Background: Systematic reviews indicate that exercise has the most evidence of effectiveness in treatment of midportion Achilles tendinopathy. However, there is a lack of long-term follow-ups (>4 years). Purpose: To evaluate the 5-year outcome of patients treated with exercise alone and to examine if certain characteristics, such as level of kinesiophobia, age, and sex, were related to the effectiveness of the treatment. Study Design: Case series; Level of evidence, 4. Methods: Thirty-four patients (47% women), 51 ± 8.2 years old, were evaluated 5 years after initiation of treatment. The evaluation consisted of a questionnaire regarding recovery of symptoms and other treatments, the Victorian Institute of Sports Assessment–Achilles questionnaire (VISA-A) for symptoms, the Tampa Scale for Kinesiophobia, and tests of lower leg function. Results: Twenty-seven patients (80%) fully recovered from the initial injury; of these, 22 (65%) had no symptoms, and 5 (15%) had a new occurrence of symptoms. Seven patients (20%) had continued symptoms. Only 2 patients received another treatment (acupuncture and further exercise instruction). When compared with the other groups, the continued-symptoms group had lower VISA-A scores (P = .008 to .021) at the 5-year follow-up and the previous 1-year follow-up but not at any earlier evaluations. There were no significant differences among the groups in regard to sex, age, or physical activity level before injury. There was a significant (P = .005) negative correlation (−0.590) between the level of kinesiophobia and heel-rise work recovery. Conclusion: The majority of patients with Achilles tendinopathy in this study fully recovered in regard to both symptoms and function when treated with exercise alone. Increased fear of movement might have a negative effect on the effectiveness of exercise treatment; therefore, a pain-monitoring model should be used when patients are treated with exercise.

Background: Bone-anchored prosthesis is still a rather unusual treatment for patients with limb loss. Objectives: The aim of this study was to improve our understanding about the experience of living with an osseointegrated prosthesis (OI-prosthesis) compared to one suspended with a socket, through the use of qualitative research methodology. Study design: A qualitative phenomenological research method. Methods: Thirteen Swedish patients (37–67 years) with unilateral upper or lower limb amputation (10 transfemoral, 2 transhumeral, 1 transradial), who had been using OI-prostheses for 3 to 15 years, were recruited by means of purposive sampling. An audio-taped in-depth interview was performed. The guiding question was ‘How do you experience living with your osseointegrated prosthesis compared to your earlier prostheses suspended with sockets?’. The empirical phenomenological psychological method was used for data analysis. Results: The results showed that all participants described living with an OI-prosthesis as a revolutionary change. These experiences were described in terms of three typologies, called ‘Practical prosthesis’, ‘Pretend limb’ and ‘A part of me’. Conclusions: The most important finding was that the change went beyond the functional improvements, integrating the existential implications in the concept of quality of life. Clinical relevance This qualitative in-depth interview study on patients using bone-anchored prosthetic limbs showed that all described a revolutionary change in their lives as amputees and the meaning of that change went beyond the functional improvements, integrating existential implications in the concept of quality of life.

Objectives: In regards to pain-related fear, this study aimed to: (1) identify existing measures and review their measurement properties, and (2) identify the optimum measure for specific constructs of fear-avoidance, pain-related fear, fear of movement, and kinesiophobia. Design: Systematic literature search for instruments designed to measure fear of pain in patients with persistent musculoskeletal pain. Psychometric properties were evaluated by adjusted Wind criteria. Results: Five questionnaires (Fear-Avoidance Beliefs Questionnaire (FABQ), Fear-Avoidance of Pain Scale (FAPS), Fear of Pain Questionnaire (FPQ), Pain and Anxiety Symptoms Scale (PASS), and the Tampa Scale for Kinesiophobia (TSK)) were included in the review. The main findings were that for most questionnaires, there was no underlying conceptual model to support the questionnaire's construct. Psychometric properties were evaluated by diverse methods, which complicated comparisons of different versions of the same questionnaires. Construct validity and responsiveness was generally not supported and/or untested. Conclusion: The weak construct validity implies that no measure can currently identify who is fearful. The lack of evidence for responsiveness restricts the current use of the instruments to identify clinically relevant change from treatment. Finally, more theoretically driven research is needed to support the construct and thus the measurement of pain-related fear.

To describe the occurrence of kinesiophobia and to investigate the association between kinesiphobia and pain variables, physical exercise measures and psychological characteristics in patients with musculoskeletal pain. A prospective descriptive study involving 2 selected physiotherapy departments within a primary healthcare setting in the south-west of Sweden. Included were 140 of 369 (38%) consecutive patients (aged between 18 and 65 years) with musculoskeletal pain. Questionnaires including background data, pain variables, physical exercise measures and psychological characteristics were sent to the patients prior to their appointment with the physiotherapist. A simple and a multiple logistic regression model were performed to identify associations among the variables where kinesiophobia was defined as the dependent variable. A high degree of kinesiophobia and psychological distress were observed in approximately 50% of the responders. According to the simple logistic regression analysis the factors that seemed to be associated with kinesiophobia were interference, disability, pain severity, pain intensity, life control, affective distress, depressed mood and solicitous response. The multiple logistic regression analysis showed no significant associations. Kinesiophobia is a commonly seen factor among patients with musculoskeletal pain, which ought to be taken into consideration when designing and performing rehabilitation programmes.