Kinesiophobia negatively influences recovery of joint function following total knee arthroplasty.

BACKGROUND: The influence of kinesiophobia on disability in patients with knee osteoarthritis is known, but its influence on functional recovery after total knee arthroplasty remains unexplored. AIMS: To assess the influence of kinesiophobia on functional recovery following total knee arthroplasty (TKA) in patients with knee osteoarthritis and to investigate if kinesiophobia was more common in obese patients than in non-obese patients. DESIGN: Cohort study. SETTING: Inpatients of the Physical Medicine and Rehabilitation unit of the Château-Renault hospital (France). POPULATION: The study included 89 consecutive patients (mean age = 72.6 years) hospitalized for postoperative rehabilitation after TKA. All patients completed the study. METHODS: We evaluated functional outcome by testing maximum passive flexion, pain intensity, the duration of hospitalization, and performance in a six minute walk test. Kinesiophobia was assessed by the Tampa Scale for Kinesiophobia (TSK) score. Obesity was assessed by calculation of body mass index (BMI). A Stepwise multiple linear regression was used to determine significant independent predictors of the distance at the six minute walk test. RESULTS: During the six minute walk test, patients without kinesiophobia walked significantly farther than patients with kinesiophobia (309.5 [83.6] m vs. 264.8 [96.5] m, P=0.048). There were no significant differences in the duration of hospitalization, the maximum passive flexion, or pain intensity between the two groups. The best multivariate model of factors associated with the performance in the 6 minute walk test included the Lequesne's score before surgery, the degree of active extension of the knee at the beginning of hospitalization, the TSK scores (total score, classification with the TSK score, "avoidance" subscale score). The overall TSK score did not differ between the obese and non-obese groups. CONCLUSION: Our study is consistent with previous reports that cognitive and behavioral maladaptative strategies can impair functional recovery after TKA. Moreover, unlike previous work, the principal endpoint of our study is an objective measurement of walking capacity, and not a questionnaire. CLINICAL REHABILITATION IMPACT: WE suggest that programs aimed at the management of such cognitive and behavioral factors which contribute to activity avoidance during rehabilitation are likely to improve functional recovery after TKA.