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Is kinesiophobia and pain catastrophising at baseline associated with chronic pain and disability in whiplash-associated disorders? A systematic review
  1. Alejandro Luque-Suarez1,2,
  2. Deborah Falla3,
  3. Jose Miguel Morales-Asencio2,4,
  4. Javier Martinez-Calderon1
  1. 1 Faculty of Health Sciences, Department of Physiotherapy, University of Malaga, Malaga, Spain
  2. 2 Instituto de Investigacion Biomedica de Malaga (IBIMA), Malaga, Spain
  3. 3 Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  4. 4 Faculty of Health Sciences, Department of Physiotherapy, University of Malaga, Malaga, Spains
  1. Correspondence to Dr Alejandro Luque-Suarez, Department of Physiotherapy, University of Malaga, Malaga 29016, Spain; aluques{at}


Background Kinesiophobia and pain catastrophising may be associated with patients’ transition from having acute to chronic pain following a whiplash injury.

Objective To systematically review and critically appraise the literature to determine whether kinesiophobia and pain catastrophising are associated with greater likelihood of patients developing chronic pain and disability following a whiplash injury.

Design A systematic review of the literature

Data sources Electronic searches of PubMed, AMED, CINAHL, PsycINFO, and PubPsych, and grey literature were undertaken from inception to September 2017.

Eligibility criteria for selecting studies Study selection was based on longitudinal studies evaluating how kinesiophobia and/or pain catastrophising at baseline are associated with pain intensity, disability or both after a whiplash injury.

Results We included 14 longitudinal studies that described 12 independent cohorts with a total sample of 2733 participants with whiplash-associated disorder. Kinesiophobia at baseline was not associated with pain intensity over time (three studies). Whether kinesiophobia at baseline was associated with disability was unclear as results were conflicting (six studies). There were also conflicting results when we examined the association between pain catastrophising and both pain intensity (five studies) and disability (eight studies).

Summary/conclusions Kinesiophobia at baseline was not associated with pain intensity over time. There were conflicting results for the remaining analyses. The size of the associations was small. The overall quality of the evidence was very low.

Trial registration number CRD42016053864.

  • pain
  • whiplash injury
  • fear
  • psychological factors

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  • Contributors All authors have made a substantial scientific contribution to the study and they are thoroughly familiar with the primary data. All authors have read the complete manuscript and take responsibility for the content and completeness of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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