Which Psychological and Psychosocial Constructs Are Important to Measure in Future Tendinopathy Clinical Trials? A Modified International Delphi Study With Expert Clinician/Researchers and People With Tendinopathy.

OBJECTIVE: To identify which psychological and psychosocial constructs to include in a core outcome set to guide future clinical trials in the tendinopathy field. DESIGN: Modified International Delphi study. METHODS: In 3 online Delphi rounds, we presented 35 psychological and psychosocial constructs to an international panel of 38 clinician/researchers and people with tendinopathy. Using a 9-point Likert scale (1 = not important to include, 9 = critical to include), consensus for construct inclusion required ≥70% of respondents rating "extremely critical to include" (score ≥7) and ≤15% rating "not important to include" (score ≤3). Consensus for exclusion required ≥70% of respondents rating "not important to include" (score ≤3) and ≤15% of rating "critical to include" (score ≥7). RESULTS: Thirty-six participants (95% of 38) completed round 1, 90% (n = 34) completed round 2, and 87% (n = 33) completed round 3. Four constructs were deemed important to include as part of a core outcome set: kinesiophobia (82%, median: 8, interquartile range [IQR]: 1.0), pain beliefs (76%, median: -7, IQR: 1.0), pain-related self-efficacy (71%, median: 7, IQR: 2.0), and fear-avoidance beliefs (73%, median: -7, IQR: 1.0). Six constructs were deemed not important to include: perceived injustice (82%), individual attitudes of family members (74%), social isolation and loneliness (73%), job satisfaction (73%), coping (70%), and educational attainment (70%). Clinician/researchers and people with tendinopathy reached consensus that kinesiophobia, pain beliefs, pain self-efficacy, and fear-avoidance beliefs were important psychological constructs to measure in tendinopathy clinical trials. J Orthop Sports Phys Ther 2024;54(1):1-12. Epub 20 September 2023. doi:10.2519/jospt.2023.11903.

A cross-sectional investigation of back pain beliefs and fear in physiotherapy and sport undergraduate students.

BACKGROUND: Although low back pain (LBP) beliefs have been well investigated in mainstream healthcare discipline students, the beliefs within sports-related study students, such as Sport and Exercise Science (SES), Sports Therapy (ST), and Sport Performance and Coaching (SPC) programmes have yet to be explored. This study aims to understand any differences in the beliefs and fear associated with movement in students enrolled in four undergraduate study programmes-physiotherapy (PT), ST, SES, and SPC. METHOD: 136 undergraduate students completed an online survey. All participants completed the Tampa Scale of Kinesiophobia (TSK) and Back Beliefs Questionnaire (BBQ). Two sets of two-way between-subjects Analysis of Variance (ANOVA) were conducted for each outcome of TSK and BBQ, with the independent variables of the study programme, study year (1st, 2nd, 3rd), and their interaction. RESULTS: There was a significant interaction between study programme and year for TSK (F(6, 124) = 4.90, P < 0.001) and BBQ (F(6, 124) = 8.18, P < 0.001). Post-hoc analysis revealed that both PT and ST students had lower TSK and higher BBQ scores than SES and SPC students particularly in the 3rd year. CONCLUSIONS: The beliefs of clinicians and trainers managing LBP are known to transfer to patients, and more negative beliefs have been associated with greater disability. This is the first study to understand the beliefs about back pain in various sports study programmes, which is timely, given that the management of injured athletes typically involves a multidisciplinary team.

The relationship between psychological, cognitive, and contextual factors and rehabilitation outcomes in Achilles tendinopathy: A prospective feasibility cohort study.

OBJECTIVES: This study aimed to investigate the feasibility of conducting a full-scale study investigating the influence of patient-related factors on rehabilitation outcomes in Achilles tendinopathy (AT). A secondary aim was to investigate preliminary relationships between patient-related factors and clinical outcomes at 12- and 26- weeks. DESIGN: feasibility cohort. SETTING: Australian healthcare settings. METHODS: Participants with AT receiving physiotherapy in Australia were recruited via treating physiotherapists and online. Data were collected online at baseline, 12- and 26-weeks. Progression criteria for a full-scale study were recruitment rate of ≥10 per month, conversion rate ≥20%, and response rate to questionnaires ≥80%. The relationship between patient-related factors and clinical outcomes was investigated using Spearman's rho correlation coefficient. RESULTS: The average recruitment rate was 5/month, conversion rate was 97%, and response rate to questionnaires was ≥97% at all timepoints. There was a fair to moderate correlation (rho = 0.225 to 0.683) between patient-related factors and clinical outcomes at the 12-week, but no to weak correlation at the 26-week (rho = 0.002 to 0.284). CONCLUSIONS: Feasibility outcomes suggest a future full-scale cohort study is feasible with the caveat of utilizing strategies to improve recruitment rate. Preliminary bivariate correlations at 12-weeks warrant further investigations in larger studies.

Inter-Rater and Intra-Rater Reliability of Return-to-Work Screening Tests for UK Firefighters Following Injury.

The aim of this study was to assess the inter-rater and intra-rater reliability of a return-to-work (RTW) screening test to be used on UK firefighters following injury. The inter rater and intra-rater reliability of eight tasks involved in a screening test was used to assess readiness to RTW for UK firefighters following injury. These tasks included the following: (1) putting on and removing a breathing apparatus set (BA), (2) a ladder lift simulation, (3) a ladder carry simulation, (4) a light portable pump (LPP) lift and carry simulation, (5) a hose run, (6) a ladder climb with leg lock, (7) a casualty evacuation and (8) a confined space crawl simulation. The inter-rater reliability between each individual screening task was interpreted as Excellent (ICC = 0.94-1.00) for eleven (68.75%) of the screening task videos and as Good (ICC = 0.75-0.88) for five (31.25%) of the screening task videos. Intra-rater reliability was interpreted as Excellent (ICC = 1) for twenty-six participants (74.3%), Good (ICC = 0.76-0.88) for eight participants (22.9%) and Moderate for one participant (2.8%). Due to the reliability of this screening test, it allows conclusions to be made from the results which can inform a RTW decision for a firefighter.

Identifying current uses of return to work screening tests and their effectiveness of reducing the risk of reinjury in athletic occupations - A systematic review.

OBJECTIVE: To identify the current return-to-work (RTW) screening tests conducted for athletic occupations following injury and their effectiveness of reducing reinjury risk. METHODS: A search was made of multiple databases (BioMed Central, CINAHL through ebscohost, EMBASE, Google Scholar, PUBMED, Scopus, SPORTDiscus and Web of Science) from their inception to March 2022, using relevant terms to identify articles meeting predefined inclusion/exclusion criteria. The search, data extraction, risk of bias, and evaluation of the certainty of the findings were completed independently by two authors. To understand the effectiveness of screening tests and their impact in reducing in reinjury rates, results were split into the following three time points: "Short-term" (≤1 year), "Medium-term" (≥2 years) and "Long-term" (≥3 years). RESULTS: Five studies (n = 507) met the inclusion criteria. There was a very low level of certainty for the effectiveness of screening tools reducing reinjury risk at short-term, medium-term and long-term follow ups. Only one study recorded a large effect in the reducing reinjury risk. CONCLUSION: The results demonstrated very low level of certainty for the effectiveness of screening tests reducing the risk of reinjury. A gap in our understanding currently exists for the effectiveness of RTW screening tests in tactical athletic occupations following injury and further research investigating is required.

ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Scoping Review of Psychological and Psychosocial Constructs and Outcome Measures Reported in Tendinopathy Clinical Trials.

OBJECTIVE: To identify and describe the psychological and psychosocial constructs and outcome measures used in tendinopathy research. DESIGN: Scoping review. LITERATURE SEARCH: We searched the PubMed, EMBASE, Scopus, Web of Science, PEDro, CINAHL, and APA PsychNet databases on July 10, 2021, for all published studies of tendinopathy populations measuring psychological and psychosocial factors. STUDY SELECTION: Studies using a clinical diagnosis of tendinopathy or synonyms (eg, jumper's knee or subacromial impingement) with or without imaging confirmation. DATA SYNTHESIS: We described the volume, nature, distribution, and characteristics of psychological and psychosocial outcomes reported in the tendinopathy field. RESULTS: Twenty-nine constructs were identified, including 16 psychological and 13 psychosocial constructs. The most frequently-reported constructs were work-related outcomes (32%), quality of life (31%), depression (30%), anxiety (18%), and fear (14%). Outcome measures consisted of validated and nonvalidated questionnaires and 1-item custom questions (including demographics). The number of different outcome measures used to assess an individual construct ranged between 1 (emotional distress) and 11 (quality of life) per construct. CONCLUSION: There was a large variability in constructs and outcome measures reported in tendinopathy research, which limits conclusions about the relationship between psychological and psychosocial constructs, outcome measures, and tendinopathies. Given the wide range of psychological and psychosocial constructs reported, there is an urgent need to develop a core outcome set in tendinopathy. J Orthop Sports Phys Ther 2022;52(6):375-388. doi:10.2519/jospt.2022.11005.

ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy.

BACKGROUND: Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. OBJECTIVE: To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. DESIGN: Systematic review. DATA SOURCES: Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. RESULTS: 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. CONCLUSION: 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. PROSPERO REGISTRATION: CRD42020156763.

Management of recent onset tendon-related pain in a primary contact setting: A survey of practice.

BACKGROUND: Tendon-related pain is a common and debilitating condition that affects a wide range of people. To inform future research, it is important to understand healthcare professional's current practice. OBJECTIVES: To describe the practice of First Contact Practitioners (FCPs) and Other Clinicians (OCs) for recent onset tendon pain in a primary contact setting. The secondary aim was to understand if practice differed between the locations of pain. DESIGN: Cross-sectional online survey METHOD: The online survey asked for responses relating to one scenario of shoulder pain and one of Achilles pain. Except location of pain, the scenarios were identical. Responses were collected over a four-week period to December 2020. The Chi-Square test was used to analyse the difference in proportion of responses between FCPs and OCs, and between locations of pain. RESULTS: 118 responses were received. Rotator Cuff Related Shoulder Pain (RCRSP) was preferred by 64/118 (54.2%) for the shoulder scenario. Achilles tendinopathy was the preferred term by 86/103 (83.5%) for the Achilles. FCPs were more likely to advise NSAIDs for both shoulder (p = 0.006) and Achilles (p = 0.046) scenarios than OCs. Amended duties were more likely to be advised for manual workers for the shoulder scenario compared to Achilles (p = <0.0001). CONCLUSION: There were similarities in the management of recent onset tendon-related pain; the majority of respondents recommended against further investigations, steroid injections, and recommended exercise. Understanding whether these approaches are clinically effective requires further investigation.

Psychosocial barriers and facilitators for a successful return to work following injury within firefighters.

OBJECTIVE: The aim was to explore firefighter's experiences during their recovery from injury. Focused specifically on exploring perceived psychosocial barriers and facilitators firefighters faced during recovery and return to work. METHODS: Semi-structured interviews were used to provide an in-depth understanding of the firefighter's experiences. The semi-structured interviews were informed by a topic guide. The topic guide focused on five main themes, (1) overall experience of returning to operational duties following an injury, (2) perceived barriers experienced during their return to work, (3) perceived facilitators experienced during their return to work, (4) confidence in participating in physical activity following injury and (5) where they felt areas of improvement could be made with the return to work process. Thematic analysis of the data collected was undertaken using The Framework Method. RESULTS: Two main themes were sought after transcription: barriers and facilitators. From these, nine subthemes were identified (1) communication, (2) confidence in physical activity participation, (3) modified duties, (4) physiotherapy, (5) return to operational duties, (6) support, (7) inconsistency, (8) use of station gyms, (9) detachment from the watch. CONCLUSIONS: Consideration should be made for the consistency of procedures followed during an individual's return to work following an injury. Further research is needed to understand if the themes identified in this study are the same for other fire services. Further research is also needed to understand how the findings may be best implemented within the fire service.

Implicit Motor Imagery of the Foot and Hand in People with Achilles Tendinopathy: A Left Right Judgement Study.

OBJECTIVE: To determine if impairment in motor imagery processes is present in Achilles tendinopathy (AT), as demonstrated by a reduced ability to quickly and accurately identify the laterality (left-right judgement) of a pictured limb. Additionally, this study aimed to use a novel data pooling approach to combine data collected at 3 different sites via meta-analytical techniques that allow exploration of heterogeneity. DESIGN: Multi-site case-control study. METHODS: Three independent studies with similar protocols were conducted by separate research groups. Each study-site evaluated left/right judgement performance for images of feet and hands using Recognise© software and compared performance between people with AT and healthy controls. Results from each study-site were independently collated, then combined in a meta-analysis. RESULTS: In total, 126 participants (40 unilateral, 22 bilateral AT cases, 61 controls) were included. There were no differences between AT cases and controls for hand image accuracy and reaction time. Contrary to the hypothesis, there were no differences in performance between those with AT and controls for foot image reaction time, however there were conflicting findings for foot accuracy, based on four separate analyses. There were no differences between the affected and unaffected sides in people with unilateral AT. CONCLUSIONS: Impairments in motor imagery performance for hands were not found in this study, and we found inconsistent results for foot accuracy. This contrasts to studies in persistent pain of limbs, face and knee osteoarthritis, and suggests that differences in pathoetiology or patient demographics may uniquely influence proprioceptive representation.

Patient perspectives on participation in exercise-based rehabilitation for Achilles tendinopathy: A qualitative study.

BACKGROUND: Achilles tendinopathy (AT) is common, and can be traumatic or insidious in onset and short-lasting or persistent in nature. Factors influencing the experience of pain are poorly understood; little is known about mechanisms driving pain and the response (or lack of) to rehabilitation. Despite this, there is a growing body of evidence supporting the use of exercise to manage AT. Interestingly, variation in exercise approach does not appear to significantly impact outcome. Patients' perceptions of factors related to rehabilitation that may influence outcome could provide a valuable addition to help guide future research and practice. OBJECTIVES: The aim of this study is to gain an insight into patients' experiences of participating in an exercise-based rehabilitation programme for AT. METHOD: A qualitative interpretive description design. Data generated from semi-structured interviews were analysed thematically using the guidelines set out by Braun and Clarke. FINDINGS: This is the first study to use a qualitative method of inquiry to gain data on the experiences of people undertaking exercise-based rehabilitation for AT. The four major themes that were identified from the data were: (1) 'understanding the impact' (2) 'expectations' (3) 'what matters' and (4) 'the burden of exercise'. CONCLUSIONS: Given the uncertainty surrounding the mechanisms of effect of our treatments, the insights provide a platform from which researchers and clinicians can consider further in the management of people with Achilles tendinopathy. Specifically, it has highlighted that patients value a flexible, supportive approach embracing the biopsychosocial impact of AT on the individual.

Consensus on tasks to be included in a return to work assessment for a UK firefighter following an injury: an online Delphi study.

OBJECTIVE: The aim was to provide a consensus tasks needed to be included in a return to work assessment for operational firefighters. METHODS: A two round online Delphi study was conducted with twenty-four participants including firefighters, service fitness advisers and occupational health managers. A consensus was set at 70% agreement. In round one, participants completed an online survey relating to tasks to be included during a return to work assessment for firefighters following an injury. Round two was an online consensus meeting to discuss the tasks where consensus was not achieved. RESULTS: A consensus was reached for ten of the thirteen tasks, including the number of repetitions required when lifting a light portable pump and climbing a ladder. A consensus was reached for the total distance equipment which should be carried. This included carrying a ladder, a hose and a light portable pump. CONCLUSIONS: This study has provided a consensus for tasks to be included when assessing a firefighter for return to work. Further research is needed to understand how to use this assessment optimally.

Conservative management of acute lower limb tendinopathies: A systematic review.

BACKGROUND: Most knowledge regarding conservative management for lower limb tendinopathy (LLT) is for persistent symptoms, with less known about conservative management of acute LLT. Sub-optimal management of acute LLT is detrimental in many regards, not least the likely conversion to persistent symptoms. OBJECTIVES: To synthesise existing literature on conservative management of acute LLTs. DESIGN: Systematic review of relevant literature (PROSPERO [ID: CRD42018117882]). METHOD: A search was made of multiple databases (MEDLINE, CINAHL and EMBASE) using relevant search terms. Titles, abstracts and then full texts were filtered to find articles that met the strict inclusion/exclusion criteria. Searching, data extraction and quality assessment, using the Grading of Recommendations Assessment, Development and Evaluation, were done independently by two authors. To understand how the interventions impacted the duration of reported symptoms, results were split into three time points: short-term (<4 weeks), medium-term (4-12 weeks) and long-term (>12 weeks). RESULTS: Thirteen studies (n = 534) met the criteria for inclusion. There was very low level of certainty for the effectiveness of interventions at short-term, medium-term and long-term follow ups. However, there were large effects seen across a number of different treatments on pain intensity and disability in LLTs. CONCLUSIONS: This review demonstrates that limited evidence currently exists to guide the management of acute LLT, and the quality of the existing evidence is collectively low. These findings inform the discussion of different treatment options with patients in a shared decision-making process to empower and enable the patient.

The strength of association between psychological factors and clinical outcome in tendinopathy: A systematic review.

OBJECTIVE: Tendinopathy is often a disabling, and persistent musculoskeletal disorder. Psychological factors appear to play a role in the perpetuation of symptoms and influence recovery in musculoskeletal pain. To date, the impact of psychological factors on clinical outcome in tendinopathy remains unclear. Therefore, the purpose of this systematic review was to investigate the strength of association between psychological factors and clinical outcome in tendinopathy. METHODS: A systematic review of the literature and qualitative synthesis of published trials was conducted. Electronic searches of ovid MEDLINE, ovid EMBASE, PsychINFO, CINAHL and Cochrane Library was undertaken from their inception to June 2020. Eligibility criteria included RCT's and studies of observational design incorporating measurements of psychological factors and pain, disability and physical functional outcomes in people with tendinopathy. Risk of Bias was assessed by two authors using a modified version of the Newcastle Ottawa Scale. High or low certainty evidence was examined using the GRADE criteria. RESULTS: Ten studies of observational design (6-cross sectional and 4 prospective studies), involving a sample of 719 participants with tendinopathy were included. Risk of bias for the included studies ranged from 12/21 to 21/21. Cross-sectional studies of low to very low level of certainty evidence revealed significant weak to moderate strength of association (r = 0.24 to 0.53) between psychological factors and clinical outcomes. Prospective baseline data of very low certainty evidence showed weak strength of association between psychological factors and clinical outcome. However, prospective studies were inconsistent in showing a predictive relationship between baseline psychological factors on long-term outcome. Cross sectional studies report similar strengths of association between psychological factors and clinical outcomes in tendinopathy to those found in other musculoskeletal conditions. CONCLUSION: The overall body of the evidence after applying the GRADE criteria was low to very low certainty evidence, due to risk of bias, imprecision and indirectness found across included studies. Future, high quality longitudinal cohort studies are required to investigate the predictive value of baseline psychological factors on long-term clinical outcome.

The association of working alliance, outcome expectation, adherence and self-efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study).

INTRODUCTION: This study evaluated the feasibility of a large longitudinal cohort study utilizing an online platform to investigate the association and predictive relationship of working alliance, outcome expectations, adherence and self-efficacy with outcome in Achilles tendinopathy. The objectives were: (1) to determine the recruitment and retention rate and (2) to carry out preliminary data analysis of the selected variables and clinical outcomes. METHODS: A multi-centred, longitudinal feasibility cohort study was used. Eligible participants were directed to a bespoke online platform hosting study information and the outcome measures in the form of an online questionnaire. Responses from the online questionnaire were collected on three occasions: at baseline, at 6 and at 12 weeks following completion of the first questionnaire. Feasibility outcomes (recruitment and retention rates) were described using descriptive statistics. RESULTS: The website recorded a total 55 views. These 55 views resulted in 24 participants consenting to join the study. The questionnaire at baseline was started 63 times and completed on 60 separate occasions resulting in a 95% conversion rate. Retainment for completion of the questionnaire for a second time was 83.3% and for the third time was 66.6%. All questionnaires were completed fully yielding a missing data indicator of 0%. CONCLUSIONS: Feasibility studies ask the question 'can this be done'? Based on the data from recruitment and rates and exploratory correlation analysis a future study can be done; this previously untested online platform appears feasible, but changes could be useful before proceeding to a much larger study.

The efficacy of loading programmes for improving patient-reported outcomes in chronic midportion Achilles tendinopathy: A systematic review.

OBJECTIVE: Achilles tendinopathy is a common type of overuse condition, with isolated eccentric loading (ECL) programmes being the principal conservative treatment of choice. However, alternative protocols, involving different contraction types, have more recently been investigated. The purpose of the present review was to examine the evidence from studies comparing two or more different types of loading programmes in relation to patient-reported outcomes for people with Achilles tendinopathy. METHODS: A systematic review was undertaken, and the risk of bias of included papers were assessed using the Cochrane Risk of Bias tool. An electronic search of CINAHL, MEDLINE, Embase and SPORTDiscus was undertaken from their inception to May 2018. The eligibility criteria for selecting studies were randomized controlled or clinical controlled trials investigating two or more different loading programmes for chronic (>3 months) Achilles tendinopathy. RESULTS: Seven articles were included in the review. Low-quality evidence exists that a do-as-tolerated modification of the Alfredson programme is more effective than the standardized programme at improving function in the short term. Very-low-quality evidence suggests that ECL is superior at reducing pain levels than concentric in isolation, but no more effective at improving pain or disability than concentric-eccentric programmes. CONCLUSIONS: There is conflicting evidence regarding the superiority of ECL over other contraction types, challenging the current approach to managing Achilles tendinopathy. There is also evidence that do-as-tolerated repetition volumes are more effective at improving function in the short term compared with those recommended by the standardized Alfredson protocol.

Managing Achilles Pain (the MAP study) - A process evaluation of data collection methods.

BACKGROUND: Process evaluations explore the way in which a study was conducted. The Managing Achilles Pain study (MAP study) had the primary aim of assessing the feasibility of the protocol for a future large longitudinal cohort study that would investigate the association and predictive relationship of self-efficacy, working alliance and expectations with outcome in the management of Achilles tendinopathy. OBJECTIVES: This study aimed to evaluate the processes conducted in the MAP study by exploring the acceptability of the study procedures from the participants' and physiotherapists' perspectives. DESIGN: A qualitative evaluation using semi-structured telephone interviews. METHOD: All physiotherapists and participants who participated in the MAP study were invited. Data from physiotherapists (n = 6) and participants (n = 7) were transcribed and analysed using the Framework Approach. FINDINGS: From the physiotherapists' perspective 4 themes were identified relating to obstacles; (1) access to participants; (2) recall; (3) visibility; (4) time, and 4 themes were identified relating to facilitating success; (1) training; (2) motivation; (3) incentives; (4) simplicity. From the participants' perspective 2 themes were identified relating to obstacles; (1) information from the physiotherapist; (2) follow up, 3 themes were identified relating to facilitating success; (1) motivation; (2) website; (3) questionnaire, and 1 theme relating to unintended consequences of participating in the study; positive experience. CONCLUSIONS: Although clinicians are enthused to be involved in research, organisational factors impact levels of engagement. Key influences to optimising the potential success of a study include the publicising of the study; optimising verbal recruitment strategies; and clarity in communication.

Psychosocial variables and presence, severity and prognosis of plantar heel pain: A systematic review of cross-sectional and prognostic associations.

OBJECTIVE: Plantar heel pain (PHP) is often disabling, and persistent symptoms are common. Psychosocial variables are known to affect pain and disability but the association of these factors with PHP has yet to be established. The purpose of the present systematic review was to determine if psychosocial variables are associated with the presence, severity and prognosis of PHP. METHODS: A systematic review of the literature and qualitative synthesis was carried out. Electronic searches of MEDLINE, CINAHL, SPORTDiscus, PsycINFO and EMBASE were undertaken from the inception of the respective databases up to November 2017. Any study design incorporating measurements of psychosocial variables with participants with plantar heel pain were included. The quality of included articles was appraised using the Newcastle Ottawa Scale. RESULTS: Five articles from four studies were included in the review, with a total of 422 participants. Moderate-level evidence suggested a clinically unimportant association with the incidence of PHP and depression, anxiety and stress, and limited evidence suggested a clinically unimportant association with job dissatisfaction. Moderate-level evidence suggested that there may also be an association between depression, anxiety, stress and catastrophization and PHP pain, and between depression, anxiety, stress, catastrophization and kinesiophobia and PHP function. We also found moderate-level evidence that a psychological disorder may be associated with a poorer outcome to shockwave therapy. CONCLUSION: In light of this review, the association of psychosocial variables and plantar heel pain cannot be ruled out. Given recommendations to adopt an individualized and stratified approach to other musculoskeletal conditions, clinicians should remain vigilant to their presence.