Mariana Romano Lira1, Roberta Rodrigues Lemes da Silva2, César Bataglion3, Aroldo Dos Santos Aguiar1, Stella Maris Greghi1, Thaís Cristina Chaves4. 1. Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. 2. Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. 3. Department of Restorative Dentistry at Ribeirão Preto Dental School (FORP), University of São Paulo-USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. 4. Department of Health Sciences and Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Electronic address: chavestc@fmrp.usp.br.
Abstract
OBJECTIVES: The aim of this study was to empirically derive subgroups according to pain-related fear of movement beliefs using cluster analysis within a sample of TMD patients and asymptomatic volunteers. METHODS: 129 volunteers participated in this cross-sectional study (34.78, standard deviation [SD]: 12.49 years; 92 TMD patients and 37 symptom-free volunteers). Mechanical pain sensitivity through pressure pain threshold (PPT) on orofacial and remote sites, kinesiophobia, pain catastrophizing, anxiety and depression were assessed. A cluster analysis was used to derive subgroups according to kinesiophobia scores (TSK/TMD). RESULTS: Three subgroups were derived: cluster 1 (high kinesiophobia [n = 53], TSK score: 33, SD[standard deviation] = 2.9), cluster 2 (moderate kinesiophobia [n = 50], TSK score: 26.2, SD = 2.14) and cluster 3 (no/low kinesiophobia [n = 26], TSK score 12.12, SD = 2.08) which included patients with higher overall PPT and lower scores on psychosocial variables. The group with high kinesiophobia showed high levels of pain catastrophizing, anxiety, and orofacial pain-related disability compared to the other subgroups and mechanical pain hyperalgesia in remote site compared to the low-kinesiophobia group. Also, we found a greater prevalence of triple diagnosis for the high-kinesiophobia subgroup compared to the moderate kinesiophobia group - odds ratio: 12.6 (95% confidence interval [CI]: 3.31-43.52, p < 0.01). CONCLUSION: These results suggested that patients with TMD and higher levels of kinesiophobia beliefs may show a more complex clinical feature, with high psychosocial distress, widespread mechanical pain sensitivity, and a more complex TMD disorder. In this way, we suggest a relationship between the number of TMD diagnoses and kinesiophobia severity.
OBJECTIVES: The aim of this study was to empirically derive subgroups according to pain-related fear of movement beliefs using cluster analysis within a sample of TMDpatients and asymptomatic volunteers. METHODS: 129 volunteers participated in this cross-sectional study (34.78, standard deviation [SD]: 12.49 years; 92 TMDpatients and 37 symptom-free volunteers). Mechanical pain sensitivity through pressure pain threshold (PPT) on orofacial and remote sites, kinesiophobia, pain catastrophizing, anxiety and depression were assessed. A cluster analysis was used to derive subgroups according to kinesiophobia scores (TSK/TMD). RESULTS: Three subgroups were derived: cluster 1 (high kinesiophobia [n = 53], TSK score: 33, SD[standard deviation] = 2.9), cluster 2 (moderate kinesiophobia [n = 50], TSK score: 26.2, SD = 2.14) and cluster 3 (no/low kinesiophobia [n = 26], TSK score 12.12, SD = 2.08) which included patients with higher overall PPT and lower scores on psychosocial variables. The group with high kinesiophobia showed high levels of pain catastrophizing, anxiety, and orofacial pain-related disability compared to the other subgroups and mechanical pain hyperalgesia in remote site compared to the low-kinesiophobia group. Also, we found a greater prevalence of triple diagnosis for the high-kinesiophobia subgroup compared to the moderate kinesiophobia group - odds ratio: 12.6 (95% confidence interval [CI]: 3.31-43.52, p < 0.01). CONCLUSION: These results suggested that patients with TMD and higher levels of kinesiophobia beliefs may show a more complex clinical feature, with high psychosocial distress, widespread mechanical pain sensitivity, and a more complex TMD disorder. In this way, we suggest a relationship between the number of TMD diagnoses and kinesiophobia severity.