The effects of kinesiophobia on outcome following total knee replacement: A systematic review

Oliver S. Brown, L. Hu, C. Demetriou, Toby Smith, Caroline Hing

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)
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Introduction: Kinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and functional outcomes, pain and range of motion following TKR, and to evaluate published treatments for kinesiophobia following TKR. Materials and methods: A primary search of electronic databases, grey literature, and trial registries was performed in March 2020. English-language studies recruiting adult primary TKR patients, using the Tampa Scale of Kinesiophobia (TSK) were included. Outcome measures were grouped into short (< 6 months), medium (6-12 months), and long term (> 12 months). Study quality was assessed using the Newcastle Ottawa Scale for cohort or case control studies, and the Cochrane Collaboration Risk of Bias tool for randomised controlled trials. Results: All thirteen included papers (82 identified) showed adequately low risk of methodological bias. TSK1 (activity avoidance) correlated with WOMAC functional score at 12 months in three studies (r = 0.20 p < 0.05, R = 0.317 p = 0.001, and correlation coefficient 0.197 p = 0.005). TSK score significantly correlated with mean active range of motion (ROM) at 2 weeks [65.98 (SD = 14.51) versus 47.35 (SD = 14.48) p = 0.000], 4 weeks [88.20 (SD = 15.11) versus 57.65 (SD = 14.80) p = 0.000], and 6 months [105.33 (SD = 12.34) versus 85.53 (SD = 14.77) p = 0.000] post-operation. Three post-operative interventions improved TSK score vs control following TKR: a home-based functional exercise programme [TSK − 14.30 (SD = 0.80) versus − 2.10 (SD = 0.80) p < 0.001], an outpatient cognitive behavioural therapy (CBT) programme [TSK 27.76 (SD = 4.56) versus 36.54 (SD = 3.58)], and video-based psychological treatment [TSK 24 (SD = 5) versus 29 (SD = 5) p < 0.01]. Conclusions: Kinesiophobia negatively affects functional outcomes up until 1 year post-operatively, while active ROM is reduced up to 6 months post-procedure. Post-operative functional and psychological interventions can improve kinesiophobia following TKR.

Original languageEnglish
Pages (from-to)2057–2070
Number of pages14
JournalArchives of Orthopaedic and Trauma Surgery
Issue number12
Early online date24 Aug 2020
Publication statusPublished - Dec 2020


  • Kinesiophobia
  • TKR
  • Outcome
  • Treatments
  • Systematic Review

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