Kinesiophobia (Fear of Movement), Movement-Related Threat, Pain-related Fear
Conditions
Keywords
Pain-related fear, Threat manipulation, Anxiety, Motor control, Movement-related fear, Pointing task, Walking task, Kinesiophobia
Brief summary
The goal of this clinical trial is to learn how experimentally induced movement-related threat affects emotional, autonomic, and motor responses in healthy adults. The main questions it aims to answer are: * Does movement-related threat change walking performance or upper-limb pointing movements? * Are these effects moderated by participants' level of kinesiophobia? * Does movement-related threat increase apprehension or alter heart rate variability responses? Participants will complete two experimental conditions during one session: a control condition and an experimental condition. In both conditions, inactive transcutaneous electrical nerve stimulation (TENS) electrodes will be placed in the lumbar region. In the experimental condition, participants will receive verbal suggestions about discomfort, movement-evoked pain, and potential unpredictable electrical stimulation to create the threat of pain associated with movement. Participants will complete a baseline assessment of kinesiophobia, followed by walking and pointing tasks, while perceived apprehension and autonomic responses are assessed.
Detailed description
In the presence of pain, individuals often modify the way they move. However, pain-related motor adaptations cannot be understood solely as responses to nociceptive input, as pain is shaped by a complex interplay of individual and contextual factors. As a result, motor behavior may be influenced not only by pain itself, but also by the anticipation that movement could be painful or harmful, thereby becoming a perceived threat. Within the fear-avoidance framework, fear of movement and pain-related threat are considered important factors influencing motor behavior and autonomic responses. As pain-related apprehension and kinesiophobia may also be present in pain-free individuals, experimental paradigms inducing movement-related threat in healthy participants may help clarify the mechanisms underlying behavioral adaptations associated with pain-related fear and kinesiophobia. The main objective of this study, which was concealed from participants, was to determine how movement-related threat influences motor behavior. Specifically, the study assessed whether a verbally induced threat affects walking parameters and upper-limb pointing movement time. A secondary objective was to examine whether baseline trait kinesiophobia moderates the effects of movement-related threat on motor behavior. This study uses a randomized within-subject crossover design to investigate the effects of experimentally induced movement-related threat on motor responses, perceived apprehension, and autonomic responses in healthy adults. Participants complete two experimental conditions during a single experimental session: a control condition and an experimental threat condition. In both conditions, inactive transcutaneous electrical nerve stimulation electrodes are placed in the lumbar region. In the control condition, electrodes are presented as safe and reliable, without any threat-related information. In the experimental condition, participants receive verbal suggestions regarding discomfort, movement-evoked pain, and unpredictable electrical stimulation associated with the device, in order to induce movement-related apprehension. Motor behavior is evaluated through spatiotemporal gait parameters during walking and movement time during upper-limb pointing movements toward visual targets. Autonomic nervous system responses are assessed using heart rate and heart rate variability analysis from a wearable heart rate monitor. Perceived apprehension is assessed using visual analog scales. Baseline trait kinesiophobia is assessed at the beginning of the session and used as a continuous variable in the analyses.
Interventions
BEHAVIORALMovement-Related Threat Induction
Experimental induction of movement-related threat using verbal suggestions about potential discomfort and movement-evoked pain associated with electrodes placed in the lumbar region, as well as unpredictable electrical stimulation from an inactive transcutaneous electrical nerve stimulation device. The manipulation aimed to increase movement-related apprehension and anxiety during motor tasks.
BEHAVIORALNeutral Movement Condition
Control condition using verbal suggestions about the safety and reliability of electrodes placed in the lumbar region and associated with an inactive transcutaneous electrical nerve stimulation device. No threat-related information regarding discomfort, movement-evoked pain, or unpredictable electrical stimulation was provided. The condition aimed to assess motor and autonomic responses during motor tasks under neutral instructions.
Sponsors
Universite de Picardie Jules Verne
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
BASIC_SCIENCE
Masking
NONE
Intervention model description
Participants underwent two conditions (control and experimental) in a randomized crossover within-subject design during a single experimental session.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Age between 18 and 65 years. * Ability to understand the experimental instructions and questionnaires. * No pain at inclusion and during the last 3 months. * Abstinence from short-term analgesics for 2 hours before testing. * Abstinence from coffee and cigarette smoking for 6 hours before testing.
Exclusion criteria
* History of chronic pain. * Motor, neurological, or sensory disorders. * Cardiovascular conditions likely to affect physiological measurements. * Clinically significant depressive symptoms or anxiety scores on the Hospital Anxiety and Depression Scale.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference in walking speed between the control electrode and experimental electrode conditions | Day 1, during the walking task under each randomized electrode condition | Walking speed will be assessed during the walking task using the GAITRite electronic walkway system. Walking speed will be expressed in meters per second and compared between the control and experimental electrode conditions. |
| Difference in walking cadence between the control electrode and experimental electrode conditions | Day 1, during the walking task under each randomized electrode condition | Walking cadence will be assessed during the walking task using the GAITRite electronic walkway system. Walking cadence will be expressed in steps per minute and compared between the control and experimental electrode conditions. |
| Difference in walking stride length between the control electrode and experimental electrode conditions | Day 1, during the walking task under each randomized electrode condition | Walking stride length will be assessed during the walking task using the GAITRite electronic walkway system. Walking stride length will be expressed in meters and compared between the control and experimental electrode conditions. |
| Difference in upper-limb pointing movement time between the control electrode and experimental electrode conditions | Day 1, during the upper-limb pointing task under each randomized electrode condition | Upper-limb pointing movement time will be assessed during the pointing task using a custom Arduino-based device. Movement time will correspond to the interval between finger lift-off from the starting position and contact with the illuminated target, and will be expressed in milliseconds. Movement time will be assessed across four target locations: ipsilateral 80%, ipsilateral 110%, contralateral 80%, and contralateral 110% of arm length. Movement time will be compared between the control and experimental electrode conditions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Kinesiophobia | Baseline | Kinesiophobia will be assessed using the French-Canadian version of the Tampa Scale for Kinesiophobia (TSK-CF). It is a 17-item self-report questionnaire using a Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). The total score is obtained by adding the item scores and ranges from 17 to 68. A score of 37 out of 68 is considered the threshold at which kinesiophobia becomes significant. |
| Change from Baseline in heart rate variability | Day 1: baseline, during the control electrode condition, and during the experimental electrode condition | Heart rate variability (HRV) will be assessed as an index of autonomic nervous system activity. Intervals between successive R waves (R-R intervals) will be continuously recorded throughout the single assessment session, starting with the baseline resting period and continuing through the control and experimental electrode conditions. The root mean square of successive differences (RMSSD) will be derived from the continuous recording to evaluate autonomic responses associated with pain anticipation. |
| Change from baseline in perceived apprehension | Day 1: baseline, during the control electrode condition, and during the experimental electrode condition | Perceived apprehension related to the experimental context will be assessed using a 0-10 visual analogue scale, where 0 indicates "no apprehension at all" and 10 indicates "the highest apprehension imaginable." Participants will rate their apprehension in order to evaluate changes in apprehension associated with the experimental instructions and procedures. |
Countries
France
Outcome results
None listed