Kinesiophobia Is Associated With Poor Function and Modifiable Through Interventions in People With Patellofemoral Pain: A Systematic Review With Individual Participant Data Correlation Meta-Analysis.

Fear of movement, often called kinesiophobia, is a common concern in people with patellofemoral pain, the kind of kneecap pain many runners and active people know well. This systematic review pulled together 41 studies involving 2712 people to ask two questions: what factors relate to kinesiophobia, and can any intervention actually reduce it. Using combined individual-level data, the researchers found that worse self-reported knee function was moderately linked to higher kinesiophobia, while pain itself showed only a weak relationship with it. On the treatment side, passive techniques like taping or bracing appeared more effective than minimal intervention at reducing kinesiophobia, though this rested on just two studies and was rated low-certainty.

Interventions specifically targeting fear of movement, such as education or psychologically-informed approaches, looked promising compared with standard physical therapy, but that evidence came from only five studies and was rated very low-certainty. The overall picture is suggestive rather than settled, and the small number of trials behind each comparison is the main limitation.

If you have patellofemoral pain, the ache around or behind the kneecap that's common in runners, you may have noticed some worry about certain movements making things worse. This review looked at over 40 studies and more than 2700 people to understand how this fear of movement relates to knee function and pain, and whether any treatments help reduce it. The researchers found that people who reported worse knee function also tended to report more fear of movement, a moderate link.

Pain levels were only weakly connected to that fear, suggesting the two don't always move together. When it came to treatment, taping or bracing seemed to help reduce fear of movement more than minimal care, and approaches specifically designed to address this fear, like education or psychological strategies, looked promising compared to standard physical therapy. However, these treatment findings come from very few small studies, so the confidence in them is low.

This doesn't mean the approaches don't work, just that we don't yet have strong enough evidence to be confident either way.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review speaks directly to a question many clinicians face with patellofemoral pain patients: should kinesiophobia be assessed as part of standard practice, and can it be meaningfully influenced by treatment choice? Drawing on individual participant data from 499 to 644 people across included studies, the authors found a moderate correlation between poorer self-reported function and higher kinesiophobia (r = -0.440) and only a weak correlation with pain (r = 0.162), reinforcing that fear of movement and pain intensity are distinct constructs worth assessing separately rather than assuming one tracks the other. On intervention, low-certainty evidence from two articles favored passive techniques such as taping and bracing over minimal intervention for reducing kinesiophobia, and very low-certainty evidence from five articles favored kinesiophobia-targeted approaches (psychobehavioral strategies, education, self-managed exercise) over usual physical therapist treatment not specifically addressing fear of movement. Both estimates come from a small number of studies, so these findings should be read as hypothesis-generating rather than practice-defining. The abstract does not specify study designs included beyond systematic review methodology, and does not report adverse events, so no safety conclusions can be drawn.

The main limitation is the thin evidence base behind each intervention comparison, which constrains how much confidence can be placed in any specific treatment recommendation at this stage.