Implementation of Cognitive Retraining to Diminish Kinesiophobia Associated With Chronic Ankle Instability: A Case Report

Abstract

BACKGROUND: In musculoskeletal patients, the incidence of chronic ankle instability is among the highest musculoskeletal impairments in athletes, often accompanied by kinesiophobia and fear-avoidance behaviors. Although the diagnosis of chronic ankle instability is common, there is limited literature available regarding the implementation of cognitive strategies to decrease kinesiophobia throughout rehabilitation. CASE PRESENTATION: This case describes a 28-year-old female patient who suffered an acute-on-chronic left ankle sprain 1 year before instability symptoms progressed to the point that she sought medical care in the form of a surgical ligamentous repair and arthroscopic debridement. On evaluation, she presented with high levels of kinesiophobia and fear avoidance secondary to the chronic nature of her ankle pain/instability. The use of cognitive retraining strategies and a structured physical therapy program was implemented to improve patient outcomes and allow her to return to recreational sport. OUTCOMES: The patient was able to demonstrate full return to recreational and work activities without complaints of instability or fear of reinjury. She exceeded meaningful clinically important differences (MCIDs) in all outcomes (Figure 1): Tampa Scale of Kinesiophobia (13-point change; MCID: 6 points), 17 , 25 , 28 Pain and Anxiety Symptom Scale (27-point reduction), 21 , 22 , 27 Foot and Ankle Ability Measure (12-point improvement in ADL subscale; MCID: 8 points), 4 , 20 and 100-point improvement in the Sports subscale, MCID: 9 points). 4 , 20 Literature has found that a score below 22 on the Tampa Scale of Kinesiophobia demonstrates a subclinical level of kinesiophobia, and this patient was able to achieve a score of 21 at discharge, indicative of a significant reduction in fear-avoidance and kinesiophobia tendencies. 28 JOSPT Cases 2023;3(1):16–20. Epub: 6 January 2023. doi:10.2519/josptcases.2023.11339