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Jo Nijs
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=== Kinesiophobia and catastrophizing: testing the fear-avoidance model === Nijs has investigated the fear avoidance model in ME/CFS. In this model, originally developed for chronic low back pain, it is believed patients worsen their condition by holding an irrational fear of movement called kinesiophobia. When Nijs tested this in 64 ME/CFS patients, the results contradicted the theory:<blockquote>"Our data do not support the view that kinesiophobia is associated with disability (ie, activity limitations and participation restrictions) in patients with CFS who experience pain. Our results, therefore bring into question the clinical importance of kinesiophobia."<ref name="NoKin2004" /></blockquote>Two other studies by Nijs, both published in 2004, did find a relationship between kinesiophobia and activity limitations measured with the CFS-APQ, but there was no correlation with exercise test results.<ref name="Kinesiophobia2004" /> Another concept of the fear avoidance model is catastrophizing, a tendency to interpret events negatively or to assume the worst will happen. In a group of 36 ME/CFS patients, Nijs found that “catastrophizing accounted for 41% of the variance in bodily pain."<ref name="performance2018" /> These results were questioned by [[Tom Kindlon]] who pointed out the study could not prove the assumed direction of causation. The lack of correlation between catastrophizing and the large drop in employment rate seen in the ME/CFS patients studied, suggests other factors might be more important in determining their condition."<ref name="Kindlon2009">{{Cite journal | last = Kindlon | first = T | authorlink = Tom Kindlon | title = Response to: exercise performance and chronic pain in chronic fatigue syndrome: the role of pain catastrophizing|journal=Pain Med | date = 2009 |volume=10|issue=6|pages=1144 | url = https://www.researchgate.net/publication/26802501_Response_to_Exercise_Performance_and_Chronic_Pain_in_Chronic_Fatigue_Syndrome_The_Role_of_Pain_Catastrophizing}}</ref> In 2011, Nijs collaborated with Gijs Bleijenberg to test the effect of kinesiophobia and catastrophizing in ME/CFS before a threatening activity, in this case, stair climbing. Both factors were unrelated to symptom expectancies, but they did correlate with actual stair climbing performance, i.e. the time required to complete the task.<ref name="Stair2012" /> Two years later the study was repeated using a larger sample of 49 ME/CFS patients. Findings contradicted those of the previous study as kinesiophobia and catastrophizing were no longer related to stair climbing duration.<ref name="Heins2013" /> In 2012, Nijs' research group concluded that catastrophizing is a long-term predictor of pain in ME/CFS patients.<ref name="Psych2012" /> In a 2013 review Nijs concluded that fear of movement was a highly prevalent and a clinically relevant factor in ME/CFS.<ref name="Avoidance2013" />
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