Impact of preoperative kinesiophobia on early rehabilitation compliance and functional recovery after arthroscopic meniscal repair

Table 1 Comparison of general data between two groups, n (%)/mean ± SD

Item	Kinesiophobia group (n = 120)	Non-kinesiophobia group (n = 149)	Statistic	P value
Gender			χ2 = 0.142	0.706
Male	68 (56.7)	88 (59.1)
Female	52 (43.3)	61 (40.9)
Age (years)	38.2 ± 11.5	36.8 ± 12.1	t = 0.974	0.331
BMI (kg/m2)	24.3 ± 3.2	23.9 ± 3.4	t = 0.996	0.32
Injury side			χ2 = 0.028	0.868
Left	58 (48.3)	73 (49.0)
Right	62 (51.7)	76 (51.0)
Injury type			χ2 = 2.156	0.54
Longitudinal tear	47 (39.2)	65 (43.6)
Transverse tear	28 (23.3)	38 (25.5)
Horizontal tear	26 (21.7)	27 (18.1)
Complex tear	19 (15.8)	19 (12.8)
Disease duration (months)	5.8 ± 3.2	5.4 ± 3.0	t = 1.064	0.288
Education level			χ2 = 1.824	0.402
Junior high school and below	38 (31.7)	42 (28.2)
High school/technical secondary school	45 (37.5)	63 (42.3)
College and above	37 (30.8)	44 (29.5)

BMI: Body mass index.

Table 2 Comparison of preoperative Tampa Scale for kinesiophobia scores between two groups, mean ± SD (points)

Item	Kinesiophobia group (n = 120)	Non-kinesiophobia group (n = 149)	t value	P value
TSK total score	42.8 ± 4.2	30.5 ± 3.8	25.463	< 0.001
Somatic focus dimension	25.6 ± 2.8	18.4 ± 2.5	22.118	< 0.001
Activity avoidance dimension	17.2 ± 2.1	12.1 ± 1.9	21.015	< 0.001

TSK: Tampa Scale for Kinesiophobia.

Table 3 Comparison of Modified Exercise Adherence Rating Scale scores at different time points between two groups, mean ± SD (points)

Time	Kinesiophobia group (n = 120)	Non-kinesiophobia group (n = 149)	t value	P value	Corrected P value
1 month postoperatively	52.4 ± 12.6	64.8 ± 11.3	8.625	< 0.001	< 0.001
3 months postoperatively	64.7 ± 14.2	78.5 ± 12.8	8.517	< 0.001	< 0.001
6 months postoperatively	75.3 ± 13.5	85.2 ± 11.6	6.531	< 0.001	< 0.001

Bonferroni correction was applied, α = 0.0167.

Table 4 Comparison of rehabilitation adherence grading at 3 months postoperatively between two groups, n (%)

Adherence grade	Kinesiophobia group (n = 120)	Non-kinesiophobia group (n = 149)	χ2 value	P value
Excellent (≥ 80 points)	32 (26.7)	81 (54.4)	24.186	< 0.001
Good (60-79 points)	45 (37.5)	52 (34.9)
Fair (40-59 points)	32 (26.7)	14 (9.4)
Poor (< 40 points)	11 (9.1)	2 (1.3)

Table 5 Comparison of Lysholm scores at different time points between two groups, mean ± SD (points)

Time	Kinesiophobia group (n = 120)	Non-kinesiophobia group (n = 149)	t value	P value	Corrected P value
Preoperatively	48.5 ± 8.3	49.2 ± 8.7	0.677	0.499
1 month postoperatively	62.8 ± 9.6	68.4 ± 8.5	5.154	< 0.001	< 0.001
3 months postoperatively	75.3 ± 10.2	83.6 ± 9.1	7.096	< 0.001	< 0.001
6 months postoperatively	84.7 ± 9.8	91.2 ± 7.6	6.026	< 0.001	< 0.001

Bonferroni correction was applied, α = 0.0167.

Table 6 Comparison of knee range of motion at different time points between two groups, mean ± SD (degree)

Time	Kinesiophobia group (n = 120)	Non-kinesiophobia group (n = 149)	t value	P value	Corrected P value
Preoperatively	118.3 ± 12.5	119.6 ± 11.8	0.896	0.371
1 month postoperatively	95.6 ± 10.3	102.8 ± 9.5	6.062	< 0.001	< 0.001
3 months postoperatively	115.2 ± 11.7	124.5 ± 10.2	7.038	< 0.001	< 0.001
6 months postoperatively	128.4 ± 10.5	135.8 ± 9.3	6.258	< 0.001	< 0.001

Bonferroni correction was applied, α = 0.0167.

Table 7 Comparison of Visual Analogue Scale pain scores at different time points between two groups, mean ± SD (points)

Time	VAS score type	Kinesiophobia group (n = 120)	Non-kinesiophobia group (n = 149)	t value	P value	Corrected P value
Preoperatively	Resting	2.8 ± 1.2	2.7 ± 1.1	0.717	0.474
	After activities	5.6 ± 1.4	5.5 ± 1.3	0.619	0.536
1 month postoperatively	Resting	3.2 ± 1.1	2.9 ± 0.9	2.428	0.016	0.048
	After activities	4.8 ± 1.3	3.9 ± 1.1	6.177	< 0.001	< 0.001
3 months postoperatively	Resting	1.8 ± 0.9	1.2 ± 0.7	6.234	< 0.001	< 0.001
	After activities	3.2 ± 1.1	2.3 ± 0.9	7.428	< 0.001	< 0.001
6 months postoperatively	Resting	1.1 ± 0.7	0.6 ± 0.5	6.878	< 0.001	< 0.001
	After activities	2.1 ± 0.9	1.3 ± 0.7	8.275	< 0.001	< 0.001

Bonferroni correction was applied, α = 0.0167. Bonferroni correction was only applied for different time points, and the two Visual Analogue Scale score types (resting and after activities) at each time point are presented separately as descriptive indicators. VAS: Visual Analogue Scale.

Table 8 Correlation analysis of preoperative Tampa Scale for Kinesiophobia scores with rehabilitation and functional indicators at 3 months postoperatively

TSK score	MEARS score	Lysholm score	ROM	Resting VAS	VAS after activities
TSK total score	r = -0.518; P < 0.001	r = -0.463; P < 0.001	r = -0.441; P < 0.001	r = 0.398; P < 0.001	r = 0.456; P < 0.001
Somatic focus dimension	r = -0.492; P < 0.001	r = -0.445; P < 0.001	r = -0.418; P < 0.001	r = 0.376; P < 0.001	r = 0.431; P < 0.001
Activity avoidance dimension	r = -0.487; P < 0.001	r = -0.432; P < 0.001	r = -0.421; P < 0.001	r = 0.383; P < 0.001	r = 0.428; P < 0.001

TSK: Tampa Scale for Kinesiophobia; MEARS: Modified Exercise Adherence Rating Scale; ROM: Range of motion; VAS: Visual Analogue Scale.

Table 9 Multiple linear regression analysis of factors influencing rehabilitation adherence at 3 months postoperatively

Variable	B	SE	β	t value	P value	95%CI
Constant	98.452	8.763		11.235	< 0.001	81.181-115.723
Preoperative TSK score	-0.812	0.096	-0.512	-8.458	< 0.001	-1.001 to -0.623
Education level	4.235	1.358	0.186	3.118	0.002	1.561-6.909
Disease duration	-0.683	0.27	-0.152	-2.53	0.012	-1.215 to -0.151

Adjusted R² = 0.315, F = 41.562, P < 0.001. TSK: Tampa Scale for Kinesiophobia; CI: Confidence interval.

Table 10 Binary logistic regression analysis of risk factors for postoperative complications

Variable	B	SE	Wald χ2	P value	OR	95%CI
Preoperative TSK score	0.079	0.024	10.823	0.001	1.082	1.032-1.134
MEARS score at 3 months postoperatively	-0.04	0.01	15.362	< 0.001	0.961	0.941-0.981
Constant	-2.156	1.124	3.681	0.055	0.116

Model χ² =43.728, P < 0.001; Hosmer-Lemeshow test χ² =6.842, P = 0.553. TSK: Tampa Scale for Kinesiophobia; MEARS: Modified Exercise Adherence Rating Scale; OR: Odds ratio; CI: Confidence interval.

Table 11 Detailed distribution of postoperative complications between two groups, n (%)

Complication type	Kinesiophobia group (n = 120)	Non-kinesiophobia group (n = 149)	χ2 value	P value
Joint stiffness requiring MUA	12 (10.0)	3 (2.0)	8.946	0.003
Persistent joint effusion	18 (15.0)	7 (4.7)	8.221	0.004
Superficial wound infection	4 (3.3)	2 (1.3)	1.345	0.246
Symptomatic DVT	2 (1.7)	1 (0.7)	0.673	0.412
Re-injury requiring revision	3 (2.5)	2 (1.3)	0.552	0.458
Total complications	39 (32.5)	15 (10.1)	21.758	< 0.001

MUA: Manipulation under anesthesia; DVT: Deep vein thrombosis.

Table 12 Comparison of rehabilitation progression slowdown criteria between two groups, n (%)

Criteria for slowing progression	Kinesiophobia group (n = 120)	Non-kinesiophobia group (n = 149)	χ2 value	P value
Any criterion met	51 (42.5)	27 (18.1)	18.734	< 0.001
Resting VAS increase ≥ 2 points	34 (28.3)	15 (10.1)	13.872	< 0.001
Joint swelling increase ≥ 1 cm	22 (18.3)	13 (8.7)	5.624	0.018
ROM decrease ≥ 10°	18 (15.0)	8 (5.4)	7.285	0.007
Joint locking or instability	6 (5.0)	5 (3.4)	0.402	0.527

VAS: Visual Analogue Scale; ROM: Range of motion.