Cited by 547Musculoskeletal pain and rehabilitationFibromyalgia and Chronic Fatigue Syndrome ResearchPain Management and Treatment

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Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review

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Luque-Suarez, Alejandro, Martinez-Calderon, Javier, Falla, Deborah·2019·British Journal of Sports Medicine

DOI 10.1136/bjsports-2017-098673

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Abstract

OBJECTIVE: (1) To explore the level of association between kinesiophobia and pain, disability and quality of life in people with chronic musculoskeletal pain (CMP) detected via cross-sectional analysis and (2) to analyse the prognostic value of kinesiophobia on pain, disability and quality of life in this population detected via longitudinal analyses. DESIGN: A systematic review of the literature including an appraisal of the risk of bias using the adapted Newcastle Ottawa Scale. A synthesis of the evidence was carried out. DATA SOURCES: An electronic search of PubMed, AMED, CINAHL, PsycINFO, PubPsych and grey literature was undertaken from inception to July 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies exploring the role of kinesiophobia (measured with the Tampa Scale for Kinesiophobia) on pain, disability and quality of life in people with CMP. RESULTS: Sixty-three articles (mostly cross-sectional) (total sample=10 726) were included. We found strong evidence for an association between a greater degree of kinesiophobia and greater levels of pain intensity and disability and moderate evidence between a greater degree of kinesiophobia and higher levels of pain severity and low quality of life. A greater degree of kinesiophobia predicts the progression of disability overtime, with moderate evidence. A greater degree of kinesiophobia also predicts greater levels of pain severity and low levels of quality of life at 6 months, but with limited evidence. Kinesiophobia does not predict changes in pain intensity. SUMMARY/CONCLUSIONS: The results of this review encourage clinicians to consider kinesiophobia in their preliminary assessment. More longitudinal studies are needed, as most of the included studies were cross-sectional in nature. TRIAL REGISTRATION NUMBER: CRD42016042641.

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Psychometric and network analysis of kinesiophobia in Iranian surgical patients
Nia, H. S., Froelicher, E. S., Hosseinzadeh, E., Hejazi, S. S., Fatehi, R., & Nowrozi, P. (2024) · Scientific Reports · doi:10.1038/s41598-024-78407-1 · Cited by 6
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Elit futbolcularda alt ekstremite yaralanması sonrası hareket korkusu ve egzersiz öz yeterliliği
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“(TSK), as well as the closely related Fear Avoidance Beliefs Questionnaire, are both correlated with greater levels of pain behavior, and poorer treatment in spine pain patients.(4,5) The fear-avoidance model states that patients have altered movement patterns and reduced physical activity which in turn contributes to…”
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“A greater degree of kinesiophobia predicts the progression of disability overtime, with moderate evidence [11].”
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“In addition, the associations between KOOS pain and TSK total scores were low, whereas patients with chronic pain conditions have been shown to have strong associations between kinesiophobia and pain-related outcomes [40].”
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“Kinesiophobia may predict greater pain severity but not greater pain intensity (4).”
BackgroundMethodInfluential
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“The term originates from the Greek words “kinesis”, meaning movement, and “phobos”, meaning fear, and was first introduced in the field of rehabilitation medicine to describe patients who develop maladaptive movement avoidance behaviors [9,10].”
Association of pain intensity and psychological factors among patients with chronic low back pain (LBP). A correlational cross-sectional study
Pérez, S. E. M., Lupgens, D. D. Z., Pagés, M. C., Santaella, J. J. G., Pérez, J. L. A., & Pérez, I. M. (2022) · Iberoamerican Journal of Medicine · doi:10.53986/ibjm.2023.0002 · Cited by 4
“is well known that, in addition to physical factors, psychological and emotional factors also increase the risk of poor prognosis in pain recovery [7, 8].”
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Prevalence of weakness and factors mediating discrepancy between reported and observed leg weakness in people with sciatica
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Background
The link between childhood physical activity enjoyment and adult kinesiophobia in individuals with chronic low back pain
Liu, H., Li, H., Huang, L. C., Tian, H., Wu, J., Guan, Q., Wang, Z., Zhang, X., Yang, Z., & Peng, L. (2024) · BMC Public Health · doi:10.1186/s12889-024-19953-1 · Cited by 4
“Previous studies have identified several factors that are associated with kinesiophobia in adults with CLBP, including pain intensity, pain duration, and injury history [2, 68].”
Background
Exploring Physician and Patient Perspectives on Expectations and Role Models Towards Chronic Pain Treatment in General Practice: A Qualitative Cross-Sectional Study
Dupont, D., Brinkmöller, S., Carter, S., Wensing, M., Straßner, C., Engeser, P., & Poß-Doering, R. (2025) · Healthcare · doi:10.3390/healthcare13020187 · Cited by 6
The effects of exercise therapy on lumbar muscle structure in low back pain: A systematic review and meta-analysis
Karagiannopoulou, V., Meirezonne, H., Greef, I. D., Oosterwijck, J. V., Matheve, T., Danneels, L. A., & Willems, T. M. (2025) · Annals of Physical and Rehabilitation Medicine · doi:10.1016/j.rehab.2025.101988 · Cited by 6
The Effect of Pain Belief of the Elderly People with Chronic Low Back Pain on Quality of Life and Disability
Kılıç, Z., & Alkan, B. M. (2021) · Fiziksel Tıp ve Rehabilitasyon Bilimleri Dergisi · doi:10.31609/jpmrs.2020-74455 · Cited by 4
Is There a Correlation of Cervical Mobility with Clinical Variables and Psychosocial Factors in Women with Migraine?
Pinheiro, C. F., Marçal, J. C. S., de Oliveira, A. S., Florêncio, L. L., Dach, F., Fernández‐de‐las‐Peñas, C., & Bevilaqua‐Grossi, D. (2021) · Applied Sciences · doi:10.3390/app11136077 · Cited by 4
“These physical and painful symptoms are associated with kinesiophobia in patients with neck pain and chronic musculoskeletal pain [26,27], since fear of movement, a strategy used to avoid pain, also leads to physical and functional consequences [28].”
Background
Prevalence of Kinesiophobia in Patients with Osteoarthritis Knee: A Cross Sectional Study
Kanniappan, S. P., & Vishnu Vardhan, G. D. (2021) · International Journal of Physiotherapy and Research · doi:10.16965/ijpr.2021.141 · Cited by 4
Activité Physique Adaptée et cancer métastatique : quels besoins et quelles attentes ?
Bouillet, T., Joly, F., Saghatchian, M., Guéroult-Accolas, L., Tahar, J.-M., Descotes, J.-M., & Krakowski, I. (2022) · Bulletin du Cancer · doi:10.1016/j.bulcan.2022.07.011 · Cited by 4
Assessment and treatment of patients with kinesiophobia: A Delphi consensus
Mattias, S., Diener, I., & Rob, O. (2022) · Journal of Novel Physiotherapy and Rehabilitation · doi:10.29328/journal.jnpr.1001047 · Cited by 4
Addition of tDCS and TENS to an education and exercise program in subjects with knee osteoarthritis: A study protocol
Gacto‐Sánchez, M., Lozano-Meca, J. A., Lozano-Guadalajara, J. V., Baño-Alcaraz, A., Lillo‐Navarro, C., & Montilla‐Herrador, J. (2022) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-220015 · Cited by 4
Huzurevinde Yaşayan Yaşlılarda Kinezyofobi ve İlişkili Faktörlerin Değerlendirilmesi
Genç, F. Z., & Bilgili, N. (2023) · Balıkesır Health Sciences Journal · doi:10.53424/balikesirsbd.1140101 · Cited by 4
Relationships between physical activity levels and disease activity, functional disability and kinesiophobia in chronic rheumatic diseases
Peres, D., Tordi, N., Demartino, A. M., Cheng, J., Sagawa, Y., & Prati, C. (2023) · Science & Sports · doi:10.1016/j.scispo.2022.07.013 · Cited by 4
The relationship between kinesiophobia and physical activity levels, gestational weight gain, and musculoskeletal pain in pregnant women
Okan, F., Özsoy, A. Z., Sandalcı, T., Erkek, Z. Y., & Zincir, H. (2023) · Women & Health · doi:10.1080/03630242.2023.2238843 · Cited by 4
Gender Differences in Chronic Musculoskeletal Pain – Role of Kinesiophobia, Acceptance Behaviors, Pain Catastrophizing, and Quality of Life
Panhale, V. P., Walankar, P. P., & Sayed, M. A. (2022) · Journal of Integrated Health Sciences · doi:10.4103/jihs.jihs_30_21 · Cited by 4
Factors associated with persistent pain in college athletes with a history of lateral ankle sprain
Koshino, Y., Watanabe, K., Akimoto, M., Ishida, T., Samukawa, M., Kasahara, S., & Tohyama, H. (2023) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2023.08.007 · Cited by 4
Joint position sense testing at the wrist and its correlations with kinesiophobia and pain intensity in individuals who have sustained a distal radius fracture: A cross-sectional study
Cantero‐Téllez, R., Algar, L. A., Cruz-Gambero, L., Villafañe, J. H., & Naughton, N. (2024) · Journal of Hand Therapy · doi:10.1016/j.jht.2023.12.008 · Cited by 5
Fear of movement and competence frustration mediate the relationship between pain catastrophising and physical function in people living with axSpA: an online cross-sectional survey
Rouse, P. C., Ingram, T. A., Standage, M., & Sengupta, R. (2024) · Rheumatology International · doi:10.1007/s00296-024-05557-w · Cited by 6
“A systematic review of 63 studies in people suffering from chronic musculoskeletal pain, showed fear of movement to be associated with less participation in physical activity and greater levels of pain disability [17].”
Background
Antinociceptive and antioxidant effects of Onosma platyphyllum riedl extract
Ranjbar, K., Molazadeh, A., Ardestani, A. D., Soleimanian, M., Meshkibaf, Z., & Meshkibaf, M. H. (2021) · Physiology and Pharmacology · doi:10.52547/phypha.26.4.10 · Cited by 4
Promouvoir une activité physique régulière chez les patients : l’importance de la perception de l’effort
Cheval, B., & Boisgontier, M. P. (2023) · Staps · doi:10.3917/sta.pr1.0091 · Cited by 6
PULMONER HİPERTANSİYONLU BİREYLERDE KİNEZYOFOBİ
Harputlu, Ö. E., Aslan, G. K., Akıncı, B., & Okumuş, N. (2019) · Türk fizyoterapi ve rehabilitasyon dergisi · doi:10.21653/tjpr.665154 · Cited by 4
Investigation of the Relationship Between Kinesiophobia, Foot and Ankle Function and Physical Activity of Athletes with Chronic Ankle Instability
Seyhan, S., Açar, G., Yaşasın, Y., & Üzümcü, B. (2024) · Turkish Journal of Sport and Exercise · doi:10.15314/tsed.1499080 · Cited by 3
Examination of the Relationship Between Pain Intensity, Pain Perceptions, and Kinesiophobia in Patients with Non-Specific Chronic Musculoskeletal Pain
Sgourda, S., Loulla, M., Zisiopoulou, E., Katsiou, K., Nikolaidi, S., Kyrosis, I., & Christakou, Α. (2025) · Muscles · doi:10.3390/muscles4030027 · Cited by 3
“A systematic review by Luque-Suarez et al. concluded that elevated levels of kinesiophobia are associated with increased pain intensity and reduced quality of life in individuals with chronic musculoskeletal pain [7].”
Influential
Pragmatic approaches to screening for anxiety and depression in physiotherapy: simple tools for busy clinicians
Vancampfort, D., Stubbs, B., & McGrath, R. L. (2025) · European Journal of Physiotherapy · doi:10.1080/21679169.2025.2553765 · Cited by 3
Home-Based, Telematic Gradual Exercise for Permanent Colostomy Patients: Protocol for a Randomized Controlled Trial
Antequera-Antequera, Á., Valenza-Peña, G., Raya-Benítez, J., Navas‐Otero, A., Valenza, M. C., Mateo, A. C., & Martos, I. C. (2025) · Healthcare · doi:10.3390/healthcare13212742 · Cited by 4
Music therapy and Benson relaxation in postoperative care: A randomized controlled trial on pain and kinesiophobia after lumbar discectomy
Bagheri, M., Abbasi, A., Kurdi, S., Moslemi, F., & Mottahedi, M. (2025) · EXPLORE · doi:10.1016/j.explore.2025.103311 · Cited by 4
The relationship between the motivation for physical activity and the level of physical activity among medical college students: based on the mediating effect of exercise self-efficacy and the moderating effect of kinesiophobia level
Pan, J., Cao, X., Li, F., Wu, R., Rong, Z., Tao, J., Qinging, M. I. A. O., Fu, Y., Xie, J., Zhan, X., et al. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1750697 · Cited by 3
Kinesiophobia Level in Fibromyalgia Patients and Its Relationship with Cognitive Functions, Anxiety, Depression, Disease Activity and Pain Level
Sarıhan, K., İnaltekin, A., & Yilmaz, O. A. (2026) · Healthcare · doi:10.3390/healthcare14091137 · Cited by 3
“Kinesiophobia is defined as an excessive, irrational, and debilitating fear of engaging in physical activities due to perceived vulnerability to painful injury or re-injury [17,18].”
The RISE FOR HEALTH study: Methods for in‐person musculoskeletal assessment
Fitzgerald, C. M., Fok, C. S., Kenton, K., Lukacz, E. S., Markland, A. D., Meister, M., Newman, D. K., Rudser, K. D., Smith, E., Wyman, J. F., et al. (2022) · Neurourology and Urodynamics · doi:10.1002/nau.25086 · Cited by 3
“(2) places their hands on their lower back with palms facing out, (3) slumps forward, (4) fully flexes their cervical spine, (5) examiner extends one knee and dorsiflexes the foot, (6) if pain is provoked in the back and leg, the participant extends the cervical spine to assess for symptom relief—a positive test demon…”
Background
Psychometric Values of a New Scale: The Rett Syndrome Fear of Movement Scale (RSFMS)
Lotan, M., Zwilling, M., & Romano, A. (2023) · Diagnostics · doi:10.3390/diagnostics13132148 · Cited by 3
Enhanced Muscle Endurance Through Self-regulated Dual-Task Exercises in Elbow Fracture Rehabilitation: A Cross-sectional Study
Cruz‐Montecinos, C., López, L., Núñez‐Cortés, R., López‐Bueno, R., Suso‐Martí, L., Méndez-Rebolledo, G., Morral, A., Andersen, L. L., Casaña, J., & Calatayud, J. (2024) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000002462 · Cited by 3
Comparison of short term recovery in patients with midportion Achilles tendinopathy with varying degrees of kinesiophobia treated with the Silbernagel protocol: A prospective single cohort analysis
Smitheman, H. P., Hanlon, S. L., Lundberg, M., Pohlig, R. T., & Silbernagel, K. G. (2024) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2024.10.004 · Cited by 3
Upper limb muscle strength and neuromuscular coordination and other factors as determinants of kinesiophobia in people with cervical and cervicothoracic spine dysfunction
Weremczuk, M. A., Kostka, J., Piekarski, J. H., Otocka-Kmiecik, A., Pikala, M., Adamczewski, T., Figas, G., & Kujawa, J. E. (2025) · Scientific Reports · doi:10.1038/s41598-025-86109-5 · Cited by 3
The impact of pain from medial meniscus injuries on walking movement patterns
Chen, Y., Wang, L., Fan, Z., Zhou, H., & Lu, A. (2025) · Frontiers in Bioengineering and Biotechnology · doi:10.3389/fbioe.2025.1545521 · Cited by 3
The Effect of Kinesiophobia on Quality of Life and Shoulder Functionality in Painful Shoulder Pathologies
Pirinççi, C. Ş., Cihan, E., Arca, M., Durmaz, E. D., & Yıldırım, N. Ü. (2020) · Anadolu Kliniği Tıp Bilimleri Dergisi · doi:10.21673/anadoluklin.755320 · Cited by 3
Outcomes with Additional Manual Lymphatic Drainage to Rehabilitation Protocol in Primary Total Knee Arthroplasty Patients: Preliminary Clinical Results
Cihan, E., Yıldırım, N. Ü., Bilge, O., Bakar, Y., & Doral, M. N. (2021) · Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi · doi:10.22312/sdusbed.963963 · Cited by 3
Clinical Presentation Differences Among Four Subtypes of Femoroacetabular Impingement: A Case–Control Study
González-de-la-Flor, Á., Valera‐Calero, J. A., García-Fernández, P., López‐de‐Uralde‐Villanueva, I., Fernández‐de‐las‐Peñas, C., & Plaza‐Manzano, G. (2023) · Physical Therapy · doi:10.1093/ptj/pzad179 · Cited by 3
Association between joint position sense, range of motion, pain-related anxiety, disability and deep neck muscles thickness in non-specific chronic neck pain patients with high and low levels of fear of pain: a cross-sectional study
Molaei, F., ShahAli, S., Shanbehzadeh, S., & Yassin, M. (2024) · Current Psychology · doi:10.1007/s12144-024-06903-8 · Cited by 3
Exploring the impact of illness uncertainty on psychosocial and functional outcomes in knee osteoarthritis
Gacto‐Sánchez, M., Lozano-Meca, J. A., Lozano-Guadalajara, J. V., & Montilla‐Herrador, J. (2025) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2025.2522912 · Cited by 4
The SLIM study—Shared medical appointments to change lifestyles of overweight people with haemophilia: A randomized multiple baseline (n‐of‐1) design
Hendriks, M. A. L., van Wanroij, J. W. M., Gorkom, B. A. P. L., der Sanden, M. W. G. N., & Hoogeboom, T. J. (2021) · Haemophilia · doi:10.1111/hae.14306 · Cited by 3
“2 0 (0) 0 (0) 0 (0) Kinesiophobia 0 (0) 0 (0) 0 (0) 2 PA motivation 50 (0) 50 (0) 50 (0) EH motivation 50 (0) 50 (0) 50 (1) Pain in rest 22 (19) 24 (6) 55 (18) Pain during PA 32 (21) 38 (5) 68 (16) PSK nr.”
Influential
A Biobehavioral Pain Hygiene Model: Narrative Review and Conceptualization
Saravanan, A., & Reagan, L. (2021) · Topics in Pain Management · doi:10.1097/01.tpm.0000756300.54102.46 · Cited by 3
Factors in the Use of Workplace Health Promotion on Back Health. Results of the Survey “German Health Update”
Hermann, S., Starker, A., Geene, R., & Jordan, S. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.638242 · Cited by 3
“Furthermore, fear of movement (also known as kinesiophobia) and catastrophizing may influence the development of chronic discomfort and lower performance in the work environment, although these issues are poorly studied (2, 4, 5).”
Background
Kinematic changes in goal-directed movements in a fear-conditioning paradigm
Nishi, Y., Osumi, M., Sumitani, M., Yozu, A., & Morioka, S. (2021) · Scientific Reports · doi:10.1038/s41598-021-90518-7 · Cited by 3
“07), whereas the RM-ANOVA revealed a significant main effect for Block (F (3, 171) = 55.”
BackgroundMethodInfluential
Estimulación eléctrica nerviosa transcutánea (TENS) como manejo efectivo del dolor y la fatiga en mujeres con fibromialgia
Gálvez, L. A., & Rodríguez, L. M. (2021) · Revista de la Sociedad Española del Dolor · doi:10.20986/resed.2021.3931/2021 · Cited by 3
Psychological assessment of persons with chronic pain
Jamison, R. N., & Craig, K. D. (2022) · Wiley eBooks · doi:10.1002/9781119701170.ch11 · Cited by 3
Alt Ekstremitenin Kronik Ortopedik Problemlerinde Ağrı, Hareket Korkusu ve Kaygı Düzeyi Arasındaki İlişkinin Araştırılması
Numanoğlu, E. A., Arık, A., Gökşen, A., Canlı, K., Yıldız, N. T., Coşkun, G., Erden, Z., & Can, F. (2023) · Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi Dergisi · doi:10.21020/husbfd.1178079 · Cited by 2
Evaluating Sensitization-associated, Neuropathic-like Symptoms and Psychological Factors in Patients With Interstitial Lung Disease
Parás‐Bravo, P., Fernández‐de‐las‐Peñas, C., Pargada, D. J. F., Druet-Toquero, P., Cacho, L. M. F., Martínez, J. M. C., Arendt‐Nielsen, L., & Herrero‐Montes, M. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.104533 · Cited by 2
Rehabilitation outcome domains following rotator cuff surgical repair: A systematic review
Ciardi, G., Novara, D., Quattrini, F., & Ricci, E. (2024) · Journal of Orthopaedic Reports · doi:10.1016/j.jorep.2024.100409 · Cited by 2
Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain- A case-control study
Kumar, P., Ferreira, A. D. S., Nogueira, L. A. C., Watson Arulsingh, D. R., & Patil, M. (2024) · F1000Research · doi:10.12688/f1000research.152751.1 · Cited by 3
Investigation of the relationship between mobility levels of older patients undergoing spinal surgery and fear of pain and fear of falling, and the affecting factors
Damar, H. T., Baksi, A., & Salman, F. (2025) · Geriatric Nursing · doi:10.1016/j.gerinurse.2025.02.017 · Cited by 2

Authors: Luque-Suarez, A., Martinez-Calderon, J., & Falla, D.
Affiliations: University of Birmingham (GB)
ORCID: Falla, Deborah
Venue: British Journal of Sports Medicine
Publisher: BMJ
Published: 2018-04-17
Volume: 53
Issue: 9
Pages: 554-559
ISSN: 0306-3674 (ISSN-L)
1473-0480
DOI: 10.1136/bjsports-2017-098673
OpenAlex: W2800915060
Cited by: 546
References: 116
Citations by year: 2026: 98 · 2025: 93 · 2024: 80 · 2023: 87 · 2022: 86 · 2021: 58 · 2020: 33 · 2019: 11
FWCI: 2.98
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: other-oa
Locations: British Journal of Sports Medicine (publishedVersion)
PubMed (publishedVersion)
RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
HighWire Press Open Archive (submittedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Funders: Universidad de Málaga
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: kinesiophobia, chronic musculoskeletal pain, disability, quality of life, pain intensity, Tampa Scale for Kinesiophobia, prognostic value, disability progression
MeSH terms: Cross-Sectional Studies, Fear, Disabled Persons, Persons with Disabilities, Humans, Quality of Life, Musculoskeletal Pain, Observational Studies as Topic

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Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review

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