Association between pain, physical performance, and kinesiophobia in older women with low back pain: A cross-sectional study

PLoS One. 2026 Feb 27;21(2):e0337553. doi: 10.1371/journal.pone.0337553. eCollection 2026.

ABSTRACT

BACKGROUND: Kinesiophobia is a psychological element that may contribute to persistent pain and functional decline in older women with chronic low back pain. Clarifying its role could inform more effective rehabilitation strategies.

OBJECTIVES: To examine associations between kinesiophobia, pain intensity, and physical performance in older women with chronic low back pain.

METHODS: A cross-sectional study was conducted in 2024 with 119 women aged ≥ 60 years reporting nonspecific low back pain. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia (TSK-17), and pain with the Visual Analog Scale (VAS). The Timed Up and Go test and the 30-second sit-to-stand test were performed to evaluate balance and lower limb strength, respectively (physical performance). Correlation, regression, and mediation analyses were used to explore relationships among variables.

RESULTS: Higher pain intensity was strongly associated with higher kinesiophobia (β = 0.74, p = 0.001), while lower limb strength showed a negative association (β = -0.17, p = 0.005). No significant relationship emerged between kinesiophobia and balance (p > 0.05). Regression indicated that pain was the strongest predictor of kinesiophobia. Mediation analyses suggested that kinesiophobia fully explained the relationship between pain and reduced lower limb strength, while strength itself partially mediated the link between pain and kinesiophobia, highlighting both direct and indirect effects.

CONCLUSIONS: In older women with chronic low back pain, kinesiophobia is positively related to pain severity and negatively related to lower limb strength, but not balance. Findings suggest fear of movement may mediate the impact of pain on physical performance, underscoring the importance of addressing psychological as well as physical factors in rehabilitation. Given the cross-sectional design, causal inferences should be drawn cautiously.

PMID:41758814 | DOI:10.1371/journal.pone.0337553