Kinesiphobia hinders functional performance outcomes in juvenile idiopathic arthritis: Study

USA: According to a study published in Pediatric Rheumatology, activities involving bodily transfers were difficult for kids with Juvenile Idiopathic Arthritis (JIA) and Kinesiophobia, a pain-related phobia of movement, severely impacted functional task performance and may affect clinical outcomes.

Even when children with JIA express minimal disease activity, discomfort, and disability, they modify their walking gait to achieve greater lower limb joint flexion, reduced hip and knee extension, and a more crouched guarded gait pattern. Children with JIA have lower pain thresholds than their healthy peers, which may increase central nervous system excitability and pain sensitization.

"Unfortunately, there is limited research on how severe kinesiophobia is in children with chronic rheumatologic pain and how it relates to everyday physical function, self-reported impairment, and quality of life. There is a critical knowledge gap here that demands attention," the authors said.

The investigators aimed to measure the disparities in physical function between JIA patients and healthy controls, as well as to ascertain how kinesiophobia affects physical activity and performance.

JIA patients (n = 26) and healthy controls (n = 17) were the subjects of a cross-sectional, comparative investigation. Lower extremity joints were affected in patients with the JIA cohort. Gait speed, chair navigation, and stair navigation were used to gauge performance. The Physical Function Mobility and Pain Interference Scales, the Patient Reported Outcome Measurement Information System (PROMIS), and the Pediatric Functional Activity Brief Scale were used as self-reported assessments (Pedi-FABS). PROMIS strongly emphasized evaluating social, mental, and physical health.

The Tampa Scale of Kinesiophobia (TSK-11), a valid, 2-factor, 11-item questionnaire, was used to examine fear of activity and re-injury because of pain. As per the International League of Associations of Rheumatology (ILAR), patients diagnosed with JIA who now or previously had sacroiliac joint or lower extremity joint dysfunction were included in the study. Patients' ages ranged from 7 to 21. Each patient underwent evaluations for joint swelling, range of motion, and pain when moving, as well as a physician global assessment of disease activity. The connection between TSK-11 scores and performance test or Pedi-FABS scores was assessed using linear regression models.

Conclusive points of the study:

• Compared to controls, JIA participants' gait speeds were 11–15% slower, chair rise repeats were 28% lesser, and stair ascent and descent times were 26-31% slower.
• JIA patients had PROMIS® Physical Function Mobility values 10% lower and pain interference scores 2.6 times higher compared to healthy controls,
• JIA subjects had greater TSK-11 scores than controls.
• In regression models for stair climb time, chair rise performance, and Pedi-FABS scores, TSK-11 scores accounted for 11.7–26.5% of the variance after adjusting for variables.

The investigators concluded that children with JIA typically score lower on self-report and performance tests in the mobility and body weight transfer domains.

"The performance of body weight transfer motions and levels of physical activity were directly impacted by the kinesiophobia that JIA-affected youngsters in this group displayed. Through the patient's perspective on their experience of living with JIA, kinesiophobia may aid in clinical care," the authors added.

REFERENCE

Woolnough, L.U., Lentini, L., Sharififar, S. et al. The relationships of kinesiophobia and physical function and physical activity level in juvenile idiopathic arthritis. Pediatr Rheumatol 20, 73 (2022).

https://doi.org/10.1186/s12969-022-00734-2