Task-specific vs general measures of pain-related fear relative associations with spinal motor behaviour: a systematic review and meta-analysis.

Abstract

Musculoskeletal pain, particularly low back and neck pain, is associated with maladaptive changes in spinal motor behaviour (SMB). Psychological factors such as pain-related fear play a role in driving these adaptations. While previous research found weak associations between general psychological measures and SMB, task-specific measures may provide more precise insights into movement avoidance. This systematic review and meta-analysis aimed to compare the relative associations of general and task-specific pain-related fear measures with SMB. Following PRISMA guidelines, we included 13 studies (651 participants) assessing both general (Tampa Scale of Kinesiophobia and Pain Anxiety Symptoms Scale) and task-specific measures alongside objective spinal motor outcomes (eg, amplitude, velocity, muscle activity, coordination, variability). A three-level meta-analytic model revealed a weak but significant association between general measures and SMB (r = 0.12, 95% CI: 0.04-0.21, P = 0.007), whereas task-specific measures showed a stronger association (r = 0.29, 95% CI: 0.18-0.40, P < 0.001). The difference between these correlations (Δr(task-specific - general) = 0.16, 95% CI: 0.04 to 0.27, P = 0.008) was statistically significant, indicating that task-specific measures better capture the relationship between perceived fear and movement alterations. Despite methodological heterogeneity, our findings highlight the importance of task-specific assessments in understanding motor impairments associated with pain-related fear. These results support the integration of task-specific evaluations in clinical and research settings. To further elucidate the mechanisms linking psychological factors to SMB, future studies should use longitudinal designs, improve the contextual validity of the motor tasks studied, and explore new approaches of movement analysis.