A study with patients with degenerative spine conditions, found that higher scores on the Tampa Scale of Kinesiophobia (TSK) and the Demoralization Scale (DS), correlate with worse gait and balance.1 This led the authors to conclude that “psychological factors … contribute to significantly worse function,” and that their study “does advance the clinical utility of TSK and DS … to help identify… patients… who may benefit from additional behavioral therapy before and after surgery.”1
We think that results do not support necessarily these statements, since:
- a) This study only gathered data before surgery.
- b) Confounders were not analyzed (e.g., pain on movement, duration and severity of pain and disability, falls due to gait/balance impairments, expectations of recovery after failure of treatments recommended before surgery, and so on).
- c) Association is not causation, and does not imply directionality. Results from this study do not rule out that more severe and lasting symptoms (including gait and balance impairments) lead to higher scores for TSK and DS, and not the opposite. In fact, this has been shown for other psychological constructs,2 and a previous study from the same research group has found that psychological distress improves when nonpsychological treatments succeed at improving physical symptoms.2,3
References
1. Haddas R, Lieberman I, Sandu C, et al. Functional ability classification based on moderate and severe kinesophobia and demoralization scores in degenerative spine patients.
Spine (Phila Pa 1976) 2021; 46:E826–E831.
2. Kovacs FM, Seco J, Royuela A, et al. The prognostic value of catastrophizing for predicting the clinical evolution of low back pain patients. A study in routine clinical practice within the Spanish National Health Service [NCT00502333].
Spine J 2012; 12:545–555.
3. Haddas R, Lieberman I, Block A, et al. The effect of surgical decompression and fusion on functional balance in patients with degenerative lumbar spondylolisthesis.
Spine (Phila Pa 1976) 2020; 45:E878–E884.
