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BACKGROUND: Exercise is an established treatment to alleviate pain and improve function among adults with knee osteoarthritis (KOA). However, long-term adherence to exercise is poor and effective approaches to support adherence are limited. The objective of this dissertation was to 'gain a new look' into long-term exercise adherence. With study #1, the experiences of participants in the Boston Overcoming Osteoarthritis through Strength Training (BOOST) study, were explored to identify participants' experiences, feelings and perspectives with exercise over 2-years and factors that influenced adherence to a prescribed exercise program after 2 years. With study #2, we examined if kinesiophobia: i) was associated with physical performance measures, ii) improved after a 6-week exercise program and iii) change was associated with change in pain and function among adults with KOA. METHODS: Participants of both studies completed a 6-week exercise program. For study #1 all participants received an automated telephone reminder to continue with their exercises and complete their logs, in addition, those randomized into the intervention group received a motivational computer adaptive telephone program. Participants were purposively sampled and in-depth interviews were conducted at the 2-year assessment. For study #2, data analysis was conducted prior to randomization with a sample of participants who completed the Tampa Scale of Kinesiophobia (TSK) questionnaire. Additional data included stair negotiation, 5 and 10 time sit-to-stand, and timed-up-and go tests. RESULTS: Study #1: Three themes were identified describing beliefs about exercise: i) monitoring, ii) knowledge of how to manage exercise behaviors, and iii) benefits of exercise. Those who reported high-adherence exhibited self-determination and self-efficacy, those who reported low-adherence expressed ambivalence about the benefits of exercise and a desire for more social support. Participants valued monitoring by peers and instructors during the exercise class and telephone technology. Study #2: Higher TSK was associated with slower stair and 5 time sit-to-stand times. TSK decreased after the exercise class but did not attain statistical significance. Change in TSK was associated with change in self-report physical function. CONCLUSIONS: Future research on the use of telephone technology and importance of self-determination and kinesiophobia on exercise adherence among adults with KOA is warranted.

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Objektiv: Temporomandibulär dysfunktion (TMD) utgör vanligaste formen av kronisk orofacial smärta. Kronisk TMD har negativ inverkan på det psykosociala tillståndet vilket påverkar livskvaliteten. Syftet är att utreda huruvida en korrelation mellan TMD, katastrofiering, kinesofobi och fysiska symtom föreligger. Material och metod: Studien baseras på data från TMJ Impact Project som utvärderar 401 individer (333 kvinnor, 86 män, medelålder 45.8) från den initiala studien The Validation Project som utvärderar diagnostiken enligt RDC/TMD, insamlingen utfördes på University of Minnesota, University of Washington och University of Buffalo (2003-2006). 218 individer hade smärtsam TMD, 111 icke-smärtsam TMD, 63 smärtfria kontroller och data saknades för 9 individer. Deltagarna genomgick diagnostik enligt RDC/TMD som inkluderar en klinisk- och radiologisk undersökning (axel I) och en psykosocial utvärdering (axel II). För att undersöka en potentiell korrelation mellan TMD, katastrofiering, kinesofobi och fysiska symptom användes följande instrument: Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, The Patient Health Questionnaire och Areas of Pain.Resultat: Deltagare med smärtsam TMD uppvisade statistisk signifikant grad av kinesofobi, somatisering och fysiska symtom jämfört med kontroller. Deltagare med smärtfri TMD uppvisade högre grad av kinesofobi jämfört med kontroller. Det råder en låg- till moderat positiv korrelation mellan katastrofiering och kinesofobi hos deltagare med smärtsam TMD (r=0,37 p<0,001) och smärtfri TMD (r=0,53 p<0,001).Konklusion: Resultaten uppvisar associationer mellan katastrofiering och kinesofobi hos patienter med TMD oberoende av smärtförekomst. Överlag föreslår resultaten att utvärderingen av kinesofobi och katastrofiering, utspridd smärta och multipla icke-TMD relaterade symtom kan vara av klinisk vikt vid utvärderingen av patienter med TMD. / Objectives: Temporomandibular disorders (TMD) are the most common causes of chronic orofacial pain and affects both psychological and social aspects of life. The aim was to investigate the possible relationship between TMD, catastrophizing, kinesiophobia and physical symptoms. Methods: The study was based on 401 participants (333 women, 86 men, mean age 45.8 years) in the TMJ Impact Project recruited at University of Minnesota, University of Washington and University of Buffalo 2003-2006. Of these, 218 had TMD pain, 111 non-painful TMD, 63 were pain-free controls and data was missing for 9 individuals. Participants were diagnosed in accordance with the Diagnostic Criteria for TMD, including a clinical and radiographic examination (axis I) and a psychosocial assessment (axis II). The possible correlations between TMD, catastrophizing, kinesiophobia and physical symptoms were evaluated with the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, the Patient Health Questionnaire, together with Areas of Pain. Results: Compared to controls, participants with TMD pain showed a statistically significant degree of kinesiophobia, somatic symptoms, and areas of pain and participants with non-painful TMD showed a higher degree of kinesiophobia. There was a positive, low to moderate correlation between catastrophizing and kinesiophobia for participants with TMD pain (r=0.37, p<0.001) and non-painful TMD (r=0.53, p<0.001).Conclusions: The results suggest an association between catastrophizing and kinesiophobia in individuals with TMD regardless of presence of pain. The findings suggest that evaluating fear of movement and catastrophizing, as well as widespread pain and multiple non-TMD symptoms can be useful in the assessment of patients with TMD.

Background: Low back pain is a common muskuloskeletal issue. Kinesiophobia constitutes as excessive fear of movement and has been associated with greater levels of pain. Nocebic terms has been found to influence kinesiophobia. Purpose: The purpose of this study was to investigate the participants’ experiences with low back pain and nocebic terms, and if the language use of the healthcare professionals correlated with negative beliefs. Method: A digital survey was sent out to individuals with low back pain who had visited a healthcare professional. The survey included questions from Tampa Scale of Kinesiophobia, and questions about nocebic terms and the understanding of them. Participants were recruited via Luleå University of Technology and Facebook. Results: The study included a total of 51 participants. In the kinesiophobic group, there was 13 participants, and the most occurring terms were injury, disc herniation, and wear and tear. In the non-kinesiophobic group, there was 38 participants, and the most occurring terms were weakness, pinched nerve and bad posture. Conclusion: No strong correlation was found between language use and kinesiophobia, thus challenging the hypothesis that language use has an influence on patients’ beliefs. The most occurring nocebic terms differed between the kinesiophobic group and non-kinesiophobic group.

Bakgrund: På Akademiska sjukhuset i Uppsala genomförs ungefär 700 hjärtoperationer varje år. Efter en hjärtoperation är det av stor vikt att patienterna är fysiskt aktiva för att minska risken för postoperativa komplikationer. Det finns ett flertal faktorer som kan påverka den fysiska aktivitetsnivån, så som tidigare fysisk aktivitetsnivå, rörelserädsla och bröstsnittsmärta.    Syfte: Syftet med studien var att undersöka hur patienter som genomgått hjärtkirurgi via sternotomi skattade tidigare fysisk aktivitetsnivå, rörelserädsla och bröstsnittssmärta, och utifrån dessa variabler undersöktes sambandet till den fysiska aktivitetsnivån, mätt med antal steg, under sjukhusvistelsen.   Metod: Studien var en tvärsnittsstudie med en deskriptiv design, som bestod av formulär, skattningsskala och stegräknare. Den innefattade även en korrelerande design där samband mellan variablerna analyserades.   Resultat: Det var totalt 20 deltagare som medverkade, varav 15 som slutförde hela studien. Sambandet mellan antal steg och tidigare fysisk aktivitetsnivå visade en korrelationskoefficient r = 0,60 (p = 0,04) och mellan antal steg och rörelserädsla r = 0,69 (p = 0,02). Sambandet mellan antal steg och bröstsnittsmärta var r = - 0,25 (p = 0,38), det vill säga ej signifikant.   Konklusion: Positiv korrelation fanns mellan tidigare fysisk aktivitetsnivå och antal steg samt mellan rörelserädsla och antal steg. Det var dock svårt att generalisera till målpopulationen på grund av för lågt deltagarantal. Ingen korrelation fanns mellan bröstsnittsmärta och antal steg.

INTRODUÇÃO: O medo do movimento (cinesiofobia) parece desempenhar um papel importante no desenvolvimento da dor crónica. No entanto, em Disfunção Temporomandibular (DTM), há uma escassez de estudos sobre este tema. A Escala de Tampa para Kinesiophobia para DTM (TSK / TMD) é o instrumento mais utilizado para medir o medo de movimento e não está disponível em Português do Brasil. OBJETIVO: O objetivo deste estudo foi adaptar transculturalmente o TSK/TMD para o Português Brasileiro e avaliar suas propriedades psicométricas em termos de consistência interna, confiabilidade, validade de construto e estrutural. MÉTODOS: Um total de 100 pacientes do sexo feminino com DTM crônica participaram do processo de validação da TSK/TMD-Br. O coeficiente de correlação intraclasse (CCI) foi utilizado para a análise estatística de confiabilidade (teste-reteste), ? de Cronbach para consistência interna, correlação de Pearson para classificar a validade de construto e análise fatorial confirmatória (AFC) para a validade estrutural. RESULTADOS: AFC aprovou o modelo pré-especificado com dois domínios e 12 itens (Evitando Movimento-EM/Foco Somático-SF) e todos os itens apresentaram carga fatorial superior a 0,4. Foram encontrados níveis aceitáveis de confiabilidade (CCI> 0,75) para todas as questões e domínios da TSK/TMD-Br. Para consistência interna, ? de Cronbach de 0,78 para ambos os domínios. Foram observadas correlações moderadas (0,40 <r <0,70) para a maioria dos domínios e para o escore total entre TSK/TMD-Br vs. catastrofização, depressão e limitação funcional da mandíbula. CONCLUSÃO: TSK / TMD-Br 12 itens demonstrou propriedades de medida satisfatórias (validade transcultural, confiabilidade, consistência interna e análise estrutural), e pode ser utilizado em ambientes clínicos e para fins de pesquisa. / BACKGROUND: Fear of movement (kinesiophobia) seems to play an important role in the development of chronic pain. However, in Temporomandibular Disorders (TMD) there is a scarcity of studies about this topic. The Tampa Scale for Kinesiophobia for TMD (TSK/TMD) is the most widely used instrument to measure fear of movement and it is not available in Brazilian Portuguese. OBJECTIVE: The purpose of this study was to culturally adapt the TSK/TMD to Brazilian Portuguese and to assess its psychometric properties in terms of internal consistency, reliability, and construct and structural validity. METHODS: A total of 100 female patients with chronic TMD participated in the validation process of the TSK/TMD-Br. The intraclass correlation coefficient (ICC) was used for statistical analysis of reliability (testretest), Cronbach\'s alpha for internal consistency, Pearson\'s rank correlation for construct validity, and confirmatory factor analysis (CFA) for structural validity. RESULTS: CFA endorsed the pre-specified model with two domains and 12-items (Activity Avoidance - AA/ Somatic Focus - SF) and all items obtained a loading factor greater than 0.4. Acceptable levels of reliability were found (ICC>0.75) for all questions and domains of the TSK/TMD-Br. For internal consistency, Cronbach\'s ? of 0.78 for both domains were found. Moderate (0.40<r<0.70) correlations were observed for the majority of domains and for the total score between TSK/TMD-Br vs. catastrophizing, depression and jaw functional limitation.CONCLUSION: TSK/TMD-Br 12 items demonstrated sound psychometric properties (transcultural validity, reliability, internal consistency and structural validity) and can be used in clinical settings and for research purposes.

Syfte och frågeställningar: Syftet med studien var att undersöka sambanden mellan rörelserädsla och olika aspekter av fysisk funktionsförmåga hos en grupp personer med långvarig smärta som genomgått multimodal rehabilitering. Studien utgick från tre frågeställningar som gäller: 1. Sambandet mellan rörelserädsla och fysisk funktionsförmåga före rehabilitering. 2. Om rörelserädsla före predicerar fysisk funktionsförmåga efter rehabilitering. 3. Rörelserädslans och den fysiska funktionsförmågans gemensamma bidrag till uppnådda resultat efter rehabilitering. Metod: Studien genomfördes som en korrelationsstudie med pretest-posttest gruppdesign och kvantitativ ansats. 38 personer, 6 män och 32 kvinnor, som genomgått multimodalrehabilitering ingick i studien. Data samlades in före och efter rehabiliteringsperioden med hjälp av väl beprövade självskattningsformulär och objektiva test. Rörelserädsla skattades med hjälp av Tampa Scale of Kinesiophobia. För fysisk funktionsförmåga användes delar ur Test Instrument for Profile of Physical Ability (TIPPA); bedömning av den egna fysiska funktionsförmågan, gångsträcka och snabbgång. Dessutom användes Multidimensional Pain Inventory för att skatta smärtans inverkan på aktivitet och smärtintensitet. Utifrån datans skalegenskaper gjordes icke parametiska sambandsanalyser. Resultat: De viktigaste resultaten från studien var att rörelserädsla före rehabiliteringen, utöver påverkan av skattningen av den egna fysiska funktionsförmågan, hade ett starkt samband med bedömningen av den egna förmågan efter rehabiliteringens avslut. Höga värden för rörelserädsla gav en sju gånger högre risk för låg bedömning av den egna förmågan efter rehabilitering. Dessutom visade resultaten att de patienter som har en kombination av hög rörelserädsla och låg bedömning av den egna fysiska funktionsförmågan före rehabilitering i mycket mindre grad uppnådde en bra funktionsförmåga efter rehabilitering, jämfört med patienter som enbart hade hög rörelserädsla eller låg bedömning av den egna förmågan. Utöver dessa resultat hade alla fysiska funktionsmått hämtade ur TIPPA ett samband med varandra. Däremot sågs inget samband mellan vare sig rörelserädsla eller fysisk funktionsförmåga och påverkan på aktivitet eller smärtintensitet. Slutsats: Resultaten tyder på att det är viktigt att sammanväga rörelserädsla och bedömningen av den egna fysiska funktionsförmågan för att hitta rätt fokus i, och rimliga mål för, rehabiliteringen. Kort sagt understryker resultaten att det är viktigt att individuellt anpassa rehabiliteringsinsatser efter patientens unika svårigheter. / Aim: The aim of this study was to investigate the correlations between kinesiophobia and different aspects of physical ability in a group of persons with longstanding pain who participated in interdisciplinary rehabilitation. This study answered three questions dealing with: 1. The correlation between kinesiophobia and physical ability before the rehabilitation. 2. If kinesiophobia before predicts physical ability after rehabilitation. 3. The joint contribution between kinesiophobia and physical ability to achieved results after rehabilitation. Method: This study was carried out as a correlational pretest-posttest group design with quantitative approach. 38 persons, 6 male and 32 female, who participated in interdisciplinary rehabilitation were part of this study. Data was collected before and after the rehabilitation period, with well tested self-rating instruments and objective tests. Kinesiophobia was rated with Tampa Scale of Kinesiophobia. For physical ability parts of Test Instrument for Profile of Physical Ability (TIPPA) were used; self-assessment of current physical ability, walking distance and speed walking. Also Multidimensional Pain Inventory was used to rate the pain impact on activity and pain intensity. Due to scale properties non-parametric correlational analysis were being used. Results: The most important results from this study were that kinesiophobia before rehabilitation, in addition to the influence of self-assessment of current physical ability, had a strong correlation to self-assessment of current physical ability after rehabilitation. High scores on kinesiophobia gave seven times higher risk to low self-assessment of current physical ability after rehabilitation. It was also found that those patients with a combination of high kinesiophobia and low self-assessment of current physical ability before rehabilitation in much lower extent reached a good ability after rehabilitation, compared to patients who either have high kinesiophobia or low self-assessment of current physical ability. In addition to these results all the physical ability measures from TIPPA were correlated to each other. But no correlations were being found between kinesiophobia or physical ability to impact on activity and pain intensity. Conclusions: These results indicate that it is important to put the measures of kinesiophobia and self-assessment of current physical ability together in consideration to find the right focus, and reasonable goals, in rehabilitation. In short the results underline the importance of individually customized actions in rehabilitation to the unique difficulties of each patient.

ABSTRACT Purpose: The purpose of the study was threefold. Firstly, to investigate if a four week program in pain rehabilitation had any effect on how much individuals with persistent pain worked and their degree of kinesiophobia. Secondly, to study if there was a correlation between how much these individuals worked and their degree of kinesiophobia. Thirdly, to study if there was a correlation between the change in these variables. Method: 112 patients who had participated in a four week rehabilitation program took part in the study. The study had a retrospective design, which was based on a review on medical records and consisted of three minor parts. The first part had a quasi-experimental comparative design and the other two parts had non-experimental cross-sectional correlative designs. Kinesiophobia was analyzed with the Swedish version of the Tampa Scale of Kinesiophobia (TSK-SV). How much a patient was working was measured in percent. Results: Both work status and kinesiophobia had improved significant in every measurement. The highest improvement in the variable of kinesiophobia was discovered by the end of the program in pain rehabilitation and by the twelve month follow-up in the variable about how much patients was working. Analysis with Spearman’s rang correlation coefficient showed a weak statistical significant correlation between how much individuals work and their degree of kinesiophobia in the twelve months follow-up. There was however no statistical significant correlation between the change of how much individuals worked and the change of their degree of kinesiophobia, neither in the two nor in the twelve months follow-up. Conclusions: This is one of the first studies that have been done who investigate the correlation between kinesiophobia and how much individuals with persistent pain are working and it shows that there is a need to continue to investigate the correlation between them, both for the individual as well as for the society in general and if possible also study what importance self-efficacy has in this context.