ArticleEuropean journal of investigation in health, psychology and education2026
Kinesiophobia and Work Disability in Fibromyalgia: Cognitive Mediation in a Population-Based Study of Women.
Article in European journal of investigation in health, psychology and education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWork disability in fibromyalgia is only partially explained by symptom severity, suggesting a relevant contribution of cognitive-behavioral mechanisms.
objectiveThis study aimed to determine whether kinesiophobia is associated with fibromyalgia impact and work-related disability and to assess whether pain catastrophizing mediates these relationships within a hierarchical biopsychosocial framework.
methodsThis cross-sectional study included 2096 women with fibromyalgia recruited through a nationwide online survey. Participants completed validated instruments assessing fibromyalgia impact (FIQ), pain catastrophizing (PCS), depressive symptoms (PHQ-9), central sensitization (CSI), and kinesiophobia (Tampa Scale). Pain-related work disability was defined using the Graded Chronic Pain Scale-Revised (GCPS-R). Hierarchical logistic regression models identified factors independently associated with work disability. Mediation was tested using bootstrapped analyses (5000 resamples).
resultsKinesiophobia demonstrated a robust independent association with work disability (OR 1.03; 95% CI 1.02-1.05) after adjustment for sociodemographic factors, clinical pain phenotype, systemic burden, pain severity, psychocognitive load, and medication burden. Other relevant contributors included pain severity (OR 1.96; 95% CI 1.70-2.27), psychocognitive burden (OR 1.35; 95% CI 1.15-1.58), use of benzodiazepines (OR 1.74; 95% CI 1.33-2.28), and opioid use (OR 1.29; 95% CI 1.06-1.56). Mediation analysis indicated a significant indirect effect of kinesiophobia on work disability through pain catastrophizing (β = 0.131; 95% CI 0.078-0.188).
conclusionsKinesiophobia is a proximal determinant of work disability in fibromyalgia, exerting direct and cognitively mediated effects through pain catastrophizing, reinforcing the fear-avoidance framework and the need for psychologically informed rehabilitation.
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