Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing

Firestormm

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Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimental study

Posted online on February 12, 2012: http://informahealthcare.com/doi/abs/10.3109/09638288.2011.641661


Jo Nijs1,2,3, Mira Meeus1,2, Marianne Heins4, Hans Knoop4, Greta Moorkens5, Gijs Bleijenberg4

Purpose:

'Kinesiophobia and catastrophizing are frequent among people with chronic fatigue syndrome (CFS). This study was aimed at examining (1) whether kinesiophobia, anticipated symptoms and fatigue catastrophizing are related to stair climbing performance in people with CFS; and (2) whether kinesiophobia and fatigue catastrophizing are related to daily physical activity in CFS.

Method:

Patients with CFS filled in a set of questionnaires, performed a physical demanding task (two floors stair of climbing and descending) with pre-test and post-test heart rate monitoring and immediate post-stair climbing symptom assessment. Real-time activity monitoring was used between the baseline and second assessment day (7 days later).

Results:

Kinesiophobia and fatigue catastrophizing were strongly related (??=?0.62 and 0.67, respectively) to poorer stair climbing performance (i.e. more time required to complete the threatening activity). Kinesiophobia and fatigue catastrophizing were unrelated to the amount of physical activity on the first day following stair climbing or during the seven subsequent days.

Conclusion:

These findings underscore the importance of kinesiophobia and fatigue catastrophizing for performing physical demanding tasks in everyday life of people with CFS, but refute a cardinal role for kinesiophobia and fatigue catastrophizing in determining daily physical activity level in these patients.

Implications for Rehabilitation

People with chronic fatigue syndrome (CFS) can easily perform stair climbing, a daily physical activity perceived by themselves as threatening, without triggering symptom flares. This is important as it can be used clinically to convince people with CFS of undertaking such a threatening task during treatment programs such as graded activity or graded exposure.

The finding that kinesiophobia and fatigue catastrophizing are strongly related to stair climbing performance in CFS underscores the importance of restructuring the beliefs of these patients about the relationship between activity and symptoms. This should be a key component of the early stages of rehabilitation for people with CFS.

In rehabilitation practice, diminishing kinesiophobia and fatigue catastrophizing in patients with CFS appears only relevant for targeting physical activities that are perceived as threatening (e.g. stair climbing), and not for increasing work-related or social (physical) activities.

Clinicians can use the Tampa Scale Kinesiophobia version CFS for assessing the fear of patients with CFS to exacerbate their symptoms (including pain, fatigue and brain fog) due to physical activities.

Clinicians can use the Tampa Scale fatigue for assessing the fear of patients with CFS to exacerbate their fatigue level due to physical activities.'

Note:

Am only reposting. I haven't read it in full neither can I understand how the heck 'Kinesiophobia' came to be associated with CFS!
 

Nielk

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'Kinesiophobia and catastrophizing are frequent among people with chronic fatigue syndrome (CFS)
This is the first statement of "purpose" of this "study".
Where do they get this from? Is it from the same "clinical scientific double blinded study" that shows/proves that CFS patients are "malingerers"?

Did they consider the possible fact that the one's who feared climbing the two stairs were ones who have done it before and know what it does to their bodies?

How many ways can they spin studies to try to prove that our problems are psychological?
 
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People with chronic fatigue syndrome (CFS) can easily perform stair climbing, a daily physical activity perceived by themselves as threatening, without triggering symptom flares.
Disappointing they don't give sample size in the abstract (which I believe is best practice), but certainly extrapolating stair climbing findings to 'people with CFS' would at best only apply to patients with the same characteristics (eg case definition and activity levels) as the sample they used.

Kinesiophobia and fatigue catastrophizing were strongly related (??=?0.62 and 0.67, respectively) to poorer stair climbing performance (i.e. more time required to complete the threatening activity).
This could be because patients who were closer to their PEM threshold climbed more slowly to minimise any PEM. Or put another way, patients for whom stair climbing was a comfortable activity climbed faster with less fear because they knew it was withing their capabilities.

Overall, it is an interesting approach, though, since they made some measure of activity (if not symptoms) in the 7 days after the perceived threatening activity.
 

maddietod

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So researchers "studied" a group of "CFS patients," self-selected by being willing to participate in a physical stress study.

They established a baseline of physical activity. They asked questions designed to determine how terrified of physical exertion these people were.

The people climbed the stairs wearing heart-rate monitors.

Heart rate was also monitored immediately after the stress test.

The people who were most frightened to climb the stairs climbed them more slowly.

One week later the researchers did another baseline activity assessment.

The only conclusion I can draw is that in this particular group of people presumed to have CFS (what criteria?), who are well enough to submit to a physical stress test, the participants did an excellent job of predicting how difficult the test would be for them (??=?0.62 and 0.67, respectively).
 

Firestormm

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Ok I'm just 'liking' all the comments here rather than make any of my own. Earlier I did conclude (elsewhere) that this study was 'rollocks' if that helps, but in the interests of balance I shall at some point endeavour to read the full paper. Just don't hold your breath. This features well down on my list of 'must read' priorities. :D
 

Desdinova

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No but it will help prove that we malingerers not only suffer from fear avoidance (avoiding activity) but that we catastrophize certain things (activity in this case climbing stairs) in our lives. Which they then tie into the old assumption of false beliefs (illness beliefs). Catastrophizing is taken right out of the CBT manual.
 

Calathea

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Oh for heaven's sake, they need to ban words like "catastrophising" and "kinesiophobia" in relation to ME, and quite possibly in their entirety. I am going to put up a poll about tendency to overexertion vs underestimating how much we can do, just for the sake of it.
 

Sushi

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Oh for heaven's sake, they need to ban words like "catastrophising" and "kinesiophobia" in relation to ME, and quite possibly in their entirety. I am going to put up a poll about tendency to overexertion vs underestimating how much we can do, just for the sake of it.
This article is incredibly annoying! As many have said, you wouldn't agree to participate if you knew you would get payback from climbing stairs.

I once had an autonomic nervous specialist tell me that if I told him I could climb stairs he would tell me that I didn't have dysautonomia. Then he explained why stair climbing is particularly hard for those with autonomic dysfunction.

Sushi
 

Valentijn

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So researchers "studied" a group of "CFS patients," self-selected by being willing to participate in a physical stress study.
Those patients are also self-selected to the extent that they're willing to go to (and stay with) the psych CFS clinics.

But I also agree that obviously people who suffer more from climbing stairs, will climb them slower.

They needed a proper control group for this study. Not healthy people, but people with a disabling disease that these "researchers" believe exists, to see how much stair-fear people with ME/CFS have when compared to people with emphysema or even a nice case of the flu.
 

justinreilly

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This is sick.

fyi, Bleijenberg has taken over from Straus the authorship of the "CFS" entry in Harrison's Principles of Internal Medicine, the best-selling medical text, under Fauci's editorship. The charlatans maintain their stranglehold on the perception of ME in the medical communities by authoring these bogus studies with fake definitions and then repeating the fake science in their near-monopoly on review articles and book chapters. This is why our doctors don't believe us.

Help out by adding a review on Harrison's and other books on Amazon.

http://www.amazon.com/review/R3QXEQQ6NLJC67/ref=cm_cr_pr_viewpnt#R3QXEQQ6NLJC67
 

SOC

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Isn't it also best practice to put the selection criteria in the abstract?

We haven't a clue (until we read the paper) whether they had ME patients or people with the symptom chronic fatigue, but called them "CFS patients". I'm too aggravated to read the paper at the moment, but I'll try to get to it later. I just hate to read such blether and bs -- I don't need the stress -- but we can't in fairness criticize much before we read the blasted thing. They get us coming and going, don't they?
 

alex3619

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Stair climbing is not a huge problem for me much of the time. However, if my OI is worse, I collapse on stairs ... almost every stair. Once I collapsed three times on ten steps or so. I eventually made it to the top. At other times I have had to sit on stairs and go up backwards. I also know when I fit one category and not the other. The only reason I get in trouble is if I am in a hurry and not paying attention to the signs (like I am late for something). Of course on a really bad day the first step is difficult and I dont bother with the rest. That first step is just getting out of bed. So I agree with oceanblue - they only thing they appear to have shown (and I havent read the full paper either) is that we can estimate how we will perform - and that implies no catastrophizing at all because they are matched. I really should read the full paper, but I have more important things to do. Bye, Alex
 
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I really worry for the manufacturers of stair lifts. No, really I do. I mean 'research' like this could put thousands out of a job. And I so love those adverts... :D
You probably know this already, but the intent is most likely to save insurance companies and governments money by propagandizing doctors. :sad:

The putting manufacturers out of business is probably not the original intent.
 
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This is the first statement of "purpose" of this "study".
They cited several studies,

The role of fear of physical movement and activity in chronic fatigue syndrome.
Chronic fatigue syndrome: lack of association between pain-related fear of movement and exercise capacity and disability.
Kinesiophobia in chronic fatigue syndrome: assessment and associations with disability.
Is the chronic fatigue syndrome an exercise phobia? A case control study.

The above do not agree on whether kinesiophobia is an important factor or not.

The authors state,

In summary, the study aims at examining (1) whether stair climbing performance (i.e. speed) is associated with symptom expectancies, kinesiophobia and fatigue catastrophizing in people with CFS and (2) whether kinesiophobia and fatigue catastrophizing are related to daily physical activity in CFS.
SF-36 physical functioning data was: 51.4?SD=19.8

The questionnaires were the Tampa scale for kinesiophobia, translated into Dutch and references to "pain" were replaced with "fatigue" and "my symptoms" where relevant.
They then say that fatigue related kinesiophobia was measured using:

Based on a varimax rotated factor analysis, we developed a shortened scale (TS-fatigue-S) consisting of eight items (items 1, 3, 6, 7, 10, 11, 14 and 17 of the original TS-fatigue-S) with a total score ranging from 8 to 36. Reliability of the new scale was assessed in 195 patients with a diagnosis of CFS and was sufficient (Cronbachs ??=?0.80).
http://www.tac.vic.gov.au/upload/tampa_scale_kinesiophobia.pdf

Looking at the questions, there seems to be some ideological bias in the validity of those questions (as applied to CFS patients)

The second was the Jacobson fatigue catastrophizing scale here (and translated into Dutch):
http://www.cas.usf.edu/~jacobsen/FCS.pdf
(scored as 1-5 Likert scale and then the total score is divided by 10)


TSK-CFS 32.0?SD=?5.3
TS-fatigue 13.0?SD=?4.6
Fatigue catastrophizing 0.9?SD=0.5


Activity levels were not measured BEFORE the exercise test, so we don't know whether it resulted in a reduction of activity due to symptoms or not.

Symptoms were 'measured' at baseline, 24 hours and 7 days using a visual analog scale for the CFS Symptom List.
The raw data for this is not provided, we are simply told the difference in symptoms was p>0.01.

I wonder, was there a difference for high-catastrophizing scores vs low scores? We are not told (sample size too small?) I suspect all they did was compare the group as a whole, which is not useful on its own. All this may mean is that all of the patients correctly predicted how to limit their performance so not as to impact their symptoms too much the next day.

Additionally, isn't the trend dependent on the weighting of the scoring? Visual analogue scales are subjective and patients indicating a moderate increase may or may not turn up as 'statistically significant' depending entirely on how you scale the result. I can't seem to find if this questionnaire has been validated on a large sample or not.
The type of scoring matters, because this study is not making comparisons between control groups.

Likewise, we aren't given the physical activity data either, but simply told that TSK-CFS and TS-fatigue scores were unrelated to physical activity levels, p>0.01.

Unless the relationship between the activity levels, symptom levels, performance and questionnaire results are studied together in a single model, rather than as separate measures, it is hard to form any conclusions.
 
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They cited several studies,

The role of fear of physical movement and activity in chronic fatigue syndrome.
Chronic fatigue syndrome: lack of association between pain-related fear of movement and exercise capacity and disability.
Kinesiophobia in chronic fatigue syndrome: assessment and associations with disability.
Is the chronic fatigue syndrome an exercise phobia? A case control study.

The above do not agree on whether kinesiophobia is an important factor or not.

SF-36 physical functioning data was: 51.4?=19.8

Activity levels were not measured BEFORE the exercise test, so we don't know whether it resulted in a reduction of activity due to symptoms or not. [seems a game-ending flaw to me

I wonder, was there a difference for high-catastrophizing scores vs low scores? We are not told
Thanks, would love to read the full text.

Given that these patients attended a clinic and presumably agreed to try the stair test and had a mean SF36 score of 51 I wouldn't have expected climbing 2 flights of steps to be too challenging.

The above points are powerful, haven't had time to study the others.
 

Calathea

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I haven't read it, it'll just wind me up, but did they measure PEM at two or three days later, when it commonly hits?

Agreed that anyone who is well enough to volunteer for such a study probably doesn't get severe enough symptoms for the results to be obvious from just climbing two flights of stairs. The problem is that if you made people with ME go through enough exertion to show up the PEM clearly, it would probably be unethical.
 

biophile

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Perhaps this study was always going to be a lose-lose situation, because no matter the outcome or associations (or lack of) between kinesiophobia and fatigue catastrophizing vs climbing performance vs immediate post-climbing symptoms vs overall activity levels, the results were always going to be twisted to support cognitive behavioural speculations regardless of alternative explanations.

The abstract suggests their CFS patients feared symptom exacerbation despite never experiencing such symptom exacerbation after climbing stairs. The latter is unusual, but more on that later. Other posters on this thread already pointed out that the association between higher levels of "kinesiophobia and fatigue catastrophizing" and worse climbing performance could merely reflect patients being in tune with their capabilities in order to avoid post-exertional symptoms.

An alternative explanation for this could be that CFS symptoms may not worsen in this group after climbing up and down 2 flights of stairs, but such exertion requires much more effort than normal so the patients are understandably wanting to avoid too much effort: those who are more "fearful" despite lack of worsening symptoms are so because they experience more demand for effort to override central exhaustion to perform such tasks irrespective of post-exertional exacerbations. The abstract doesn't mention anything about self-reported effort.

It also appears that climbing up and down 2 flights of stairs test was a once off for the entire week, so another possibility is that a single bout of paced climbing was OK once a week for this group but repeated bouts is not. We don't know how the test impacted physical activity compared with usual because it wasn't adequately tested. There was also no relevant control group.

No doubt the results of this study will be misinterpreted by biopsychosocialists as evidence that it is safe for CFS patients to climb much more frequently than once a week even for patients who do experience post-exertional symptoms after climbing stairs, just look at the wording of the conclusion: "People with chronic fatigue syndrome (CFS) can easily perform stair climbing, a daily physical activity perceived by themselves as threatening, without triggering symptom flares. This is important as it can be used clinically to convince people with CFS of undertaking such a threatening task during treatment programs such as graded activity or graded exposure."

Similarly, this wording is also concerning: "The finding that kinesiophobia and fatigue catastrophizing are strongly related to stair climbing performance in CFS underscores the importance of restructuring the beliefs of these patients about the relationship between activity and symptoms. This should be a key component of the early stages of rehabilitation for people with CFS. In rehabilitation practice, diminishing kinesiophobia and fatigue catastrophizing in patients with CFS appears only relevant for targeting physical activities that are perceived as threatening (e.g. stair climbing), and not for increasing work-related or social (physical) activities."

What about all those hordes of patients who as a brute fact of life do experience symptom exacerbations after climbing up and down 2 flights of stairs??? And how many flights of stairs are we allowed to be "fearful" of without attracting psychobabble, 20? Is it OK to "perceive" a marathon as "threatening"? A major red flag indicating this paper studied a questionable cohort is that the patients were able to "easily" climb up and down 2 flights of stairs without any self-reported "immediate post-stair climbing symptom" (they are not talking about delayed PENE). What kind of CFS group could do this without some reporting symptoms and even stopping along the way? The abstract doesn't mention the CFS criteria used, but looking at the authors' names you can practically guarantee whatever they used didn't require post-exertional symptoms of any kind.

The other implication of this paper is that kinesiophobia and fatigue catastrophizing have nothing to do with overall physical activity levels, which would probably also translate into overall physical disability, a blow to previous speculations about kinesiophobia and fatigue catastrophizing being responsible for reduced overall physical functioning. As the authors concluded: "In rehabilitation practice, diminishing kinesiophobia and fatigue catastrophizing in patients with CFS appears only relevant for targeting physical activities that are perceived as threatening (e.g. stair climbing), and not for increasing work-related or social (physical) activities."

In recent years there has been a shift towards more specific behaviour-babble as the more general pillars of the cognitive behavioural model of CFS are crumbling. Thanks for looking at the full text Snow Leopard (Post#16 : http://forums.phoenixrising.me/show...stair-climbing&p=241132&viewfull=1#post241132). Sounds like smoke/mirrors from the authors and poor presentation of results.
 

maddietod

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Perhaps this study was always going to be a lose-lose situation, because no matter the outcome or associations (or lack of) between kinesiophobia and fatigue catastrophizing vs climbing performance vs immediate post-climbing symptoms vs overall activity levels, the results were always going to be twisted to support cognitive behavioural speculations regardless of alternative explanations.
Or, it's entirely a publicity ploy, to connect the words "kinesiophobia" and "catastrophizing" with CFS.

Every time somebody cites or quotes the study, this insane idea gets more real.