Kinesiophobia and Adhesive Capsulitis (kinesiophob)

The Effect of Kinesiophobia on Pain, Range of Motion, Disability, and Quality of Life in Patients With Adhesive Capsulitis

Frozen shoulder (also known as adhesive capsulitis) is a painful condition that affects the shoulder joint. This is a painful condition in which the movement of the shoulder becomes limited. Normally, the soft tissue surrounding the shoulder joint (capsule) is usually stretchy and elastic allowing joint mobility. Frozen shoulder occurs when the capsule around the shoulder joint becomes thickened and inflamed, causing pain, stiffness and reduced range of motion. This painful stiffening over time leads to sleep disturbance and limits ability to use arm in day-to-day activities.

Kinesiophobia (fear of movement) defined as "an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability due to painful injury or reinjury" is an important psychological factor in musculoskeletal disorders. Kinesiophobia has been implicated in the transition from acute to chronic pain and in the persistence of pain-related disability even after tissue healing.

The goal of this observational study is to investigate the relationship between kinesiophobia and pain, range of motion, disability, and quality of life in patients with adhesive capsulitis.Participants in the study will only undergo a physical examination and complete some questionnaires; no invasive procedures will be performed.

Study Overview

• Status: Completed
• Conditions: Adhesive Capsulitis of the Shoulder
• Intervention / Treatment: Diagnostic test: Active and passive shoulder range of motion will be measured using a standard goniometer

Detailed Description

Adhesive capsulitis is a common shoulder disorder characterized by pain and progressive restriction of both active and passive range of motion, leading to substantial limitations in activities of daily living, occupational performance, and leisure activities. It most frequently affects middle-aged individuals and is more prevalent in women.

Clinically, patients with adhesive capsulitis present with shoulder pain and progressive stiffness. Functional limitations typically include difficulty performing overhead activities and tasks requiring hand-behind-the-back movements, which significantly impair quality of life. Although restriction occurs in all planes of shoulder motion, passive external rotation is generally the most limited, followed by abduction and internal rotation.

The exact etiopathogenesis of adhesive capsulitis remains unclear; however, it is widely accepted that the pathological process primarily involves the joint capsule, particularly the coracohumeral ligament and the anterior-superior capsule. Chronic inflammation, possibly triggered by autoimmune mechanisms, infectious agents, or biochemical mediators, is thought to initiate the process. Subsequent fibroblastic proliferation, collagen deposition, capsular thickening, fibrosis, and adhesion formation lead to restricted joint mobility. In addition to these biological mechanisms, psychological factors have also been suggested to contribute to the development and persistence of adhesive capsulitis.

Kinesiophobia, defined as an excessive, irrational, and debilitating fear of movement due to the expectation of pain or re-injury, is an important psychological factor in musculoskeletal disorders. It is commonly associated with avoidance behaviors and hypervigilance. Kinesiophobia has been implicated in the transition from acute to chronic pain and in the persistence of pain-related disability even after tissue healing. Consequently, higher levels of kinesiophobia have been associated with increased pain intensity, greater disability, reduced range of motion, and poorer quality of life in individuals with chronic musculoskeletal conditions.

Although the relationship between kinesiophobia and clinical outcomes has been extensively studied in various musculoskeletal disorders, evidence in shoulder pathologies remains limited. Previous studies have reported significant associations between kinesiophobia and pain, disability, and functional limitations. For example, Mintken et al. demonstrated a strong relationship between elevated kinesiophobia levels and increased pain and disability. Similarly, Luque-Suarez et al. reported that higher kinesiophobia levels were associated with greater pain intensity and disability. Another study involving 85 patients found that increased kinesiophobia was linked to poorer upper extremity function and higher pain levels.

Understanding the relationship between kinesiophobia and clinical as well as sociodemographic factors in patients with adhesive capsulitis may contribute to improved prognostic evaluation and more effective clinical decision-making. Therefore, the aim of this study was to investigate the relationship between kinesiophobia and pain, range of motion, disability, and quality of life in patients with adhesive capsulitis.

• Study Type: Observational
• Enrollment (Actual): 60

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Meram
    • Konya, Meram, Turkey (Türkiye), 42110
      • Necmettin Erbakan University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Outpatient clinic of the Department of Physical Medicine and Rehabilitation at Necmettin Erbakan University Faculty of Medicine in Konya

Description

Inclusion Criteria:

• Age between 18 and 65 years
• Clinical diagnosis of adhesive capsulitis according to Vermeulen criteria, defined as ≥50% loss of passive range of motion in at least one of the following planes compared to the contralateral side: abduction, flexion, or external rotation in abduction
• Ability to understand and complete questionnaires Exclusion Criteria
• Presence of other orthopedic, rheumatologic, neurological, or malignant conditions affecting the shoulder
• History of shoulder trauma, fracture, dislocation, or surgery
• Full-thickness rotator cuff tear (e.g., positive drop arm test, significant weakness)
• Cervical radiculopathy or thoracic outlet syndrome
• Receipt of intra-articular injection, physical therapy, or other shoulder treatments within the previous 6 months
• Cognitive impairment or psychiatric/neurological disorders affecting comprehension

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
adhesive capsulitis; patients with adhesive capsulitis	Diagnostic test: Active and passive shoulder range of motion will be measured using a standard goniometer; shoulder range of motion measurement

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Range of Motion (ROM)	Active and passive shoulder ROM were measured using a standard goniometer. Normal values were considered as follows: flexion and abduction 180°, external rotation 90°, internal rotation 70-90°, and extension 45-60°. Reductions in these measures were interpreted as functional limitations.	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tampa Scale for Kinesiophobia (TSK)	Kinesiophobia will be assessed using the 17-item Tampa Scale for Kinesiophobia (TSK). Each item is rated on a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree). Items 4, 8, 12, and 16 are reverse-scored. Total scores range from 17 to 68, with higher scores indicating greater fear of movement. A cutoff score of >37 was used to define high kinesiophobia.	Baseline
Shoulder Pain and Disability Index (SPADI)	Pain and disability were assessed using the Shoulder Pain and Disability Index (SPADI), a 13-item patient-reported questionnaire consisting of two subscales: pain (5 items) and disability (8 items). Scores are converted to percentages ranging from 0 (no disability) to 100 (maximum disability).	Baseline
Short Form-36 Health Survey (SF-36)	Quality of life was evaluated using the Short Form-36 Health Survey (SF-36), which includes eight domains: physical functioning, role limitations (physical and emotional), bodily pain, general health, vitality, social functioning, and mental health. Scores range from 0 to 100, with higher scores indicating better health status.	Baseline

Collaborators and Investigators

• Sponsor: Necmettin Erbakan University

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2025
• Primary Completion (Actual): April 3, 2026
• Study Completion (Actual): April 3, 2026

Study Registration Dates

• First Submitted: April 9, 2026
• First Submitted That Met QC Criteria: April 9, 2026
• First Posted (Actual): April 16, 2026

Study Record Updates

• Last Update Posted (Actual): April 21, 2026
• Last Update Submitted That Met QC Criteria: April 16, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: pain; quality of life; kinesiophobia; disability; adhesive capsulitis
• Additional Relevant MeSH Terms: Neurologic Manifestations; Musculoskeletal Diseases; Mental Disorders; Joint Diseases; Phobic Disorders; Anxiety Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Kinesiophobia; Pain; Bursitis; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Exercise
• Other Study ID Numbers: 2025/5751

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No