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

Knee Surg Sports Traumatol Arthrosc. 2014 Oct;22(10):2295-300. doi: 10.1007/s00167-014-2968-7. Epub 2014 Apr 2.


Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Observational Study

MeSH terms

  • Activities of Daily Living
  • Adult
  • Anxiety
  • Arthralgia / complications
  • Arthralgia / psychology*
  • Arthralgia / therapy
  • Catastrophization / etiology*
  • Cohort Studies
  • Culture
  • Depression / etiology*
  • Disability Evaluation
  • Fear
  • Female
  • Humans
  • Knee
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Movement
  • Pain / psychology
  • Pain Measurement
  • Patellofemoral Pain Syndrome / complications
  • Patellofemoral Pain Syndrome / psychology*
  • Patellofemoral Pain Syndrome / therapy
  • Phobic Disorders / etiology*
  • Prospective Studies
  • Regression Analysis
  • Surveys and Questionnaires
  • Young Adult