Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 10, pp 2295–2300 | Cite as

Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain

  • Julio Doménech
  • Vicente Sanchis-AlfonsoEmail author
  • Begoña Espejo



The purpose of the study was to investigate if changes in psychological variables are related to the outcome in pain and disability in patients with chronic anterior knee pain.


A longitudinal observational study on 47 patients with chronic anterior knee pain was performed in a secondary healthcare setting. Pain was measured with the visual analogue scale and disability with the Lysholm scale. The psychological variables, such as anxiety, depression, pain coping strategies, catastrophizing and fear to movement beliefs, were studied by using self-administered questionnaires.


Among the pain coping strategies, only the catastrophizing subscale showed a significant reduction. Similarly, anxiety, depression and kinesiophobia were significantly reduced after treatment. Those patients who decreased the catastrophizing, kinesiophobia, anxiety and depression showed a greater improvement in pain and disability after a purely biomedical treatment. A multiple regression analysis revealed that changes in catastrophizing predicted the amount of improvement in pain severity and that changes in both catastrophizing and anxiety predicted changes in disability after treatment.


What has been found suggests that clinical improvement in pain and disability is associated with a reduction in catastrophizing and kinesiophobia. Therefore, co-interventions to reduce catastrophizing thinking and kinesiophobia may enhance the results.

Level of evidence

Prospective Cohort Study, Level I for prognosis.


Anterior knee pain Patellofemoral pain Kinesiophobia Catastrophizing Anxiety Depression 


  1. 1.
    Boeckstyns MEH, Backer M (1989) Reliability and validity of the evaluation of pain in patients with total knee replacement. Pain 38:29–33PubMedCrossRefGoogle Scholar
  2. 2.
    Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR (2009) The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 37:890–897PubMedCrossRefGoogle Scholar
  3. 3.
    Brox JI, Sørensen R, Friis A, Nygaard Ø, Indahl A, Keller A, Ingebrigtsen T, Eriksen HR, Holm I, Koller AK, Riise R, Reikerås O (2003) Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 28:1913–1921PubMedCrossRefGoogle Scholar
  4. 4.
    Burns JW, Glenn B, Bruehl S, Harden RN, Lofland K (2003) Cognitive factors influence outcome following multidisciplinary chronic pain treatment: a replication and extension of a cross-lagged panel analysis. Behav Res Ther 41:1163–1182PubMedCrossRefGoogle Scholar
  5. 5.
    Chmielewski TL, Zeppieri G Jr, Lentz TA, Tillman SM, Moser MW, Indelicato PA, George SZ (2011) Longitudinal changes in psychosocial factors and their association with knee pain and function after anterior cruciate ligament reconstruction. Phys Ther 91(9):1355–1366PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Crombez G, Eccleston C, Baeyens F (1998) When somatic information threatens, catastrophic thinking enhances attentional interference. Pain 75:187–198PubMedCrossRefGoogle Scholar
  7. 7.
    De Das S, Vranceanu AM, Ring DC (2013) Contribution of kinesophobia and catastrophic thinking to upper-extremity-specific disability. J Bone Joint Surg Am 95:76–81CrossRefGoogle Scholar
  8. 8.
    Domenech J, Sanchis-Alfonso V, Lopez L, Espejo B (2013) Influence of kinesiophobia and catastrophizing on pain and disability in anterior knee pain patients. Knee Surg Sports Traumatol Arthrosc 21:1562–1568PubMedCrossRefGoogle Scholar
  9. 9.
    Edward RR, Smith MT, Stonerock G et al (2006) Pain-related catastrophizing in healthy women is associated with greater temporal summation of and reduced habituation to thermal pain. Clin J Pain 22:730–737CrossRefGoogle Scholar
  10. 10.
    Edwards RR, Giles J, Bingham CO III, Campbell C, Haythornthwaite JA, Bathon J (2010) Moderators of the negative effects of catastrophizing in arthritis. Pain Med 11:591–599PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    García Campayo J, Rodero B, Alda M, Sobradiel N, Montero J, Moreno S (2008) Validación de la versión española de la Pain Catastrophizing Scale en pacientes con fibromialgia. Med Clin 131:487–492CrossRefGoogle Scholar
  12. 12.
    Gracely RH, Geisser ME, Giesecke T (2004) Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain 127:835–843PubMedCrossRefGoogle Scholar
  13. 13.
    Herrero MJ, Blanch J, Peri JM et al (2003) A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. Gen Hosp Psychiatry 25:277–283PubMedCrossRefGoogle Scholar
  14. 14.
    Jensen MP, Karoly P, O’Riordan EF, Bland F Jr, Burns RS (1989) The subjective experience of acute pain: an assessment of the utility of 10 indices. Clin J Pain 5:153–159PubMedCrossRefGoogle Scholar
  15. 15.
    Johnson LL, van Dyk GE, Green JR (1998) Clinical assessment of asymptomatic knees: comparison of men and women. Arthroscopy 14:347–359PubMedCrossRefGoogle Scholar
  16. 16.
    Keefe FJ, Affleck G, Lefebvre JC (1997) Pain coping strategies and coping efficacy in rheumatoid arthritis: a daily process analysis. Pain 69:35–42PubMedCrossRefGoogle Scholar
  17. 17.
    Kori KS, Miller RP, Todd DD (1990) Kinesiophobia: a new view of chronic pain behaviour. Pain Manag 3:35–43Google Scholar
  18. 18.
    Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW (2007) The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 30:77–94PubMedCrossRefGoogle Scholar
  19. 19.
    Leeuw M, Goossens ME, van Breukelen GJ, de Jong JR, Heuts PH, Smeets RJ, Köke AJ, Vlaeyen JW (2008) Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial. Pain 138:192–207PubMedCrossRefGoogle Scholar
  20. 20.
    Linton SJ, Nordin E (2006) A 5-year follow-up evaluation of the health and economic consequences of an early cognitive behavioral intervention for back pain: a randomized, controlled trial. Spine 15:853–858CrossRefGoogle Scholar
  21. 21.
    Macintyre NJ, Hill NA, Fellows RA (2006) Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome. J Bone Joint Surg 88A:2596–2605CrossRefGoogle Scholar
  22. 22.
    Peters ML, Vlaeyen JWS, Weber WEJ (2005) The joint contribution of physical pathology, pain-related fear and catastrophizing to chronic back pain disability. Pain 113:45–50PubMedCrossRefGoogle Scholar
  23. 23.
    Picavet HSJ, Vlaeyen JWS, Schouten SAG (2002) Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol 156:1028–1034PubMedCrossRefGoogle Scholar
  24. 24.
    Piva SR, Fitzgerald GK, Wisniewski S, Delitto A (2009) Predictors of pain and function outcome after rehabilitation in patients with patellofemoral pain syndrome. J Rehabil Med 41:604–612PubMedCrossRefGoogle Scholar
  25. 25.
    Powers CM, Bolgla LA, Callaghan MJ, Collins N, Sheehan FT (2012) Patellofemoral pain: proximal, distal, and local factors, 2nd international research retreat. J Orthop Sports Phys Ther 42:A1–A54PubMedCrossRefGoogle Scholar
  26. 26.
    Rainville J, Smeets RJ, Bendix T, Tveito TH, Poiraudeau S, Indahl AJ (2011) Fear-avoidance beliefs and pain avoidance in low back pain-translating research into clinical practice. Spine J 11:895–903PubMedCrossRefGoogle Scholar
  27. 27.
    Riddle DL, Wade JB, Jiranek WA, Kong X (2010) Preoperative pain catastrophizing predicts pain outcome after knee arthroplasty. Clin Orthop Relat Res 468(3):798–806PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Rodríguez Franco L, Cano García FJ, Blanco Picabia A (2004) Evaluación de las estrategias de afrontamiento del dolor crónico. Actas Esp Psiq 32:82–91Google Scholar
  29. 29.
    Rosenstiel AK, Keefe FJ (1983) The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 17:33–44PubMedCrossRefGoogle Scholar
  30. 30.
    Sanchis-Alfonso V (2014) Holistic approach to understanding the anterior knee pain. Clinical implications. Knee Surg Sports Traumatol Arthrosc (in press)Google Scholar
  31. 31.
    Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA (2006) Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain 7:261–271PubMedCrossRefGoogle Scholar
  32. 32.
    Sullivan HJL, Bishop SR, Pivik J (1995) The Pain Catastrophizing Scale: development and validation. Psychol Assess 7:524–532CrossRefGoogle Scholar
  33. 33.
    Sullivan M, Tanzer M, Stanish W, Fallaha M, Keefe FJ, Simmonds M, Dunbar M (2009) Psychological determinants of problematic outcomes following total knee arthroplasty. Pain 143:123–129PubMedCrossRefGoogle Scholar
  34. 34.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMedGoogle Scholar
  35. 35.
    Theunissen M, Peters ML, Bruce J, Gramke HF, Marcus MA (2012) Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain 28:819–841PubMedCrossRefGoogle Scholar
  36. 36.
    Thomeé P, Thomeé R, Karlsson J (2002) Patellofemoral pain syndrome: pain, coping strategies and degree of well-being. Scand J Med Sci Sports 12:276–281PubMedCrossRefGoogle Scholar
  37. 37.
    Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, Bombardier C, Felson D, Hochberg M, van der Heijde D, Dougados M (2005) Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann Rheum Dis 64:34–37PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Vlaeyen JW, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332PubMedCrossRefGoogle Scholar
  39. 39.
    Wade JB, Riddle DL, Thacker LR (2012) Is pain catastrophizing a stable trait or dynamic state in patients scheduled for knee arthroplasty? Clin J Pain 28:122–128PubMedCrossRefGoogle Scholar
  40. 40.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Julio Doménech
    • 1
    • 2
  • Vicente Sanchis-Alfonso
    • 1
    • 3
    Email author
  • Begoña Espejo
    • 4
  1. 1.Department of Orthopaedic SurgeryHospital Arnau de VilanovaValenciaSpain
  2. 2.Facultad de Ciencias de la SaludUniversidad CEU-Cardenal HerreraValenciaSpain
  3. 3.Hospital 9 de OctubreValenciaSpain
  4. 4.Department of Methodology of the Behavioural Sciences, Facultad de PsicologíaUniversity of ValenciaValenciaSpain

Personalised recommendations