Investigating Kinesiophobia Levels After Primary and Secondary ACL Reconstruction

Background

I always joke that research is in my blood. Both my grandfathers and dad are researchers and authors, so it was natural for me to look into research as well. I had the opportunity to complete a honors thesis in undergrad and enjoyed the process so much that I wanted to do it again in graduate school! Knowing this, I looked into research opportunities within the program and found Dr. Thoma’s posttraumatic osteoarthritis (PTOA) research fascinating given my background and passion for sports and rehabilitation. Dr. Thoma required us to give 2 presentations on topics somewhat related to PTOA and while researching for a potential topic, I found copious amounts of literature about psychological factors’ impact on return to sport after ACL reconstruction, specifically kinesiophobia. I enjoyed researching and presenting on the topic so much. As initial thoughts of capstone loomed, I discussed the possibility of doing something related to kinesiophobia for my capstone. Luckily for me, Dr. Baez recently joined faculty in the EXSS department on campus and this is her area of expertise. I feel very lucky that all the stars aligned to make this capstone possible! 

Statement of Need

Anterior cruciate ligament (ACL) ruptures is a common orthopedic injury with an annual incidence of 68.8 per 100,000 people. There has been a significant increase in the rate of ACL reconstruction (ACLR) over time, indicating an increased significance for patients to previous level of activity and return to sport. One-third of patients, however, fail to return to prior level of sport after ACLR and patients who underwent ACLR spend less time in moderate-vigorous physical activity and have lower step count compared to their healthy, age-matched peers. The latter is especially concerning since lack of regular physical activity can lead to a myriad of chronic diseases.

Evidence has firmly established the importance of physical performance and readiness to return to sport, but current literature is also showing the importance of psychological readiness as well with some research suggesting it is the most important factor in returning to sport after ACLR. Psychological factors, specifically injury-related fear and self-efficacy were associated more significantly than functional outcomes with return to sport and physical activity levels. Decreased psychological readiness also delayed return to sport and decreased return to sport rates. Patients with high levels of self-reported fear are also four times more likely to report lower levels of physical activity. Psychological readiness could be the reason for decreased physical activity levels even after successful rehabilitation so addressing this in conjunction with physical readiness is of the utmost importance for patients to remain healthy for the remainder of their lives.  

Kinesiophobia is one aspect of psychological readiness and can be defined as “excessive, irrational and debilitating fear to carry out physical movement, due to a feeling of vulnerability to a painful injury or reinjury.” The Tampa Scale of Kinesiophobia (TSK) is a common self-report measure used to measure a patient’s kinesiophobia level. It is a 17-item with a scoring range of 1 to 4 totaling 17- to 68. A score of 17 indicates no kinesiophobia whereas a score of 68 indicates severe kinesiophobia. High levels of kinesiophobia are associated with greater levels of pain intensity and disability. High levels of kinesiophobia are also associated with stiffened movement patterns and decreased loading of the ACLR limb, both of which can increase risk of reinjury.

Reinjury can be defined either as contralateral ACL tear or ipsilateral graft rupture of the reconstructed limb. Patients who went on to suffer an ipsilateral secondary ACL injury had a greater TSK-11 score at the time of return to sport than those who did not suffer a secondary ACL injury. The negative impact kinesiophobia has on return to sport rates, physical activity engagement, risk of reinjury warrants it as a topic that should be further explored. There is even further limited research on kinesiophobia levels in individuals after their secondary ACLR.

Purpose

The purpose of this study is to compare differences in kinesiophobia 4 to 8 months after an individual’s primary versus secondary ACLR. This time range was selected because this is a typical time of transition in rehabilitation to potentially fear-evoking strength, agility, and return to sport activities.

Products

The main product of this capstone is a manuscript that is attached below. 

Mishra_Capstone_Final

A handout detailing the impact of kinesiophobia on ACL rehabilitation served as the health literacy component to this project. The intended audience is clinicians. 

KinesiophobiaHandout_Mishra_Capstone.4.21.2023 (1)

Evaluation and Self Reflection

I would say that this project was a success, and all my goals and objectives were met. I learned an incredible amount in such a short amount of time with this capstone project. There were times where it felt very vast, almost too big for me to handle, but through the guidance and mentorship of my committee members, I was able to break it down into manageable pieces. They let me safely struggle and spend a lot of time with the material before stepping in to help. This allowed me to grow my skills, increase my autonomy, and knowledge on the subject matter. I’ve improved in my scientific writing throughout this process and I know it will continue to grow. I learned the importance of flexibility when I had to alter my topic slightly and the importance of asking others for help when needed. My communication skills with my peers, mentors, and other scientists were easier and more natural as time went on as well. In the future, I plan to submit this manuscript with some alterations for possible publication in a scientific journal and other conferences. 

For the evaluation portion of the project, I was in constant contact with Dr. Thoma and Dr. Baez. Dr. Baez and I held weekly meetings throughout the semester to touch base on progress on the project and if any questions had come up. This held me accountable, and our conversations made me think critically. Dr. Thoma and I also met frequently to discuss the project’s progression. My committee provided me outstanding feedback regarding my manuscript’s content, readability, and syntax. They really guided me through the scientific writing process, and I couldn’t have done it without them. 

Acknowledgements

To Dr. Louise Thoma, PT, DPT, PhD and Dr. Shelby Baez, ATC, PhD: Words cannot express how thankful and grateful am I for you both. You were the heart and soul of this project, and I couldn’t have done it without your guidance and constant support! You both challenged me to be at my best and produce my best work. Thank you for stepping in and taking the lead for adjusting the project to fit better with the data available. It’s also been a pleasure to get to know you both on a more personal level! You’ve made this research experience invaluable! 

To Dr. Deidra Charity, PT, DPT, SCS: Thank you so much for being on my committee! I’ve enjoyed learning from you throughout this process and all of your feedback. You provided great clinician-oriented feedback which was invaluable to the clinical implications of this project. 

To Joseph Hart, ATC, PhD and the rest of the LEAP team: Thank you so much for collecting and distributing the data used for this secondary analysis. Huge thank you for answering all the countless emails from a very confused (at times) DPT student! 

To my DPT Class of 2023 family: I cannot believe this day is already here! It seemed like it was just yesterday that we started this journey together. Thank you for laughing, crying, and most importantly, supporting me throughout this journey. I cannot wait to see where we all go! We’re going to do big things!

References For This Page

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