Shilpi Singh¹*, Abha Rani Sinha², Ashish Singh³ and Lavanya Singh⁴

¹Research Scholar, Department of Psychology, Babasaheb Bhimrao Ambedkar Bihar University, Patna, Bihar, India
²Department of Psychology, Babasaheb Bhimrao Ambedkar Bihar University, Patna, Bihar, India
³Anup Institute of Orthopaedics and Rehabilitation, Patna, Bihar, India
⁴The Hazeley Academy, Emperor Drive, Hazeley, Milton Keynes, United Kingdom

*Corresponding Author: Shilpi Singh, Research Scholar, Department of Psychology, Babasaheb Bhimrao Ambedkar Bihar University, Patna, Bihar, India.

Received: December 09, 2024; Published: January 30, 2025

Abstract

Osteoarthritis is a leading cause of disability, and total knee replacement (TKR) is a common treatment for severe cases. However, recovery is often hindered by kinesiophobia, a fear of movement affecting many patients. This randomized controlled trial (RCT) evaluated the impact of Cognitive Behavioral Therapy (CBT) on kinesiophobia and rehabilitation outcomes in TKR patients. A total of 105 participants were randomly assigned to either a CBT group or a control group receiving standard care, with randomization conducted using a computer-generated allocation sequence and sealed envelopes. The CBT intervention included four tailored sessions addressing kinesiophobia through education, progressive muscle relaxation, and graded functional exercises. Outcomes were assessed at baseline, 6 weeks, and 12 weeks post-intervention. The primary outcome was kinesiophobia, measured by the Tampa Scale for Kinesiophobia (TSK), while secondary outcomes included pain, disability, and quality of life. Results demonstrated that the CBT group had significantly reduced kinesiophobia and improved functional outcomes compared to the control group. These findings support CBT as an effective intervention for enhancing recovery and reducing psychological barriers in TKR patients.

Keywords: Cognitive Behavioral Therapy; Kinesiophobia; Total Knee Replacement; Rehabilitation; Tampa Scale for Kinesiophobia

References

1. Shichman Ittai., et al. "Projections and epidemiology of primary hip and knee arthroplasty in medicare patients to 2040-2060”. JBJS Open Access1 (2023): e22.
2. March Marie K., et al. "Does psychological health influence hospital length of stay following total knee arthroplasty? A systematic review”. Archives of Physical Medicine and Rehabilitation12 (2018): 2583-2594.
3. Bletterman Anouck N., et al. "Preoperative psychosocial factors predicting patient’s functional recovery after total knee or total hip arthroplasty: a systematic review”. Clinical Rehabilitation4 (2018): 512-525.
4. Strauss EJ., et al. "Does obesity influence the outcome after the operative treatment of ankle fractures?” The Journal of Bone and Joint Surgery British Volume6 (2007): 794-798.
5. Doury-Panchout F., et al. "Kinesiophobia negatively influences recovery of joint function following total knee arthroplasty”. European Journal of Physical and Rehabilitation Medicine2 (2014): 155-161.
6. Filardo G., et al. "Kinesiophobia and depression affect total knee arthroplasty outcome in a multivariate analysis of psychological and physical factors on 200 patients”. Knee Surgery, Sports Traumatology, Arthroscopy25 (2017): 3417-3423.
7. Brown OS., et al. "The effects of kinesiophobia on outcome following total knee replacement: a systematic review”. Archives of Orthopaedic and Trauma Surgery 140 (2020): 2057-2070.
8. Monticone Marco., et al. "A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study”. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society10 (2014): 2105-2113.
9. Oksuz Sevim and Edibe Unal. “The effect of the clinical pilates exercises on kinesiophobia and other symptoms related to osteoporosis: Randomised controlled trial”. Complementary Therapies in Clinical Practice 26 (2017): 68-72.
10. Rojas Marcos Carolena., et al. "Psychosocial Interventions to Reduce Post operative Pain in Total Knee Arthroplasty: A Systematic Review”. HSS Journal^®(2024): 15563316241260717.
11. Cai Libai., et al. "Does a program based on cognitive behavioral therapy affect kinesiophobia in patients following total knee arthroplasty? A randomized, controlled trial with a 6-month follow-up”. The Journal of Arthroplasty3 (2018): 704-710.
12. Helminen EE., et al. "Determinants of pain and functioning in knee osteoarthritis: a one-year prospective study”. Clinical Rehabilitation 9 (2016): 890-900.
13. Smith Toby O., et al. "Behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement (PEP-TALK): study protocol for a pragmatic randomised controlled trial”. BMJ Open7 (2020): e035014.
14. Larsson Caroline., et al. "Kinesiophobia and its relation to pain characteristics and cognitive affective variables in older adults with chronic pain”. BMC Geriatrics16 (2016): 1-7.
15. Vlaeyen Johan WS., et al. "Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance”. Pain3 (1995): 363-372.
16. Lundberg Mari KE., et al. "A psychometric evaluation of the Tampa Scale for Kinesiophobia-from a physiotherapeutic perspective”. Physiotherapy Theory and Practice2 (2004): 121-133.
17. Hu W. "Cross-cultural adaptation of simplified Chinese version of TSK/FABQ, and its clinical application in the assessment of fear avoidance for patients with low back pain”. Naval Medical University (2012).
18. Areeudomwong Pattanasin and Vitsarut Buttagat. "Reliability and validity of the cross-culturally adapted thai version of the tampa scale for kinesiophobia in knee osteoarthritis patients”. The Malaysian Journal of Medical Sciences: MJMS2 (2017): 61.
19. Kikuchi Norimasa., et al. "Psychometric properties of the Japanese version of the Tampa Scale for Kinesiophobia (TSK-J) in patients with whiplash neck injury pain and/or low back pain”. Journal of Orthopaedic Science20 (2015): 985-992.
20. Wei Xianzhao., et al. "The Chinese version of the Tampa Scale for Kinesiophobia was cross-culturally adapted and validated in patients with low back pain”. Journal of Clinical Epidemiology10 (2015): 1205-1212.
21. Charan Jaykaran and Tamoghna Biswas. "How to calculate sample size for different study designs in medical research?”. Indian Journal of Psychological Medicine2 (2013): 121-126.
22. Kocic Mirjana., et al. "Influence of fear of movement on total knee arthroplasty outcome”. Annali Italiani di Chirurgia2 (2015): 148-155.
23. Cai Libai., et al. "Incidence and risk factors of kinesiophobia after total knee arthroplasty in Zhengzhou, China: a cross-sectional study”. The Journal of Arthroplasty9 (2018): 2858-2862.
24. Morgounovski Johanna., et al. "The fear-avoidance model to predict return to work after an orthopedic trauma”. Annals of Physical and Rehabilitation Medicine 1 (2016): e110-e111.
25. Birch Sara., et al. "Effectiveness of a physiotherapist delivered cognitive-behavioral patient education for patients who undergoes operation for total knee arthroplasty: a protocol of a randomized controlled trial”. BMC Musculoskeletal Disorders18 (2017): 1-9.
26. Jensen Mark P., et al. "Changes after multidisciplinary pain treatment in patient pain beliefs and coping are associated with concurrent changes in patient functioning”. Pain1-2 (2007): 38-47.

Citation

Citation: Shilpi Singh., et al. “The Impact of Cognitive Behavioral Therapy on Kinesiophobia and Rehabilitation After Total Knee Replacement".Acta Scientific Orthopaedics 8.2 (2025): 09-18.

Copyright

Copyright: © 2025 Shilpi Singh., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.