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Bushra tasneem ali srinivas college of physiotherapy and research center, pandeshwara


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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1

Name of the Candidate

and Address
BUSHRA TASNEEM ALI

SRINIVAS COLLEGE OF PHYSIOTHERAPY AND RESEARCH CENTER, PANDESHWARA,

MANGALORE-575001.



2

Name of the Institute


SRINIVAS COLLEGE OF PHYSIOTHERAPY AND RESEARCH CENTER, MANGALORE.

3

Course of Study and


Subject

Master of Physiotherapy (MPT)

2 years Degree Course.

“Musculoskeletal Disorders & Sports”


4

Date of Admission


To Course

15/09/2011

5

Title of the Topic


Prevalence Of Fear Of Movement [Kinesiophobia] in Individuals with Non-Traumatic Low Back, Hip, Knee and Ankle Pain Complaints – A Cross Sectional Study



6.

7

8

Brief resume of the intended work:

6.1 NEED OF THE STUDY

Kinesiophobia is a term that was introduced by Miller, Kori and Todd in 1990 at the Ninth Annual Scientific Meeting of the American Pain Society and describes a situation where “a patient has an excessive, irrational and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury”.1

The persistence of pain (or chronic pain) can lead to changes in behaviour for both physical and psychological reasons.2One source reported that up to 80% of the population will have musculoskeletal pain and that it is a major cause of disability and limitation of activity.3

Kinesiophobia,(also known as fear of movement/(re)injury) may

lead to avoidance behaviour resulting in hypervigilance to bodily sensations, followed by disability, disuse and depression which may lead to a vicious circle of fear and avoidance in patients experiencing pain. This is in contrast to non-catastrophizing patients in whom not pain-related fear but rather a rapid confrontation with daily activities is likely to occur, leading to faster recovery.4

Studies on patients with chronic low back pain reported that patients with higher levels of pain-related fear, have higher scores on pain and disability.5Studies have been done in post and pre surgical population operated for lumber disc herniation in which kinesiophobia is present.6

The Tampa Scale for Kinesiophobia (TSK) is a 17 item questionnaire used to assess the subjective rating of kinesiophobia or fear of movement.7

Furthermore, studies on acute low back pain and osteoarthritis in primary care have confirmed the relation between fear avoidance and disability.8 In both acute and chronic low back pain cases, kinesiophobia is present.9

Studies have been done in upper extremity to find out the kinesiophobia in acute & chronic conditions with shoulder, arm, neck and hand pain, but in lower extremity it is not been done.

So the purpose of the present study is to find out the prevalence of kinesiophobia in patients with non-traumatic complaints of low back pain, hip, knee & ankle pain.




    1. Review of Literature:

  1. H. Susan J. Picavet et al (2002) conducted a study to see whether an excessively negative orientation toward pain (pain catastrophizing) and fear of movement/(re)injury (kinesiophobia) are important in the etiology of chronic low back pain and associated disability, as clinical studies have suggested. The significant associations remained after adjustment for pain duration, pain severity, or disability at baseline. For those without low back pain at baseline, a high level of pain catastrophizing or kinesiophobia predicted low back pain with disability during follow-up.10

  2. EJCM Swinkels - Meewisse et al (2003): conducted a study were to investigate, in a population with acute LBP, the reliability of TSK and FABQ through evaluation of the internal consistency, the test-retest reliability, and the concurrent validity between TSK and FABQ. It may be concluded that in a population with acute LBP, both the TSK and the FABQ are reliable measures of pain-related fear. In the clinical setting they may provide the practitioner a means of identifying pain-related fear in a patient with acute LBP.11

  3. Lundberg M et al (2006) conducted a study to describe the occurrence of kinesiophobia and to investigate the association between kinesiophobia and pain variables, physical exercise measures and psychological characteristics in patients with musculoskeletal pain. A high degree of kinesiophobia and psychological distress were observed in approximately 50% of the responders. Kinesiophobia is a commonly seen factor among patients with musculoskeletal pain, which ought to be taken into consideration when designing and performing rehabilitation programes.12

  4. Anita Feleus et al. (2007) conducted a study to compare the non traumatic arm, neck or shoulder complaints in general practitioner. It is concluded that among out of sample size 795 patient, about 50% do not recover within 6 months, In non-recovered patients the mean TSK-AV score at baseline was 26.1, which remained unchanged over 12- months follow-up period.4

  5. Harriet Branstrom et al (2008) conducted a study to investigate the degree of kinesiophobia with chronic musculoskeletal pain to examine differences in kinesiophobia and other pain-related characteristics between men and women, and to examine differences in pain-related characteristics between patients with high and low levels of kinesiophobia. He concluded that women with high kinesiophobia tended to be younger, had more pain and showed more tiredness, disability, stress, interference and life dissatisfaction compared with women with low kinesiophobia. These differences were not seen in men.13

  6. Karen Hudes et al (2011) conducted a study to review the literature regarding TSK and neck pain, perceived disability and range of motion of the cervical spine. They concluded that the fear avoidance model can be applied to neck pain sufferers and there is value from a psychometric perspective in using the TSK to assess kinesiophobia.2

  7. Gunilla Limback Svensson et al (2011) conducted a study to see the occurrence of kinesiophobia which has not been investigated previously in patients after disc herniation surgery. In this cross-sectional study, they investigated kinesiophobia in patients who had been treated surgically for lumbar disc herniation. 10–34 months after surgery, questionnaires were sent to 97 patients out of which 36 of 80 patients reported having kinesiophobia.6

  8. Jeffrey Roelofs et al (2011) conducted a study aimed to develop norms for the Tampa Scale for Kinesiophobia (TSK), Data from Dutch, Canadian, and Swedish pain samples were used (N = 3082). It was concluded that chronic low back pain displayed the highest scores on the TSK scores followed by upper extremity disorder, fibromyalgia, and osteoarthritis. Gender was predictive of TSK somatic focus scores and age of TSK activity avoidance scores, with male patients having somewhat higher scores than female patients and older patients having higher scores compared with younger patients.14

  9. Marie Birk Jorgensen et al (2011) conducted a study to evaluate the effects of a 3-month workplace trial with interventions to improve physical or cognitive behavioural resources among cleaners. Based on true observations the strength and balance improvements corresponded to ~20% and ~16%, respectively. As a result the improved strength, postural balance and kinesiophobia may improve the cleaners' tolerance for high physical work demands.15

  10. M Ramprasad et al (2011) conducted a study to examine the relation between fear of movement and perturbation induced electromyographic global trunk muscle voluntary responses with pre-programmed reactions among persons with chronic low back pain (CLBP). It is concluded that there is a significant association between fear of movement and the trunk muscle responses was differentially influenced by expected and unexpected postural demands.16



    1. Objectives of the study

  1. To examine the prevalence of kinesiophobia in patients with non-traumatic complaints of low back pain, hip, knee & ankle pain.

  2. To compare the prevalance of kinesiophobia between acute & chronic non-traumatic complaints of low back pain, hip, knee & ankle pain conditions.

  3. To compare the prevalance of kinesiophobia between non-traumatic complaints of low back pain, hip, knee & ankle joint.

6.4 Hypothesis:

Experimental hypothesis:

  1. There will be difference in the prevalance of kinesiophobia between acute & chronic non-traumatic complaints of low back pain, hip, knee & ankle pain conditions.

  2. There may be difference in the prevalance of kinesiophobia between non-traumatic complaints of low back pain, hip, knee & ankle joints.


Null hypothesis:

  1. There will be no difference in the prevalance of kinesiophobia between acute & chronic non-traumatic complaints of low back pain, hip, knee & ankle pain conditions.

  2. There may be no difference in the prevalance of kinesiophobia between non-traumatic complaints of low back pain, hip, knee & ankle joint.

Material and Methods:

7.1 Source of data:

400 subjects from age group of 25-64 years from general population diagnosed with non-traumatic low back pain, hip, knee and ankle pain will be selected for this study.



Set up:

Study will be conducted in the outpatient department of Srinivas College of Physiotherapy & Research Centre and Srinivas Hospital OPD, Mangalore.



Sampling: PURPOSIVE SAMPLING

Sample Size: 400 subjects with non-traumatic low back pain, hip, knee & ankle pain will be included for this study.

Inclusion Criteria:

  • Age group of 25-64 yrs

  • Both male and female patients.

  • The population with the history low back pain, hip, knee & ankle pain

  • Patients who agree to voluntarily participate in this study and sign informed consent.

Exclusion Criteria:

1. Subjects with no history of any surgery related to musculoskeletal complaints.

2. Individuals doing regular exercises.

3. Subjects having any psychiatric disorders.

4. Subjects with any systemic disorder.

5. Subjects with congenital deformities.

6. Subjects with any trauma, fracture, malignancy, amputation & prosthesis using.

7.2 Method of collection of data:

Subjects with non-traumatic low back pain, hip, knee & ankle pain will be screened for kinesiophobia to be selected according to the inclusion and exclusion criteria. Samples will be asked to sign the written consent form stating the voluntary acceptance to participate in this study. Then, the pre-participation data or demographic data [i.e. Age, Sex, Site/severity of pain, Duration, occupation, Medical conditions, Medications, Surgery/Trauma details] will be collected from all the selected subjects via an interview or interaction. Then these individual data is divided into acute & chronic group.

Then TAMPA scale will be given to the individual to fill and then it will be collected.

Materials to be used:

  • TAMPA Scale of Kinesiophobia

  • A-4 size paper sheets

  • Pen

Measurement for Fear of Movement:

  1. The Tampa Scale for Kinesiophobia (TSK) is a 17 item questionnaire used to assess the subjective rating of kinesiophobia or fear of movement.

  2. The TSK is a self-completed questionnaire and the range of scores are from 17 to 68 where the higher scores indicate an increasing degree of kinesiophobia.
Statistical analysis:

Study design: A Cross sectional Study.

TEST: Descriptive statistics

ANOVA


7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly.

NO. This study only required the interview & interaction with individuals.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?

YES. Consent has been taken from the institute ethical clearance committee.
List of references:AffiliationsAffiliations

    • ENT Department, Hippokrateion General Hospital of Athens, Athens, Greece

    • ENT Department, Hippokrateion General Hospital of Athens, Athens, Greece

    • corresponding author informationAddress. Petros V. Vlastarakos, 29 Dardanellion str., 16562 Athens, Greece. Mobile: +306977803852 begin_of_the_skype_highlighting +306977803852 end_of_the_skype_highlighting; Fax: +302109714870.

Affiliations


    • Pain Clinic, Hippokrateion General Hospital of Athens, Athens, Greece

Affiliations


    • ENT Department, Hippokrateion General Hospital of Athens, Athens, Greece

Affiliations


    • Pain Clinic, Hippokrateion General Hospital of Athens, Athens, Greece

  1. Miller RP, Kori S, Todd D. The Tampa Scale: a measure of kinesiophobia. Clin J Pain.1991; 7(1):51–52.

  2. Karen Hudes, The Tampa Scale of Kinesiophobia and neck pain, disability and range of motion: a narrative review of the literature, J Can Chiropr Assoc.2011; 55(3):222-232.

  3. Lundberg MKE, Styf J, Carlsson SG. A psychometric evaluation of the Tampa Scale for Kinesiophobia – from a physiotherapeutic perspective. Physiotherapy Theory and Practice.2004; 20(2):121–133.

  4. Anita Feleus, Tineke van Dalen1, Sita MA Bierma-Zeinstra, Roos MD Bernsen, Jan AN Verhaar, Bart W Koes and Harald S Miedema. Kinesiophobia in patients with non-traumatic arm, neck and shoulder complaints: a prospective cohort study in general practice. BMC Musculoskeletal Disorders 2007; 8:117.

  5. Gunilla Limback Svensson, Mari Lundberg, Hans Christian Ostgaard, and Gunilla Kjellby Wendt. High degree of kinesiophobia after lumbar disc herniation surgery. Acta Orthop. 2011;82(6): 732–736.

  6. Lundberg M, Styf J, Jansson B. On what patients does the, Tampa Scale for Kinesiophobia fit? Physiotherapy Theory and Practice. 2009;25(7):495–506.

  7. Grotle M, Vollstad NK, Vierod MB, Brox JI. Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain. Pain 2004, 112:343-352.

  8. Zina Trost. Kinesiophobia in chronic low back pain. Pain 2008;137(1):26-33.

  9. H. Susan J. Picavet1, Johan W. S. Vlaeyen2, and Jan S. A. G. Schouten1,3, Pain Catastrophizing and Kinesiophobia: Predictors of Chronic Low Back Pain, Am J Epidemiol 2002;156:1028–1034.

  10. E J C M Swinkels-Meewisse, R A H M Swinkels, A L M Verbeek, J W S Vlaeyen, R A B Oostendorp. Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Manual therapy 2003;91(2):29-36.

  11. Lundberg M, Larsson M, Ostlund H, Styf J. Kinesiophobia among patients with musculoskeletal pain primary healthcare. J Rehabil Med 2006 Jan;38(1):37-43.

  12. Harriet Branstrom and Martin Fahlstrom. Kinesiophobia in patients with chronic musculoskeletal pain: differences between men and women, J Rehab Med 2008; 40:375–380.

  13. Jeffrey Roelofs a, Gerard van Breukelen b, Judith Sluiter c, Monique H.W. Frings-Dresen, Mariëlle Goossens, Pascal Thibault, Katja Boersma, Johan W.S. Vlaeyen. Norming of the Tampa Scale for Kinesiophobia across pain diagnoses and various countries. PAIN 2011;152:1090–1095.

  14. Marie Birk Jorgensen, John Ektor-Andersen, Gisela Sjogaard, Andreas Holtermann and Karen Sogaard. A randomized controlled trial among cleaners-Effects on strength, balance and kinesiophobia. BMC Public Health 2011; 11: 776.

  15. M Ramprasad, D Shweta Shenoy, Jaspal Singh Sandhu and N Sankara. The influence of kinesiophobia on trunk muscle voluntary responses with pre-programmed reactions during perturbation in patients with chronic low back pain. J Body Mov Ther 2011; 15(4):485-495.

  16. Lundberg, Mari, Styf, Jorma, Carlsson, Sven. A psychometric evaluation of the Tampa Scale for Kinesiophobia — from a physiotherapeutic perspective. Informa healthcare 2004;20(2):121-133(13).

  17. Burwinkle T, Robinson JP, Turk DC, Fear of movement: factor structure of the Tampa scale of kinesiophobia in patients with fibromyalgia syndrome. J Pain. 2005 June;6(6):384-91.

  18. Jo Nijs, Kenny De Meirleir, William Duquet. Kinesiophobia in Chronic Fatigue Syndrome: Assessment and Associations With Disability. Arch Phys Med Rehabil 2004;85.

  19. Authors: Nijs J, Meeus M, Heins M, Knoop H, Moorkens G, Bleijenberg G, Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimental study. 2012;14:19.

  20. Mari Lundberg, Kinesiophobia Various Aspects of Moving with Musculoskeletal Pain. Journal of Rehabilitation Medicine 2006;1:37-43.

  21. Kernan T, Rainville J. Observed outcomes associated with a quota-based exercise approach on measures of kinesiophobia in patients with chronic low back pain. J Orthop Sports Phys Ther.2007; 37(11):679-87.

  22. Bie Nio Ong, Phdclare Jinks, and Andrew Morden. The Hard Work of Self-Management: living with chronic knee pain, Int J Qual Stud Health Well-Being. 2011;6(3):10.3402/7035.

  23. Alexis A. Wright, Chad Cook, J. Haxby Abbott. Variables associated with the progression of hip Osteoarthritis: A systematic review. Arthritis Care & Research 2009;61(7):925–936.

  24. Dennis E. Enix, Joseph H. Flaherty, Kasey Sudkamp, Jessica Schulz. Balance Problems in the Geriatric Patient. Topics in Integrative Health Care 2011;2(1)ID: 2.1002.http://www.tihcij.com/Articles/Balance-Problems-in-the-Geriatric-Patient.aspx?id=0000256.




9
Signature of the Candidate

10
Remarks of the Guide

11

Name & Designation of:





11.1 Guide

11.2 Signature

DR. KARTHIKEYAN G.

Associate Professor in Physiotherapy.






11.3 Co-guide (if any)

11.4 Signature
DR. RAMPRASAD M.
Professor in Physiotherapy and Principal.



11.5 Head of the Department


11.6 Signature
DR. T.JOSELEY SUNDERRAJ PANDIAN
Associate Professor in Physiotherapy and P.G Coordinator.

12
12.1 Remarks of Chairman and Principal


12.2 Name and Signature
Accepted by the scientific and ethical committee
DR. RAMPRASAD M.

Professor and Principal




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