Kinesiophobia among health professionals’ interventions: a scoping review

Identifying the research questions

Two key questions were formulated for this scoping review. The first question was: What were the potential reasons for health professionals experiencing kinesiophobia or displaying kinesiophobic behaviour? By investigating the potential reasons health professionals experience kinesiophobia or display kinesiophobic behaviour, we aim to identify the underlying factors contributing to this phenomenon. Understanding these reasons is essential for developing targeted interventions and support systems to mitigate kinesiophobia among healthcare providers, thereby improving the quality of care and patient outcomes. The second question was: What were the possible outcomes on the patient attitude of health professionals’ experiencing kinesiophobia or displaying kinesiophobic behaviour during their interventions? This research question focuses on the possible outcomes on patient attitudes resulting from health professionals experiencing kinesiophobia or displaying kinesiophobic behaviour during interventions. This inquiry is crucial for comprehensively assessing the impact of kinesiophobia on patient-provider interactions and healthcare outcomes. By elucidating the consequences of kinesiophobia from the patient’s perspective, we can better understand the broader implications of this phenomenon on patient care and satisfaction. Within the broader context of the field, these questions can highlight their implications for clinical practice, education, and policy development during health interventions.

Identifying relevant studies

The establishment of the study criteria was broad to target the topic of the study appropriately using Mnemonic PCC (Population, Concept, Context) as a framework (Aromataris & Munn, 2020). Population: Health professionals suffering from kinesiophobia’s characteristics; Concept: To determine whether health professionals suffer from kinesiophobia’s characteristics based on factors such as fear-avoidance, pain, physical disability, deconditioning, fear of pain, self-efficacy or catastrophizing that create kinesiophobic behaviours and/or beliefs and/or knowledge that impact their interventions (BaykalŞahin, Kalaycíoğlu & Şahin, 2021; Ding et al., 2022; Sharpe et al., 2022); Context: Within the intervention of health professionals.

Studies selection

The scoping review has been conducted on the CINHAL, Medline, and Sportdiscus databases as of May 2024. An experienced health sciences librarian helped conduct searches on the databases. The librarian identified the most relevant databases based on the research questions and the review topic. Searches were limited to French and English language citations. We combined the following keywords using Boolean operators to ensure no relevant studies were missed. Appendix S1 details the Boolean operators for each database. The following keywords were used: “Pain-Related Fear”, “Avoidance behaviour”, “Pain belief”, “Fear of movement”, “Kinesiophobia”, “Fear avoidance”, “Anticipation of pain”, “Fear”, “Movement”, “Occupational therapists”, “Nurses”, “Physical Therapists”, “Physicians”, “Physicians, Family”, “Rheumatologists”, “Physical therapist”, “Physiotherapist”, “Kinesiotherapist”, “Clinician”, “Health professional”, “Health personnel”, “Practitioner”, “Chiropractor”, “Physician”, “Health care provider”, “Rheumatologist”. Thus, reference lists of articles identified in the databases were reviewed.

Data extracting and mapping

A data charting form in Microsoft Excel was utilized during the data extraction process. This form was provided to the evaluators with a descriptive summary of the results (Table 1). The data charting form helps to identify the concepts corresponding to the research questions. Three evaluators extracted data independently (LD, ST, MT). The form contained authors, year of publication, population, number of participants, kinesiophobic attitudes, behaviours and beliefs of health professionals, influence on interventions and patients’ outcomes. The three evaluators (LD, ST, MT) agreed on each item on the data charting form. To select the suitable studies, the evaluators followed a three-step process that involved reviewing the titles, abstracts, and complete scientific articles. The data was then mapped thematically, including study descriptions, summaries of results, identification of kinesiophobic behaviour among health professionals, and the influence on both the health professional’s intervention and the eventual outcomes for their patients.

Selection of studies

Overall, 2,162 potential studies have been identified throughout the databases for the review. After removing duplicates, the initial selection was made by reading the title, and then the abstracts, 43 articles remained for the entire reading. Of the forty-three, 30 articles were excluded because they did not answer the research questions where seven studies focused on the effect of intervention among health professionals, seven studies were oriented to the pain prevalence in clinicians and its impact on their job (none clinical aspects), five studies were education on treatment guidelines, three studies were conducted that specifically targeted students, three studies focused on questionnaires’ validation, one was an editorial article, one article described the advice from a physiotherapist, two studies that solely concentrate on patients and their caregivers, and one study was excluded because the publisher was identified on Beall’s list (Beall, 2023). At the end of the process, a total of 13 articles were included in the study (Fig. 1).

Characteristics of the studies

The thirteen studies selected explore and catalogue the extent of scientific research that identifies the causes and consequences of kinesiophobia, kinesiophobic behaviour or fear-avoidance behaviour among health professionals while they perform their intervention. Among those, 10 studies investigated the association between the professional’s knowledge (n = 2), fear-avoidance beliefs (n = 10), attitudes (n = 5), sense of self-efficacy (n = 1) and fear of falling and exercising (n = 3) and the impact on their interventions. One study directly examines the association between the professionals’ fear and those of their recipients. Two articles were systematic literature reviews. Nine articles were quantitative studies and used questionnaires. Two qualitative studies used semi-structured interviews as data collection methods. Two articles used physical capacity tests and questionnaires. Ten studies studied patients who suffered from pain, more precisely chronic pain and acute lower back pain. One article studied cardio-respiratory disorders, one studied aging people and dementia. The professionals studied were physiotherapists (n = 6), physicians (n = 3), nurses (n = 4), care assistants (n = 2), massage therapists (n = 1) and exercise physiologists (n = 1). Table 1 summarises the characteristics of the 13 included studies.

Overview

The recent publication years of the selected articles (2002 to 2024) represent the relevance of this study and evoke the emergence of this topic. The wide variety of results provides a broad understanding of the causes and consequences of the professional’s kinesiophobia in their interventions. Table 2 presents the major findings of the review divided into seven themes according to the characteristics of kinesiophobia related to professionals’ intervention.

Theme 1. Kinesiophobia and kinesiophobic behaviours influence on their interventions. Two-thirds of the literature suggests that health professionals may have a wide range of kinesiophobia and kinesiophobic behaviours, which can have negative but also positive impacts on their patient’s intervention. More precisely, professionals with high levels of fear-avoidance beliefs, which are related to kinesiophobia and kinesiophobic behaviours, tend to refer their patients to other health specialists less frequently, increase medication usage, and limit their patients’ physical or daily activity, despite treatment guidelines recommending otherwise. Conversely, professionals with low levels of fear-avoidance beliefs tend to be more proactive by referring patients to other specialists and adhering to treatment guidelines. Seven out of eight articles were related to interventions for patients’ chronic back pain, and only one article was related to geriatric patients with dementia. The health professionals assessed were mostly physiotherapists, but also physicians (general practitioners, specialists), nurses, massage therapists, occupational therapists, and professional caregivers. Theme 2. Professionals’ guidance provided to their patients. Almost half of the literature identified that professionals’ guidance might be influenced by their beliefs, whereas professionals tend to limit advice when they report a high level of fear-avoidance beliefs. Four out of six articles were related to the interventions with chronic back pain patients; one was for cardio-rehabilitation patients, and one was for healthy individuals. The health professionals assessed were mostly physiotherapists, but also physicians, nurses, and exercise physiologists (kinesiologists). Theme 3. Professionals’ fear-avoidance beliefs. Approximately half of the literature about professionals’ and patients’ fear-avoidance beliefs was found to be closely related, and professionals tend to influence their intervention but non-intentionally through their beliefs. Although these six articles were all about interventions for patients with chronic back pain. The health professionals assessed were mostly physiotherapists, but also physicians (general practitioners, specialists).

Theme 4. Professionals’ fear of pain. An article observed that professionals’ fears of patients’ falls and injuries predict the patients’ loss of functional autonomy. However, the study was related to geriatric patients with dementia, and the health professionals were professional caregivers. Theme 5. Professionals’ health condition and pain. Approximately one-quarter of the literature reported that professionals who experience pain were more inclined to report fear-avoidance beliefs or project themselves onto their patients or their interventions. Two articles were related to interventions with chronic back pain patients. Health professionals were physiotherapists and nurses. Theme 6. Professionals’ experience. Two articles observed that the professional’s level of experience influences the patient’s interpretation according to their pain perception, whereas senior professionals tend to help less experienced colleagues and their patients cope with the pain. These articles were related to physiotherapists’ interventions with chronic back pain patients. Theme 7. Professionals’ relationships with patients. Two articles identified the relationship between health professionals and patients as a key component. Professionals tend to satisfy their “passive” patients more easily and reduce the risk of conflicts with them by avoiding dissonance. These articles were related to physiotherapists’ interventions with chronic back pain patients.

Limitations

It is important to understand that this scoping review, while comprehensive, is not a systematic review or quantitative study. Therefore, the results should not be generalized or interpreted as cause–effect relationships. While extensive, the use of three databases (Medline, SportDiscus, and CINAHL) in this study may limit the breadth of our findings and interpretations of the results. In addition, it’s important to mention that a large portion of the literature we found focused on interventions by physiotherapists, with the most frequently studied health condition being chronic back pain. This limits also the applicability of the findings to other healthcare professionals and health conditions, highlighting the need for future research to explore a wider range of kinesiophobia manifestations. No selected studies directly address kinesiophobia or kinesiophobia behaviours among health professionals but studied fear-avoidance beliefs among health professionals, which highlights the need for further research to address directly this topic.

Practical implications

Even though the generalization is difficult, it appears that professionals’ kinesiophobia and kinesiophobic symptoms are important issues that lead to negative outcomes among patients. Health professionals should be more aware of the impacts of their kinesiophobic beliefs and behaviours in their interventions. Health professionals can benefit from training, debriefing and skill building in physical activity, and how to manage to include physical activity in their interventions should identify the psychosocial needs of the patients and adopt an interdisciplinary/multidisciplinary approach to ease referrals and comprehensive, coordinated care of patients (Gardner et al., 2017; Fitzgerald, Hadjistavropoulos & MacNab, 2009). Health professionals should empower their patients to understand their disease, encourage self-reliance, and promote patient participation.