Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Correlates of Physical Function in Axial Spondylarthropathy: Fear of Movement as an Independent Contributor.

Swinnen3,  Thijs, Vlaeyen4,  Johan, Dankaerts1,  Wim, Westhovens5,  Rene, de Vlam2,  Kurt

Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium
Department of Rheumatology, University Hospitals Leuven, Sint Martens Leerne, Belgium
Department of Rheumatology, University Hospitals Leuven, Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium
Research Group on Health Psychology, Catholic University of Leuven, Department of Clinical Psychological Science, Maastricht University, Leuven, Belgium
University Hospitals Leuven, Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium

Purpose:

To establish the independent contribution of the psychological attribute "fear of movement and (re)injury" in explaining physical function in a large cohort of patients with axial Spondylarthropathy (aSpA).

Methods:

We collected measures of anthropometrics (Body Mass Index), gender, disease duration, the use of medication (Biologicals and NSAIDs), physical function (Bath Ankylosing Spondylitis Functional Index), stiffness (averaged items 5 and 6 of the Bath Ankylosing Spondylitis Disease Activity Index), pain (Numerical Rating Scale), spinal mobility (Bath Ankylosing Spondylitis Metrology Index) and fear of movement and (re)injury (Tampa Scale for Kinesiophobia1) in 126 patients with aSpA. We used a stepwise multiple linear regression modeling approach with physical function as the dependent variable. Because the assessment of fear of movement in aSpA is new, we checked for the Tampa Scale for Kinesiophobia's normal distribution and internal consistency with the Shapiro-Wilk and Cronbach's Alpha tests respectively. The level of significance was set at.05 for all analyses.

Results:

Spinal mobility (mean=3.3;stb=.409;p=.000), pain (mean=3.6;stb=.347;p=.000), stiffness (mean=3.8;stb=.277;p=.000), fear of movement and (re)injury (mean=25.6;stb=.175;p=.000), the use of biologicals (no=0/yes=1:61/65;stb=.118;p=.011) and gender (male=0/female=1:80/46;stb=.103;p=.032) contributed significantly to physical function (mean=3.9). Disease duration (13.3years;p=.517), anthropometrics (mean=26.3;p=.273) and the use of NSAIDs (no=0/yes=1:52/74;p=.632) were not entered during the stepwise analysis. Pain partially mediated the effect of fear of movement on physical function as evidenced by simple mediation (Sobel test;p=.000) and after controlling for all other modeled variables in our mediation model (bootstrapping procedure;95% confidence interval=.0103-.0503). Our potent model on correlates of physical function explained as much as 76% of the variance (adjusted R2) without violating any assumption of regression modeling. The Tampa Scale for Kinesiophobia scores were normally distributed (p=.348) and showed a good internal consistency (a=.81).

Conclusion:

Fear of movement and (re)injury is an important contributor to physical function beyond traditional disease-specific outcome measures in patients with aSpA. The Tampa Scale for Kinesiophobia appears to be an appropriate instrument to assess fearful beliefs related to movement and (re)injury. Further exploration in this area is both justified and needed.

References:

1Woby, SR, Roach, NK, Urmston, M & Watson, PJ. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain. 2005 Sep;117(1–2):137-44.

To cite this abstract, please use the following information:
Swinnen, Thijs, Vlaeyen, Johan, Dankaerts, Wim, Westhovens, Rene, de Vlam, Kurt; Correlates of Physical Function in Axial Spondylarthropathy: Fear of Movement as an Independent Contributor. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :520
DOI: 10.1002/art.28289

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