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Does kinesiophobia modify the effect of physical therapy on outcome in patients with sciatica in primary care? Subgroup analysis from a randomized controlled trial
Verwoerd AJH, Luijsterburg PAJ, Koes BW, el Barzouhi A, Verhagen AP
Physical Therapy 2015 Sep;95(9):1217-1223
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: A higher level of kinesiophobia seems to be associated with poor recovery in patients with sciatica. OBJECTIVE: To investigate if kinesiophobia modifies the effect of physical therapy on outcome in patients with sciatica. DESIGN: A subgroup analysis from a randomized controlled trial. SETTING: Primary care. PATIENTS: A total of 135 patients with acute sciatica. INTERVENTION: Patients were randomized to physical therapy plus general practitioners' care or to general practitioners' care alone. MEASUREMENTS: Kinesiophobia at baseline was measured with the Tampa Scale for Kinesiophobia (TSK) and a single substitute question for kinesiophobia (SQK). Pain and recovery were assessed at 3 and 12-months follow-up. Regression analysis was used to test for interaction between the level of kinesiophobia at baseline and treatment allocation. Subgroup results were calculated for patients 'suggestive of high fear of movement' and for patients 'suggestive of low fear of movement'. RESULTS: Kinesiophobia at baseline interacted with physical therapy in the analysis with leg pain intensity at 12-months follow-up (interaction effect for TSK and SQK p = 0.07 and p < 0.01, respectively). Kinesiophobia did not interact with physical therapy at baseline regarding any outcome at 3-months follow-up or recovery at 12-months follow-up. When comparing both treatment groups in the 73 patients 'suggestive of high fear of movement', the only significant result was found for leg pain intensity difference from baseline at 12-months follow-up (-5.0 +/- 2.6 for the patients randomized to physical therapy versus -3.6 +/- 2.7 for the patients in the control group). LIMITATIONS: The post-hoc study design and relatively small sample size. CONCLUSIONS: In these patients with sciatica, we found preliminary evidence that patients with a higher level of kinesiophobia at baseline may particularly benefit from physical therapy with regard to decreasing leg pain intensity at 12-months follow-up.

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