Avaliação da relação entre cinesiofobia, autoeficácia e desvio dos padrões de movimento em pessoas com dor femoropatelar

Abstract

Introduction: Musculoskeletal pain is a global public health issue with significant impacts on individuals’ quality of life and functionality. Among these conditions, patellofemoral pain (PFP) is one of the most prevalent complaints in young adults, especially women, and is characterized by anterior knee pain during activities that increase joint load. Although historically considered self-limiting, recent evidence shows that PFP can persist and result in long-term functional limitations. Current literature emphasizes the importance of a multifactorial approach to chronic pain, addressing not only biomechanical aspects but also cognitive-behavioral factors such as kinesiophobia, pain catastrophizing, and self-efficacy, which directly influence the pain experience and motor behavior. The motor response, in turn, may reflect both adaptive and maladaptive learned strategies. Dynamic assessment methods, such as the Lateral Step-Down (LSD) test, allow for a more sensitive analysis of movement responses to nociceptive stimuli compared with traditional retrospective measures. Therefore, it is essential to investigate cognitive-behavioral, functional, and motor factors in an integrated manner among individuals with PFP, aiming to develop more effective, individualized, and patient-centered therapeutic strategies. Objectives: The main objectives of this thesis are: 1) To evaluate the associations between kinesiophobia, cognitive-behavioral factors, pain, and functional domains in individuals with patellofemoral pain (PFP). 2) To determine which self- reported pain measure: (a) average pain over the past 15 days, (b) pain at baseline (upon arrival for assessment), or (c) pain during each movement set, shows the strongest association with the Movement Deviation Profile (MDP) during the Lateral Step-Down (LSD) test in people with PFP. Methods: 1)This is a cross-sectional study involving 66 individuals with PFP, who underwent kinematic assessment during the Lateral Step-Down (LSD) test, concomitantly with cognitive-behavioral evaluation. To examine angular kinematics during the LSD, the Movement Deviation Profile (MDP) was used. The cognitive-behavioral assessment was conducted using scales designed to measure fear of movement (Tampa Scale for Kinesiophobia), the individual’s confidence in performing activities despite pain (Pain Self- Efficacy Scale – PSEQ-10 and Chronic Pain Self-Efficacy Scale – CPSE), and the negative emotional and behavioral impact associated with coping with pain (Pain Catastrophizing Scale). Before the main analyses, data normality and homogeneity were verified to ensure the adequacy and consistency of subsequent statistical procedures. A statistical model was then built to identify the factors most associated with kinesiophobia, using automatic variable selection and model quality criteria. 2) This is a cross-sectional study including 66 individuals with PFP who underwent kinematic evaluation during 12 cycles of the LSD test, concomitant with pain assessment using the Numerical Pain Rating Scale. To analyze angular kinematics during the LSD, the MDP was used. For pain assessment, the numerical pain rating scale was applied at six different time points: initially, considering the 15 days prior to data collection; then, before starting the single-leg squat; and subsequently, after every four repetitions of the exercise. The study employed a generalized linear model to analyze the evolution of variables across multiple series, considering possible interactions between variables and estimating regression coefficients and existing associations. Results: 1) Kinesiophobia decreased by 0.31 points for every one-point increase in the Pain Self-Efficacy Questionnaire (PSEQ-10) score. Conversely, the MDPmean variable showed a directly proportional effect, with a 0.24-point increase in kinesiophobia for every one-degree increase in movement deviation. 2) The analysis showed that none of the pain indices, whether retrospective, baseline, or task-induced, presented a statistically significant association with movement deviation. The direction of the coefficients indicated a weak and positive trend between higher pain and higher MDP values, particularly for pain during movement; however, these trends did not reach conventional statistical significance. Conclusion: 1) The findings highlight that self-efficacy, measured by the PSEQ- 10, and the MDP are important variables for explaining kinesiophobia, demonstrating its multifactorial nature. 2) The results of this study indicated that movement deviation over four sets of single-leg squats was not associated with any pain measure, whether retrospective or experienced during exercise.