Tan Sam, Jaggi Anju, Tasker Alex, Borra Catherine, Watson Fraje
University College London, London, United Kingdom.
Royal National Orthopaedic Hospital, London, United Kingdom.
PLoS One. 2025 Jun 10;20(6):e0324947. doi: 10.1371/journal.pone.0324947. eCollection 2025.
The Fear-Avoidance (FA) model aims to explain how an acute pain experience can develop into a persistent state. The FA model considers five core components: kinesiophobia, pain-related fear, catastrophisation, victimisation, and interpersonal social environment. Amongst these, kinesiophobia, tends to dominate the literature on chronic musculoskeletal pain. As a result, current reviews have not considered the other core components of the FA model when exploring its interventions. Moreover, several synonyms of the term kinesiophobia is not reflected in their search strategies. Coupled with the preference of particular study designs and outcome measures, this scoping review aims to provide and characterise an overview of treatment interventions that consider all study designs, relevant outcome measures, FA components, and FA component synonyms.
Eligible studies will be in English or with an available English translation from 1970 onwards. Databases to be searched include Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, The Allied and Complementary Database (AMED), PEDro, Web of Science, and grey literature. We will include studies involving participants ≥18 years old with chronic musculoskeletal pain, and interventions targeting FA and/or its components. Three review authors will independently screen papers using preestablished eligibility criteria and conduct assessments of risk of bias, with a fourth independent researcher employed to resolve disagreements where found. Qualitative synthesis techniques will be used to characterise the interventions. Patient and Public Involvement (PPI) has been utilised to develop this protocol and will be conducted following completion of the systematic review to discuss and reflect on the findings.
This systematic review does not require ethical approval as existing data will be used and the PPI to be conducted is an involvement activity rather than study data. The results will be disseminated through a peer-reviewed journal and via national and international conferences.
This protocol is registered on Open Science Framework: https://doi.org/10.17605/OSF.IO/NR37A.
恐惧回避（FA）模型旨在解释急性疼痛体验如何发展为持续状态。FA模型包含五个核心要素：运动恐惧症、与疼痛相关的恐惧、灾难化思维、被害感和人际社会环境。其中，运动恐惧症在慢性肌肉骨骼疼痛的文献中占据主导地位。因此，当前的综述在探索FA模型的干预措施时，并未考虑该模型的其他核心要素。此外，运动恐惧症一词的几个同义词在其检索策略中未得到体现。鉴于对特定研究设计和结局指标的偏好，本综述旨在全面介绍考虑了所有研究设计、相关结局指标、FA要素及其同义词的治疗干预措施。
符合条件的研究需为1970年起的英文研究或有可用英文译文。检索的数据库包括Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、Embase、联合与补充医学数据库（AMED）、PEDro、科学引文索引（Web of Science）以及灰色文献。我们将纳入涉及年龄≥18岁的慢性肌肉骨骼疼痛患者以及针对FA及其要素的干预措施的研究。三位综述作者将使用预先设定的纳入标准独立筛选论文，并进行偏倚风险评估，如有分歧将聘请第四位独立研究人员解决。将采用定性综合技术对干预措施进行描述。患者及公众参与（PPI）已用于制定本方案，并将在系统综述完成后进行，以讨论和反思研究结果。
本系统综述无需伦理批准，因为将使用现有数据，且即将开展的PPI是一项参与活动而非研究数据收集。研究结果将通过同行评审期刊以及国内和国际会议进行传播。
本方案已在开放科学框架注册：https://doi.org/10.17605/OSF.IO/NR37A 。
