Pain-Related Fear Contributes to Self-Reported Disability in Patients With Foot and Ankle Pathology

Lentz TA, Sutton Z, Greenberg S, Bishop MD. Pain-related fear contributes to self-reported disability in patients with foot and ankle pathology. Arch Phys Med Rehabil 2010;91:557-61. Objective: To determine the unique influence of pain-related fear of movement on foot and ankle disability, after accounting for pain, demographic, and physical impairment variables. Design: Cross-sectional study using retrospective chart review. Setting: Outpatient rehabilitation clinic. Participants: Referred sample of subjects with foot- and ankle-related disability (N=85, 40 men; mean age, 33y; range, 16-77y). Interventions: Not applicable. Main Outcome Measures: Lower Extremity Functional Scale (LEFS), Shortened Tampa Scale of Kinesiophobia (TSK-11). Results: Hierarchical regression analysis determined the proportions of explained variance in disability (LEES). Demographic variables were entered into the model first, followed by pain intensity and range-of-motion (ROM) deficit, and finally, TSK-11. Demographics collectively contributed 9% (P=.015) of the variance in disability scores. Pain intensity and overall ROM deficit contributed an additional 11% (P<.001) of the variance, and TSK-11 scores contributed an additional 14% (P<.001). In the overall model, age (beta=-.29, P=.004), chronicity of symptoms (beta=.23, P=.024), ROM deficit (beta=-.28, P=.003), and TSK-11 (beta=-.41, P<.001) explained 34% of the variance in the LEFS score (P<.001). Conclusions: Age, chronicity of symptoms, ROM deficit, and TSK-11 scores all significantly contributed to baseline foot and ankle self-reported disability. Pain-related fear of movement was the strongest single contributor to disability in this group of patients.