No Sex Differences In Kinesiophobia In Individuals With A History Of ACL Reconstruction

Kinesiophobia (i.e., fear of movement and/or reinjury) is a primary barrier for long-term physical activity engagement after anterior cruciate ligament reconstruction (ACLR). While similar levels of kinesiophobia have been identified in both male and female patients prior to clearance for return to activity (i.e., <9 months), it is unknown whether sex differences are observed in kinesiophobia in individuals after 9 months. These sex-based differences are important to direct future whole-person physical activity promotion interventions. PURPOSE: To examine differences in kinesiophobia between males and females ≥9 months post-ACLR. We hypothesized that females would exhibit higher kinesiophobia than males. METHODS: 39 participants with primary, unilateral ACLR (age = 21.2 ± 3.5 years; time since ACLR = 27.9 ± 12.5 months, N = 25 females, 14 males) were included from an ongoing, longitudinal study. Participants completed the 11-item Tampa Scale of Kinesiophobia (TSK-11). The TSK-11 is a valid and reliable measure of kinesiophobia ranging from 11-44. A cut-off score of ≥17 is indicative of elevated kinesiophobia. Descriptive statistics were calculated, and an independent t-test was used to examine sex differences in the TSK-11. A Hedge’s g effect size and 95% confidence interval was calculated to examine the magnitude of sex differences and was interpreted as small (0.2-0.49), medium (0.5-0.79), and large (≥0.8). Alpha was set a priori to p ≤ 0.05. RESULTS: There were no statistically significant or clinically meaningful sex differences in TSK-11 scores (females = 17.9 ± 4.8, males 17.1 ± 3.3; p = 0.58, Hedge’s g = -0.19 [-0.84 to 0.47]). However, these averages suggest that many participants in both groups would be categorized as “elevated kinesiophobia” based on established cut-off scores. CONCLUSION: While TSK-11 scores did not differ between males and females ≥9 months post-ACLR, elevated kinesiophobia was still present in 61.5% of participants at an average of 2.5 years following ACLR. This is concerning given the association between higher kinesiophobia and lower physical activity levels which are necessary to maintaining overall well-being. Future research should identify targeted interventions to alter kinesiophobia in individuals who present with kinesiophobia after clearance from clinical care.