Do Anxiety, Depression, Fear of Movement and Fear of Achilles Rupture Correlate with Achilles Tendinopathy Pain, Symptoms or Physical Function?

Objectives: To determine if psychological factors, such as anxiety, depression, fear of movement and fear of rupture are associated with increased tendon-related disability, quantified by the Tendinopathy Severity Assessment-Achilles (TENDINS-A). Design: Cross-sectional. Setting: Online Qualtrics survey. Participants: Sixty-eight participants (54% female) with Achilles tendinopathy and a mean (standard deviation) age of 40.1 (12.6) years. Main Outcome Measures: The TENDINS-A (including subscales of pain; symptoms such as stiffness; physical function), Patient Health Questionnaire-9, General Anxiety Disorder-7, Tampa Scale for Kinesiophobia and fear of tendon rupture. Associations were evaluated using generalised linear models (adjusting for age and sex), with significance accepted when p < 0.05. Results: Anxiety symptoms were positively associated with Achilles pain (p = 0.035), symptoms (p = 0.045) and physical function (p = 0.019). Depressive symptoms were negatively associated with symptoms (p = 0.045) but not pain (p = 0.078) or physical function (p = 0.429). Fear of movement was not associated with pain (p = 0.479), symptoms (p = 0.915) or physical function (p = 0.064). Fear of rupture was associated with pain (p = 0.042), but not symptoms (p = 0.797) or physical function (p = 0.509). Conclusions: Our research demonstrated anxiety symptoms and fear of rupture, not fear of movement or depressive symptoms, are positively associated with the severity of tendon-related disability. Therefore, clinicians should include an assessment anxiety symptoms and fear of rupture in their practice.