.6]；KSES：19.6 [18.6–20.6]）。荟萃分析表明，早期 ACLR (19.8 [4.9]) 与延迟 ACLR (17.2 [5.0]) 后 > 3-6 个月的运动恐惧症相似。只有一项研究评估了比较 ACLR 与仅康复的结果。