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Association of psychological variables and outcome in tendinopathy: a systematic review
  1. Adrian Mallows1,
  2. James Debenham2,
  3. Tom Walker3,
  4. Chris Littlewood4,5
  1. 1School of Health and Human Sciences, University of Essex, Colchester, UK
  2. 2School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
  3. 3Physiotherapy department, Spire Elland, Elland, UK
  4. 4School of Health and Related Research, University of Sheffield, Sheffield, UK
  5. 5Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK
  1. Correspondence to
    Adrian Mallows, School of Health and Human Sciences, University of Essex, Colchester, Essex CO4 3SQ, UK; amallows{at}


Objective Fear, anxiety, depression, distress and catastrophisation are all factors known to affect pain and disability levels. To date, the association of such psychological factors has yet to be established in tendinopathy. Therefore, the purpose of this paper was to determine if psychological variables are associated with tendinopathy and whether any such variables may be associated with pain and disability outcomes in conservative management of tendinopathy.

Design A systematic review was undertaken and included studies were appraised for risk of bias using the Newcastle-Ottawa Scale. Owing to heterogeneity of studies, a qualitative synthesis was undertaken.

Data sources An electronic search of MEDLINE, CiNAHL, SPORTDiscus, PsycINFO, EMBASE and PsycARTICLES was undertaken from their inception to April 2016.

Eligibility criteria for selecting studies Any study design that incorporated psychological measures and clinical outcomes using participants with tendinopathy.

Results Ten articles describing nine studies and 1108 participants were included. Conflicting evidence exists regarding the association of anxiety, depression and lateral epicondylalgia (LE). Strong evidence suggests LE is not associated with kinesiophobia. Moderate evidence links catastrophisation and distress with LE. Moderate evidence suggests distress is not associated with rotator cuff tendinopathy, but kinesiophobia and catastrophisation are. Limited evidence suggests patellar tendinopathy is not associated with anxiety or depression and kinesiophobia may be linked with suboptimal outcomes in Achilles tendinopathy.

Summary/conclusions Tendinopathy requires an individualised approach to management. Clinicians should consider using validated screening tools for the presence of psychological variables as a part of their holistic management.

  • Tendinopathy
  • Psychology
  • Review

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.