Associations and Impact of Kinesiophobia on Patient Reported Outcomes and Performance-based Mobility Measures in Patients with Axial Spondyloarthritis

David Kiefer¹, Juergen Braun², Uta Kiltz³, Niklas Kolle¹, Lucia Schneider¹, Ioana Andreica⁴, Bjoern Buehring⁵, Philipp Sewerin⁶, Imke Redeker⁷, Styliani Tsiami⁸, Susanne Herbold⁹ and Xenofon Baraliakos⁸, ¹Ruhr-Universität Bochum; Rheumazentrum Ruhrgebiet, Herne, Germany, ²Rheuma Praxis, Ruhr-University Bochum, Berlin, Germany, ³Rheumazentrum Ruhrgebiet Herne, Ruhr-University, D-44649 Herne, Germany, ⁴Rheumazentrum Ruhrgebiet Herne, Herne, Germany, ⁵Bergisches Rheuma-Zentrum Wuppertal; Ruhr-Universität Bochum, Wuppertal, Germany, ⁶Ruhr-Universität Bochum, Rheumazentrum Ruhrgebiet, Herne, Germany, ⁷Ruhr Universität Bochum, Bochum, Germany, ⁸Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany, ⁹Rheumazentrum Ruhrgebiet, Herne, Herne, Germany

Meeting: ACR Convergence 2024

Keywords: Disease Activity, health status, Patient reported outcomes, physical activity, spondyloarthritis

Session Information

Date: Saturday, November 16, 2024

Title: SpA Including PsA – Diagnosis, Manifestations, & Outcomes Poster I

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: Kinesiophobia, defined as the fear of movement, poses a significant barrier to effective rehabilitation, functional recovery, and adequate physical activity.
To investigate the impact of kinesiophobia on patients with axial spondylo-arthritis (axSpA), and its relation to global functioning and health, disease activity, function, spinal mobility and physical activity in comparison to healthy controls (HC).

Methods: Post-hoc analysis of an observational study in which consecutive patients with axSpA (n=100) and 20 healthy controls (HC) were examined by the Tampa scale of kinesiophobia (TSK), and the Fear avoidance belief questionnaire (FABQ). Patient reported outcomes and objective assessments of disease activity (ASDAS, BASDAI), physical function (BASFI), global health and functioning (ASAS HI), daily level of physical activity (mSQUASH) as well as the BASMI, the AS physical performance index (ASPI) and the Short Physical Performance Battery (SPPB) were collected. Categorical analysis to differentiate results of patients with minimal/low (TSK ≤ 28) and moderate/high (TSK >28) kinesiophobia as well as linear correlations comparing TSK and FABQ with demographic data and clinical assessments were performed.

Results: While demographic data for age, sex and BMI were comparable, patients with axSpA showed higher TSK (25.5±6.8 vs 14.0±5.1) and FABQ scores (40.1±22.6 vs 3.1±6.9), worse results for pain, daily level of physical activity (p=0.001) and performance based tests compared to HC, all p≤ 0.001 (Table 1). Categorical analysis of kinesiophobia levels revealed that patients with moderate to high kinesiophobia performed significantly worse in ASPI (32.2±15.0 vs 42.0±18.3) and SPPB (10.4±1.3 vs 9.7±1.5), and showed numerical impairments in BASMI (3.8±1.7 vs 4.3±2.6), (Table 2). Significant correlations between TSK/FABQ and assessments were observed for ASAS HI (r=0.45 and r=0.52) and BASFI (r=0.38 and r=0.44), but not for ASPI, SPPB, mSQUASH. Weak correlations were found for BASMI (r=0.24 and r=0.38) and BASDAI scores (both r=0.35), see Table 3.

Conclusion: Kinesiophobia is a clinically relevant issue for patients with axSpA, with impaired mobility found in patients reporting moderate to high TSK and FABQ scores. The degree of kinesiophobia showed stronger correlations with physical function, global functioning and health than with mobility and physical activity.

*variables are mean ± standard deviation if not otherwise indicated; ASPI: the AS physical performance index; ASDAS: AS Disease Activity Score; SPPB: Short Physical Performance Battery, BASMI: Bath Ankylosing Spondylitis (AS) Metrology Index; BASDAI: Bath AS Disease Activity Index; BASFI: Bath AS Functional Index; CRP: C-reative protein; NSAIDs: Non-steroidal anti-inflammatory drugs; axSpA= axial spondyloarthritis; NRS = numerical rating scale; mSQUASH: the modified-Short QUestionnaire to Assess Health-enhancing physical activity; TSK: Tampa Scale for Kinesiophobia FABQ: Fear-Avoidance Beliefs Questionnaire; FABQ1: ‘physical activity’; FABQ2: ‘work as cause of pain’ FABQ3: ‘patients’ assumptions of their probable return to work’

*variables are mean ± standard deviation if not otherwise indicated; ASDAS: AS Disease Activity Score; BASMI: Bath Ankylosing Spondylitis (AS) Metrology Index; BASDAI: Bath AS Disease Activity Index; BASFI: Bath AS Functional Index; CRP: C-reative protein; r-axSpA = radiographic axial spondyloarthritis (axSpA); non-radiographic axSpA (nr-axSpA); NRS = numerical rating scale; mSQUASH: the modified-Short QUestionnaire to Assess Health-enhancing physical activity; TSK: Tampa Scale for Kinesiophobia FABQ: Fear-Avoidance Beliefs Questionnaire;

*p<0.05; ** =p <0.001; ***=p<0.0001; BMI = body mass index; bDMARD = biological Disease Modifying AntiRheumatic Drugs; CRP = C-reactive protein; NSAID = non-steroidal anti-inflammatory drugs; axSpA = axial spondyloarthritis; ASPI: the AS physical performance index; ASDAS: AS Disease Activity Score; SPPB: Short Physical Performance Battery, BASMI: Bath Ankylosing Spondylitis (AS) Metrology Index; BASDAI: Bath AS Disease Activity Index; BASFI: Bath AS Functional Index; axSpA= axial spondyloarthritis; mSQUASH: the modified-Short QUestionnaire to Assess Health-enhancing physical activity; TSK: Tampa Scale for Kinesiophobia FABQ: Fear-Avoidance Beliefs Questionnaire; FABQ1: 'physical activity'; FABQ2: 'work as cause of pain' FABQ3: 'patients' assumptions of their probable return to work'

Disclosures: D. Kiefer: AbbVie/Abbott, 6, Novartis, 6, UCB, 1, 6; J. Braun: AbbVie/Abbott, 2, 5, 6, Amgen, 2, 5, 6, Boehringer-Ingelheim, 2, 5, 6, Bristol-Myers Squibb(BMS), 2, 5, 6, Celgene, 2, 5, 6, Celltrion, 2, 5, 6, Centocor, 2, 5, 6, Chugai, 2, 5, 6, Eli Lilly, 2, 5, 6, Medac, 2, 5, 6, MSD (Schering-Plough), 2, 5, 6, Mundipharma, 2, 5, Novartis, 2, 5, 6, Pfizer (Wyeth), 2, 5, 6, Roche, 2, 5, 6, Sanofi-Aventis, 2, 5, 6, UCB, 2, 5, 6; U. Kiltz: AbbVie, 2, 5, 6, Amgen, 5, Biocad, 2, 6, Biogen, 5, Chugai, 2, 6, Eli Lilly, 2, 6, Fresenius, 5, 6, Grünenthal, 2, 6, GSK, 5, Hexal, 5, Janssen, 2, 6, MSD, 2, 6, Novartis, 2, 5, 6, Pfizer, 2, 5, 6, Roche, 2, 6, UCB, 2, 6; N. Kolle: None; L. Schneider: None; I. Andreica: None; B. Buehring: AbbVie/Abbott, 2, 6, 12, Travel reimbursement, Alexion, 2, Amgen, 2, 6, 12, Travel reimbursement, Biogen, 6, Boehringer-Ingelheim, 6, Gilead, 6, Janssen, 12, Travel reimbursement, Merck/MSD, 12, Travel reimbursement, Sanofi-Genzyme, 6, Theramex, 2, 6, 12, Travel reimbursement, UCB, 2, 6, 12, Travel reimbursement; P. Sewerin: AbbVie, 2, 6, Amgen, 2, 6, AXIOM Health, 2, Biogen, 2, 6, Bristol Myers Squibb, 2, 6, Celgene, 2, 6, Chugai, 2, Deutscher Psoriasis-Bund, 2, Eli Lilly, 2, 6, Gilead Sciences, 2, 6, Hexal Pharma, 2, 6, Janssen-Cilag, 2, 6, Johnson & Johnson, 2, 6, Mediri GmbH, 2, Novartis Pharma, 2, 6, Onkowissen GmbH, 2, Pfizer, 2, 6, Pharma Marketing Ltd/Chugai Europe, 2, Rheumazentrum Rhein-Ruhr, 2, 6, Roche Pharma, 2, 6, Sanofi-Genzyme, 2, 6, Spirit Medical Communication, 2, Swedish Orphan Biovitrum, 2, 6, UCB Pharma, 2, 6; I. Redeker: None; S. Tsiami: None; S. Herbold: None; X. Baraliakos: AbbVie, 2, 6, 12, Paid instructor, BMS, 2, 6, 12, Paid instructor, Chugai, 2, 6, 12, Paid instructor, Eli Lilly, 2, 6, 12, Paid instructor, Galapagos, 2, 6, 12, Paid instructor, Gilead, 2, MSD, 6, 12, Paid instructor, Novartis, 2, 5, 6, 12, Paid instructor, Pfizer, 2, 6, 12, Paid instructor, UCB Pharma, 2, 5, 6, 12, Paid instructor.

To cite this abstract in AMA style:

Kiefer D, Braun J, Kiltz U, Kolle N, Schneider L, Andreica I, Buehring B, Sewerin P, Redeker I, Tsiami S, Herbold S, Baraliakos X. Associations and Impact of Kinesiophobia on Patient Reported Outcomes and Performance-based Mobility Measures in Patients with Axial Spondyloarthritis [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/associations-and-impact-of-kinesiophobia-on-patient-reported-outcomes-and-performance-based-mobility-measures-in-patients-with-axial-spondyloarthritis/. Accessed .

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