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Table 4 The association between psychological factors and foot/ankle pain and function

From: Psychological factors associated with foot and ankle pain: a mixed methods systematic review

     

Psychological factor

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).

  1. Key: BPI, Brief Pain Inventory; FHSQ, Foot Health Status Questionnaire; HV, Hallux valgus; LEFS, Lower Extremity Functional Scale; MFPDI, The Manchester Foot Pain and Disability Index; NRPS, Numerical pain rating scale; NR, not reported; OMAS, Olerud-Molander Ankle Score; TSK: Tampa Scale of Kinesiophobia; VAS, Visual analogue scale; VISA-A, Victorian Institute of Sports Assessment – Achilles Questionnaire; HADS, Hospital Anxiety and Depression Scale