Pain, fear, and movement: Cognitive-behavioural connections in patellofemoral pain

Leite, OHC, Navarro, GJ, Rodrigues, NLM, de Paula Gomes, CAF, Barton, GJ ORCID: 0000-0002-7214-1967, Vallio, CS and Lucareli, PRG (2025) Pain, fear, and movement: Cognitive-behavioural connections in patellofemoral pain. Clinical Biomechanics, 131. p. 106716. ISSN 0268-0033

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Abstract

Background
Kinesiophobia, or fear of movement, is common in individuals with musculoskeletal pain, especially in those with patellofemoral pain, and it can lead to increased functional limitations. Although pain self-efficacy is known to affect kinesiophobia, the link between psychological factors and physical aspects such as movement patterns and pain intensity remains uncertain. This study aimed to assess the relationships between kinesiophobia and cognitive-behavioural factors, pain, and functional domains in participants with patellofemoral pain.
Methods
This was an observational, cross-sectional study involving 66 participants with patellofemoral pain who underwent assessments of cognitive-behavioural factors, self-reported pain, knee-related function, and movement function. Generalized linear models were used to examine the relationship between kinesiophobia and self-efficacy, pain catastrophizing, self-reported pain, knee-related function, and movement function measured by the Movement Deviation Profile.
Findings
The general linear model demonstrated that self-efficacy and the Movement Deviation Profile were predictors of kinesiophobia. The final model confirmed a notable inverse association between self-efficacy and kinesiophobia, with a 0.31-point decrease in kinesiophobia for each one-point increase in the Pain Self-Efficacy Questionnaire score. Regarding the Movement Deviation Profile, each one-degree increase in the movement deviation pattern was associated with a 0.24-point increase in kinesiophobia scores.
Interpretation
Kinesiophobia can decrease self-efficacy and lead to movement avoidance, negatively impacting perceived ability and physical function. Our findings emphasise the complex nature of kinesiophobia. Improving self-efficacy might help lessen fear-related avoidance, while movement patterns should be interpreted carefully by distinguishing between adaptive and maladaptive behaviours.

Item Type:	Article
Uncontrolled Keywords:	0903 Biomedical Engineering; 0913 Mechanical Engineering; 1106 Human Movement and Sports Sciences; Orthopedics; 4003 Biomedical engineering; 4201 Allied health and rehabilitation science; 4207 Sports science and exercise
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	Elsevier
Date of acceptance:	20 November 2025
Date Deposited:	26 Nov 2025 16:32
Last Modified:	26 Nov 2025 16:32
DOI or ID number:	10.1016/j.clinbiomech.2025.106716
URI:	https://researchonline.ljmu.ac.uk/id/eprint/27628

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