Kronik Non-Spesifik Boyun Ağrılı Bireylerde Kinezyofobide Ağrı, Engellilik, Denge, Depresyon ve Uyku Kalitesinin Rolü

Abstract

Amaç: Kronik non-spesifik boyun ağrılı (KNSBA) bireylerde kinezyofobi ile ilişkili faktörleri ve bağımsız belirleyicilerini incelemektir. Gereç ve Yöntem: Bu çalışmaya KNSBA tanısı olan 70 birey dâhil edilmiştir. Kinezyofobi Tampa Kinezyofobi Ölçeği (TKÖ) ile değerlendirilmiştir. Ağrı şiddeti Görsel Analog Skala (GAS), engellilik Boyun Engellilik İndeksi (BEİ), denge performansı Berg Denge Ölçeği (BDÖ), depresyon şiddeti Beck Depresyon Envanteri (BDE) ve uyku kalitesi Pittsburgh Uyku Kalitesi İndeksi (PUKİ) kullanılarak değerlendirilmiştir. Sonuçlar: TKÖ ile BDE (r=0,654) ve NDI (r=0,513) arasında güçlü pozitif ilişkiler saptanırken (p<0,001); GAS-aktivite (r=0,498, p<0,001), GAS-gece (r=0,335, p=0,004) ve PUKİ (r=0,451, p=0,006) ile orta düzeyde pozitif ilişkiler bulunmuştur. BDÖ ile TKÖ arasında güçlü, negatif bir ilişki saptanmıştır (r=−0,513, p<0,001).Regresyon analizi sonuçlarına göre GAS-aktivite BDÖ ve BDE kinezyofobinin bağımsız belirleyicileri olup, TKÖ skorlarındaki varyansın %60’ını açıklamaktadır. Tartışma: CNSNP'de kinezyofobi ile ağrı, psikolojik ve denge faktörleri ilişkilidir.

Keywords

• Boyun Ağrısı
• Denge
• Depresyon

The Role of Pain, Disability, Balance, Depression, and Sleep Quality in Kinesiophobia among Individuals with Chronic Non-Specific Neck Pain

Abstract

Purpose: To examine the factors associated with kinesiophobia and its predictors in individuals with chronic non-specific neck pain (CNSNP). Material and Methods: This study included 70 individuals with CNSNP. Kinesiophobia was assessed using Tampa Kinesiophobia Scale (TKS). Pain intensity was evaluated using the Visual Analog Scale (VAS), disability using Neck Disability Index (NDI), balance performance using Berg Balance Scale (BBS), depression severity using Beck Depression Inventory (BDI), and sleep quality using Pittsburgh Sleep Quality Index (PSQI). Results: TKS demonstrated a strong positive association with BDI (r=0.654) and NDI (r=0.513) (both p<0.001), and moderate positive associations with VAS-activity (r=0.498, p<0.001), VAS-night (r=0.335, p=0.004), and PSQI (r=0.451, p=0.006). BBS was strongly and negatively correlated with TKS (r=−0.513, p<0.001). Multiple linear regression analysis revealed that VAS-activity BBS and BDI were significant independent predictors of TKS, jointly explaining 60% of the variance in TKS scores. Discussion: Kinesiophobia in CNSNP is associated with pain, psychological, and balance factors.

Keywords

• Neck pain
• Balance
• Depression

References

1. Alpalhao, V., Cordeiro, N., & Pezarat-Correia, P. (2022). Kinesiophobia and fear avoidance in older adults: a scoping review on the state of research activity. Journal of Aging and Physical Activity, 30(6), 1075-1084. https://doi.org/10.1123/japa.2021-0409
2. Andreucci, A., Madrid-Valero, J. J., Ferreira, P. H., & Ordoñana, J. R. (2020). Sleep quality and chronic neck pain: a cotwin study. Journal of Clinical Sleep Medicine, 16(5), 679-687. https://doi.org/10.5664/jcsm.8316
3. Asiri, F., Reddy, R. S., Tedla, J. S., ALMohiza, M. A., Alshahrani, M. S., Govindappa, S. C., & Reddy, R. (2021). Kinesiophobia and its correlations with pain, proprioception, and functional performance among individuals with chronic neck pain. PLOS ONE, 16(7), e0254262. https://doi.org/10.1371/journal.pone.0254262
4. Aslan, E., Karaduman, A., Yakut, Y., Aras, B., Simsek, I. E., & Yağlı, N. (2008). The cultural adaptation, reliability and validity of the neck disability index in patients with neck pain: a Turkish version study. Spine, 33(11), E362-E365. https://doi.org/10.1097/BRS.0b013e31817144e1
5. Bilgin, S., Cetin, H., Karakaya, J., & Kose, N. (2019). Multivariate analysis of risk factors predisposing to kinesiophobia in persons with chronic low back and neck pain. Journal of Manipulative and Physiological Therapeutics, 42(8), 565-571. https://doi.org/10.1016/j.jmpt.2019.02.009
6. Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., Robertson, E. K., & American Physical Therapy Association (2017). Neck pain: Revision 2017: Clinical practice guidelines linked to the International Classification of Functioning, Disability and Health. Journal of Orthopaedic & Sports Physical Therapy, 47(7), A1–A83. https://doi.org/10.2519/jospt.2017.0302
7. Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213. https://doi.org/10.1016/0165-1781(89)90047-4
8. Boonstra, A. M., Schiphorst Preuper, H. R., Balk, G. A., & Stewart, R. E. (2014). Cut‑off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain, 155(12), 2545–2550. https://doi.org/10.1016/j.pain.2014.09.014

9. Carvalho, R. C. D., Maglioni, C. B., Machado, G. B., Araújo, J. E. D., Silva, J. R. T. D., & Silva, M. L. D. (2018). Prevalence and characteristics of chronic pain in Brazil: A national internet-based survey study. Brazilian Journal of Pain, 1(4), 331–338. https://doi.org/10.5935/2595-0118.20180063
10. Cleland, J. A., Fritz, J. M., & Childs, J. D. (2008). Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with neck pain. American Journal of Physical Medicine & Rehabilitation, 87(2), 109-117. https://doi.org/10.1097/PHM.0b013e31815b61f1
11. Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Routledge. https://doi.org/10.4324/9780203771587
12. Cohen, S. P. (2015). Epidemiology, diagnosis, and treatment of neck pain. Mayo Clinic Proceedings, 90(2), 284–299. Elsevier. https://doi.org/10.1016/j.mayocp.2014.09.008
13. Dere, T., & Alemdaroğlu-Gürbüz, İ. (2024). Muscular endurance and its association with neck pain, disability, neck awareness, and kinesiophobia in patients with chronic neck pain. Somatosensory & Motor Research, 41(3), 134-141. https://doi.org/10.1080/08990220.2023.2186390
14. Dieleman, J. L., Cao, J., Chapin, A., Chen, C., Li, Z., Liu, A., Horst, C., Kaldjian, A., Matyasz, T., Scott, K. W., Bui, A. L., Campbell, M., Duber, H. C., Dunn, A. C., Flaxman, A. D., Fitzmaurice, C., Naghavi, M., Sadat, N., Shieh, P., & Murray, C. J. L. (2020). US health care spending by payer and health condition, 1996–2016. Journal of the American Medical Association, 323(9), 863–884. https://doi.org/10.1001/jama.2020.0734
15. Elbinoune, I., Amine, B., Shyen, S., Gueddari, S., Abouqal, R., & Hajjaj-Hassouni, N. (2016). Chronic neck pain and anxiety-depression: prevalence and associated risk factors. Pan African Medical Journal, 24(1). https://doi.org/10.11604/pamj.2016.24.89.8831
16. Evans, R., Bronfort, G., Nelson, B., & Goldsmith, C. H. (2002). Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine, 27(21), 2383-89. https://doi.org/10.1097/01.BRS.0000030192.39326.FF
17. Faiz, K. W. (2014). VAS–visuell analog skala. Tidsskrift for Den norske legeforening. https://doi.org/10.4045/tidsskr.13.1145
18. Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. The Journal of Pain, 14(12), 1539-1552. https://doi.org/10.1016/j.jpain.2013.08.007
19. Gunay Ucurum, S. (2019). The relationship between pain severity, kinesiophobia, and quality of life in patients with non-specific chronic neck pain. Journal of Back and Musculoskeletal Rehabilitation, 32(5), 677-683. https://doi.org/10.3233/BMR-171095
20. Hill, J. C., Lewis, M., Sim, J., Hay, E. M., & Dziedzic, K. (2007). Predictors of poor outcome in patients with neck pain treated by physical therapy. The Clinical Journal of Pain, 23(8), 683-690. https://doi.org/10.1097/AJP.0b013e3181468e67
21. Jørgensen, M. B., Skotte, J. H., Holtermann, A., Sjøgaard, G., Petersen, N. C., & Søgaard, K. (2011). Neck pain and postural balance among workers with high postural demands-a cross-sectional study. BMC Musculoskeletal Disorders, 12(1), 176. https://doi.org/10.1186/1471-2474-12-176
22. Kluetsch, R. C., Schmahl, C., Niedtfeld, I., Densmore, M., Calhoun, V. D., Daniels, J., et al. (2012). Alterations in default mode network connectivity during pain processing in borderline personality disorder. Archives of General Psychiatry, 69(10), 993-1002. https://doi.org/10.1001/archgenpsychiatry.2012.476
23. Kocaman, H., Yıldız, N. T., Canlı, M., & Alkan, H. (2024). Kronik boyun ağrısı olan bireylerde ağrı şiddeti, servikal kas kuvveti, propriosepsiyon ve denge arasındaki ilişkilerin incelenmesi. Ergoterapi ve Rehabilitasyon Dergisi, 12(1), 1-10. https://doi.org/10.30720/ered.1327626
24. Leeuw, M., Goossens, M. E., Linton, S. J., Crombez, G., Boersma, K., & Vlaeyen, J. W. (2007). The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. Journal of Behavioral Medicine, 30(1), 77-94. https://doi.org/10.1007/s10865-006-9085-0
25. Leger, H., Tittle, R., Dowdell, S., & Thompson, C. (2022). Comparison of the validity of the timed up and go test (TUG) and activities-specific balance confidence questionnaire (ABC) to the ‘Gold standard’Berg Balance Scale (BBS) in assessing fall risk in the Elderly Population. Journal of Rehabilitation Practice and Research, 3(2), 133. https://doi.org/10.33790/jrpr1100133
26. Luque-Suarez, A., Martinez-Calderon, J., & Falla, D. (2019). Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. British Journal of Sports Medicine, 53(9), 554-559. https://doi.org/10.1136/bjsports-2017-098673
27. Matsui, T., & Fujimoto, T. (2011). Treatment for depression with chronic neck pain completely cured in 94.2% of patients following neck muscle treatment. Neuroscience and Medicine, 2(02), 71-77. https://doi.org/10.4236/nm.2011.22011
28. McBeth, J., Wilkie, R., Bedson, J., Chew-Graham, C., & Lacey, R. J. (2015). Sleep disturbance and chronic widespread pain. Current Rheumatology Reports, 17(1), 1–8. https://doi.org/10.1007/s11926-014-0469-9
29. Agargun M. Y. (1996). Pittsburgh uyku kalitesi indeksinin gecerligi ve guvenirligi. Turk Psikiyatri Dergisi, 7, 107-115.
30. Parikh, P., Santaguida, P., Macdermid, J., Gross, A., & Eshtiaghi, A. (2019). Comparison of CPG’s for the diagnosis, prognosis and management of non-specific neck pain: a systematic review. BMC Musculoskeletal Disorders, 20(1), 81. https://doi.org/10.1186/s12891-019-2441-3
31. Poole, E., Treleaven, J., & Jull, G. (2008). The influence of neck pain on balance and gait parameters in community-dwelling elders. Manual Therapy, 13(4), 317–324. https://doi.org/10.1016/j.math.2007.03.006
32. Rosenbloom, B. N., Pagé, M. G., Isaac, L., Campbell, F., Stinson, J. N., Cribbie, R., & Katz, J. (2020). Fear of movement in children and adolescents undergoing major surgery: A psychometric evaluation of the Tampa Scale for Kinesiophobia. European Journal of Pain, 24(10), 1999–2014. https://doi.org/10.1002/ejp.1643
33. Selçuk, M. A., Karakılıç, G. D., Mert, E., & Çakıt, B. D. (2025). Evaluation of kinesiophobia and physical activity levels in patients with fibromyalgia syndrome and chronic neck pain. Reumatología Clínica (English Edition), 21(4), 501849. https://doi.org/10.1016/j.reumae.2025.501849
34. Şahan, T. Y., Türker, D., & Demirdel, S. (2023). Sleep quality, body awareness and neck disability differences between patients with nonspecific mechanic neck pain and healthy individuals: A cross-sectional study. Health Academy Kastamonu, 8(1), 30-40. https://doi.org/10.25279/sak.1108857
35. Thompson, D. P., Urmston, M., Oldham, J. A., & Woby, S. R. (2010). The association between cognitive factors, pain and disability in patients with idiopathic chronic neck pain. Disability and Rehabilitation, 32(21), 1758-1767. https://doi.org/10.3109/09638281003734342
36. Ulusoy, M., Sahin, N. H., & Erkmen, H. (1998). Turkish version of the Beck Anxiety Inventory: psychometric properties. Journal of Cognitive Psychotherapy, 12(2), 163.
37. Vægter, H. B., Madsen, A. B., Handberg, G., & Graven-Nielsen, T. (2018). Kinesiophobia is associated with pain intensity but not pain sensitivity before and after exercise: an explorative analysis. Physiotherapy, 104(2), 187-193. https://doi.org/10.1016/j.physio.2017.10.001
38. Varallo, G., Scarpina, F., Giusti, E. M., Cattivelli, R., Guerrini Usubini, A., Capodaglio, P., et al. (2021). Does kinesiophobia mediate the relationship between pain intensity and disability in individuals with chronic low-back pain and obesity? Brain Sciences, 11(6), 684. https://doi.org/10.3390/brainsci11060684
39. Vernon, H., & Mior, S. (1991). The Neck Disability Index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics, 14(7), 409-415.
40. Yilmaz, O. T., Yakut, Y., Uygur, F., & Ulug, N. (2011). Turkish version of the Tampa Scale for Kinesiophobia and its test-retest reliability. Turkish Journal of Physiotherapy Rehabilitation-Fizyoterapi Rehabilitasyon, 22(1), 44-49. Zhu, J., Li, X., Wang, X., Yang, F., Wang, Q., & Lu, J. (2025). Positive association of neck pain and depression in American young adults: a cross-sectional study. Journal of Clinical Neuroscience, 137, 111315. https://doi.org/10.1016/j.jocn.2025.111315