From: Psychological factors associated with foot and ankle pain: a mixed methods systematic review
 |  |  |  |  | Psychological factor | |
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Author, Year | Design | Diagnosis | Pain | Function | Outcome measure | Results |
Awale 2016 | Observational/cross sectional - comparative | Pain, aching or stiffness in the feet | If yes, categorised as no, mild, moderate or severe pain. | NR | The Center for Epidemiologic Studies Depression Scale (CES-D) | Symptoms of depression After adjusting for age and BMI, foot pain was significantly associated with self-reported symptoms of depression (men: OR 1.84 [1.36 to 2.48]; women: OR 1.93 [1.55 to 2.45]) |
Butterworth 2016 | Observational/cross sectional - comparative | Disabling foot pain | NR* | NR | Have you ever been diagnosed as suffering depression? | Symptoms of depression After adjusting for age, education, mobility and BMI, foot pain was significantly associated with self-reported depression (OR 2.05 [95% CI 1.30 to 3.20]). |
Chimenti 2020 | Observational/cross sectional - comparative | Achilles tendinopathy | BPI: median/IQR: 2.5 (1.7–3.6) | VISA-A (median/ IQR): 39 (33–59 | PROMIS short from 8b – depression Tampa Scale of Kinesiophobia (TSK-17) Pain Catastrophising Scale (PCS) | Symptoms of depression There was no significant difference in symptoms of depression in people with and without Achilles tendinopathy. Kinesiophobia The Achilles tendinopathy group had significantly higher TSK scores: • Group with Achilles tendinopathy: 37.2 (95% CI 34.7 to 39.7) • Group without Achilles tendinopathy: 29.6 (27.1 to 32.1) Pain catastrophising The Achilles tendinopathy group had significantly higher PCS scores: • Group with Achilles tendinopathy: 12.6 (95% CI 9.2 to 15.9) • Group without Achilles tendinopathy: 1.9 (95%CI −1.5 to 5.2) |
Cotchett 2016 | Observational/cross sectional - comparative | Plantar heel pain | FHSQ: 40.8 (21.9) | NR | Depression, Anxiety and Stress Scale - 21 | Symptoms of depression Participants with plantar heel pain had greater levels of depression, compared to controls: • depression (mean difference = 4.4, 95% CI 2.3 to 6.5) Symptoms of anxiety Participants with plantar heel pain had greater levels of anxiety, compared to controls: • anxiety (mean difference = 2.6, 95% CI 0.9 to 4.3) Symptoms of stress Participants with plantar heel pain had greater levels of stress, compared to controls: • stress (mean difference = 4.8, 95% CI 1.9 to 7.8). |
Palamo Lopez 2020 | Observational/cross sectional - comparative | Hallux valgus | NPRS Mild HV 1.1 (1.3); Moderate HV: 6.4, (1.9); Severe HV: 7.4 (1.6) | NR | Tampa Scale of Kinesiophobia (TSK-11) | Kinesiophobia Participants with painful hallux valgus (Stage III and Stage IV) had significantly higher levels of kinesiophobia compared to participants without hallux valgus: Overall kinesiophobia scores: • No hallux valgus: TSK-11 = 19.6 (SD 4.8) • Stage III hallux valgus: TSK-11 = 23.6 (SD 4.6) • Stage IV hallux valgus: TSK-11 = 26.4 (SD 4.5) |
Shivarathre 2014 | Observational/cross sectional - comparative | Foot and ankle pain | NR | NR | Hospital Anxiety Depression Scale (HADS) | Symptoms of depression Depression was significantly higher in people with foot and ankle pain: Patient group: HADS (depression) median IQR = 3 (2,8) Control group: HADS (depression) median IQR = 2 (1,4) Symptoms of anxiety Anxiety was significantly higher in people with foot and ankle pain: Patient Group: HADS (anxiety) median IQR = 6 (3,11) Control Group: HADS (anxiety) median IQR = 4 (3,7) |
Silbernagle 2011 | Observational/cross sectional - comparative | Achilles tendinopathy | VISA-A: 80 (14) | VISA-A: 80 (14) | Tampa Scale of Kinesiophobia | Kinesiophobia Overall kinesiophobia scores: • Group with Achilles tendon symptoms: TSK = 26.0 (SD 6.9) • Group without Achilles tendon symptoms TSK = 28.0 (SD 5.0) |
Tojo 2018 | Survey/cross sectional | Foot and ankle pain: Great toe: 88 (14%); Lesser toe: 87 (14%); Plantar forefoot: 58 (9%); Medial arch: 56 (9%); Midfoot: 99 (16%); Ankle: 62 (10%); Plantar heel: 41 (6%); Posterior heel: 47 (7%); Overall 144 (23%) | NR | NR | Japanese version of the Job Content Questionnaire | Association between job strain* and foot and ankle pain Psychosocial factors, including high job strain OR 1.6 (95% CI 1.1 to 2.3) and low job control OR 1.4 (1.0 to 2.0), were associated with foot and ankle pain (pain measured using the Standardized Nordic Questionnaire. *Job strain = psychological demands score divided by job control score |
Briet 2016 | Observational/cross sectional | Lateral ankle sprain | Ordinal scale of pain: 2.0 (3.0) (Median, IQR) | OMAS: 59 (24) (Median, IQR) | Pain Self-Efficacy Questionnaire (PSEQ) | Association between self-efficacy and function Greater self-efficacy at baseline correlated with better ankle specific symptoms and limitations (high OMAS) at three weeks after injury (p = 0.017) Greater self-efficacy at baseline was significantly associated with better ankle specific symptoms and limitations (high OMAS) and explained 24% of the variability in OMAS (R-squared: 0.24, p < 0.001). Association between self-efficacy and pain intensity Greater self-efficacy at baseline correlated with lower pain intensity at follow up (p < 0.01). |
Harutaichun 2020 | Observational/Cohort | Plantar heel pain | VAS: 4.8 (2.5) | NR | Depression, Anxiety and Stress Scale - 21 | Association between anxiety and pain In multiple linear regression, anxiety was associated with pain intensity (β = 0.41, p = 0.01). |
Cotchett 2017 | Observational/cross sectional | Plantar heel pain | FHSQ: 45.1 (20.6) VAS 61.8 (22.3) | FHSQ: 57.1 (26.4) | Tampa Scale of Kinesiophobia −17 Pain Catastrophising Scale | Association between kinesiophobia and foot function After accounting for age, sex and BMI kinesiophobia was associated with reduced self-reported foot function (β = − 1.60; p = 0.006). Association between pain catastrophising and foot function After accounting for age, sex and BMI, pain catastrophising was associated with reduced self-reported foot function (β = − 1.61; p < 0.001). Association between pain catastrophising and first step pain After accounting for age, sex and BMI, pain catastrophising was associated with first step pain (β = −0.93; p = 0.008). |
Cotchett 2015 | Observational/cross sectional | Plantar heel pain | FHSQ: 40.83 (21.08) | FHSQ: 49.82 (23.98) | Depression, Anxiety and Stress Scale - 21 | Association between depression and heel pain and foot function After accounting for age, sex and BMI, symptoms of depression were associated with reduced self-reported foot function (β = − 0.53; p < 0.001) and foot pain (β = − 0.41; p = 0.013) In females but not males. Association between stress and heel pain and foot function After accounting for age, sex and BMI, symptoms of stress were associated with reduced self-reported foot function (β = − 0.50; p = 0.001) and foot pain in females but not males stress (β = − 0.36; p = 0.024). |
Lentz 2010 | Observational/cross sectional | Foot pain | VAS: 4.5 (2.0) | Lower Extremity Functional Scale (LEFS): 47.5 (19.5) | Tampa Scale of Kinesiophobia (TSK-11) | Association between kinesiophobia and lower extremity function In a model including age, chronicity, age, pain, ROM index, TSK-11 scores were significantly associated with lower extremity function (β = 0.40, p = 0.001). |