Kinesiophobia vs. Task-Specific Fear: Defining Movement-Related Fear in ACL Reconstruction Patients

Kinesiophophia or Task-specific Fear of Movement? What Are we Talking About in Patients Post Anterior Cruciate Ligament Reconstruction?

Kinesiophobia, defined as an excessive and irrational fear of physical movement due to perceived vulnerability to injury, has gained significant attention in clinical and scientific communities. This condition can act as a barrier to physical activity, negatively impacting patients' disability, quality of life, and the implementation of rehabilitation programs. It is particularly prevalent after anterior cruciate ligament reconstruction (ACLR), affecting physical function, return to sport rates, and patient performance.

While the Tampa Scale for Kinesiophobia (TSK) is considered a gold standard for assessing kinesiophobia, recent studies have raised concerns about its validity, especially in ACLR patients. The TSK may not adequately capture fear of specific sports activities, which is more common in ACLR patients than a general phobia of movement. Some researchers argue for an assessment approach similar to that used for pain experiences, emphasizing the subjective nature of fear.

Based on the specific phobia model, assessing kinesiophobia in the presence of a trigger, such as visualizing or confronting the movement associated with the injury, may be more relevant. This approach is supported by evidence showing that sports situations evoking the greatest fear after ACLR are cutting, jumping, and contact. Further research is needed to investigate alternative methodologies for assessing fear of movement in ACLR patients, considering the prevalence and repercussions of kinesiophobia in this population.

The objectives of this study are threefold:

• To compare the magnitude of kinesiophobia through the TSK, the subjective feeling of fear when visualising feared movements, and the subjective feeling of fear in anticipation of the feared situation.
• Evaluate the impact of focusing on feared activities on motor behavior and Autonomic Nervous System (ANS) markers.
• To assess the relation between the three methods of assessing fear of movement and indicators of motor behaviour, ANS activity, fear-avoidance beliefs, anxiety, avoidance behaviour, and physical function.

Inclusion Criteria:

• The patient must have given their informed consent and signed the consent form.
• The patient must have enough comprehension of the Portuguese language to complete the written questionnaires.
• The patient must have suffered an ACL injury, with or without a history of concomitant meniscal pathology, while playing or training for sport (recreational or organized).
• The patient must have undergone anterior cruciate ligament reconstruction surgery.
• The patient must be between 18 and 35 years old.
• The patient must still be under medical care/rehabilitation due to the ACL injury.
• The patient must have started jump landing tasks.

Exclusion Criteria:

• The subject has a history of repeated ACLR.
• The subject has not injured the ACL while playing sports.
• The subject presents a concurrent psychiatric disorder
• The subject has a history of heart disease and/or peripheral vascular disease and/or metabolic disease and/or Raynaud´s Syndrome.
• The subject is taking any medications known to affect heart rate or blood pressure
• The subject is currently a smoker.