ﺗﺮ… Y ﺣﺮﻛﺖ/ } } } } }ﻫﺎÉ ﻋﻀﻼﻧﻲ Yﺳﻜﻠﺘﻲ
ﺗﺮ ﺣﺮﻛﺖ /ﻫﺎ ﻋﻀﻼﻧﻲ ﺳﻜﻠﺘﻲ * ﺑﻬﻨﺎ ﺧﺒﺎ ،1ﺷﻬﺮ ﻣﺤﻤﺪ ،2ﻣﻬﻴﺎ ﺻﻠﻮﺗﻲ 3 84 ﻮ ﭘﺎﻳﻴﺰ 1391ﺷﻤﺎ ﻣﺴﻠﺴﻞ 53 ﺳﻴﺰﻫﻢ ﺷﻤﺎ ﺳﻮ 1ـ ﻛﺘــﺮ ﺗﺨﺼﺼــﻲ ﻓﻴﺰﻳﻮﺗﺮﭘــﻲ، ﻧﺸــﻴﺎ! ﻧﺸــﮕﺎ ﻋﻠﻮ ﺑﻬﺰﻳﺴﺘﻲ ﺗﻮﻧﺒﺨﺸﻲ ،ﺗﻬﺮ" ،ﻳﺮ" 2ـ ﻧﺸــﺠﻮ ﻛﺎ!ﺷﻨﺎﺳــﻲ !ﺷــﺪ ﻓﻴﺰﻳﻮﺗﺮﭘﻲ ،ﻧﺸﮕﺎ ﻋﻠﻮ ﺑﻬﺰﻳﺴﺘﻲ ﺗﻮﻧﺒﺨﺸﻲ ،ﺗﻬﺮ" ،ﻳﺮ" 3ـ ﻛﺘــﺮ ﺗﺨﺼﺼــﻲ ﻓﻴﺰﻳﻮﺗﺮﭘﻲ، ﺳﺘﺎ ﻧﺸــﮕﺎ ﻋﻠﻮ ﺑﻬﺰﻳﺴﺘﻲ ﺗﻮﻧﺒﺨﺸﻲ ،ﺗﻬﺮ" ،ﻳﺮ" !ﻳﺎﻓﺖ ﻣﻘﺎﻟﻪ90/04/02 : ﭘﺬﻳﺮ .ﻣﻘﺎﻟﻪ91/10/25 : * "#ﻧﻮﻳﺴﻨﺪ ﻣﺴﺌﻮ: ﺗﻬﺮ" ،ﻳﻦ ،ﺑﻠﻮ! ﻧﺸﺠﻮ ،ﺧﻴﺎﺑﺎ" ﻛﻮﻛﻴﺎ! ،ﻧﺸــﮕﺎ ﻋﻠﻮ ﺑﻬﺰﻳﺴﺘﻲ ﺗﻮﻧﺒﺨﺸﻲ ،ﮔﺮ ﻓﻴﺰﻳﻮﺗﺮﭘﻲ * ﺗﻠﻔﻦ22180039 : * ﻳﺎﻧﺎﻣﻪakhbari@uswr. ac.ir : ﭼﻜﻴﺪ ﻫﺪ :ﻫﺪ ﻳﻦ ﻣﻄﺎﻟﻌﻪ ،ﺑﺮﺳﻲ ﻣﺮ ﺗﺄﺛﻴﺮ ﻧﻲ ﻣﺜﻞ ﺗﺮ ﺗﺮ ﺣﺮﻛﺖ ﻋﻤﻠﻜﺮ ﺑﻴﻤﺎ* ﻣﺒﺘﻼ ﺑﻪ ﻫﺎ ﻋﻀﻼﻧﻲ ـ ﺳــﻜﻠﺘﻲ ﻧﺘﺎﻳﺞ ﺗﻮﻧﺒﺨﺸﻲ 0ﻧﺎ* ﺳﺖ. ﺑﺤﺚ :ﺗﺮ ﺣﺴﺎﺳــﻲ ﻫﻤﮕﺎﻧﻲ ﻧﻴﺮﻣﻨﺪ ﺳﺖ ﻛﻪ ﻣﻲﺗﻮﻧﺪ ﺗﺄﺛﻴﺮ ﻳﺎ ﻓﺘﺎ ﻧﺴﺎ* ﺷﺘﻪ ﺑﺎﺷﺪ .ﻓﺘﺎﻫﺎ ﻧﺎﺷﻲ ﺗﺮ ﻧﺘﺎﻳﺞ ﺗﻮﻧﺒﺨﺸﻲ ﺑﻴﻤﺎ* ﻣﺒﺘﻼ ﺑﻪ ﻋﻀﻼﻧﻲ ـ ﺳــﻜﻠﺘﻲ ﺛﺮ ﻣﻨﻔﻲ ﻧﺪ .ﺗﻌــﺪ ﻣﻄﺎﻟﻌﺎ ﻣﻘﻄﻌﻲ ﺛﺎﺑﺖ ﻛﺮ:ﻧﺪ ﻛﻪ ﺗﺒﺎ Bﻣﺜﺒﺘﻲ ﺑﻴﻦ ﺗﺮ ﻳﺎ ﻓﺰﻳﺶ ﺷﺪ ﻧﺎﺗﻮﻧﻲ ﺟﻮ .ﻫﻢﭼﻨﻴﻦ ﻣﻄﺎﻟﻌــﺎ ﻃﻮﻟﻲ ﻣﺘﻌﺪ ﻧﺸــﺎ* :ﻧﺪ ﻛﻪ ﺗــﺮ ﻳﺎ ﻣﻘﺪﻣﻪ ﺑــﺮ ﻧﺘﺎﻳﺞ ﺑﺎﻟﻴﻨﻲ ﺿﻌﻴﻒ ﺳــﺖ .ﺟﻮ ﻋﻘﺎﻳﺪ ﻓﻜﺎ ﻣﺨﺎﻃﺮ0:ﻣﻴﺰ ﺑﻴﻤﺎ ،ﺗﺮ ﺣﺮﻛﺖ0 /ﺳــﻴﺐ ﻣﺠﺪ ﺗﺄﺛﻴﺮ ﻣﻲﮔﺬ .ﻳﻦ ﺗﺮ ﻣﻨﺠﺮ ﺑﻪ ﺑﺮ ﻓﺘﺎﻫﺎ ﺣﺘﺮ ،ﻋﺪ Iﻛﺎﺑﺮ ،ﻓﺴﺮﮔﻲ ﻧﺎﺗﻮﻧﻲ ﺑﻴﻤﺎ ﻣﻲﺷﻮ .ﺛﺎﺑﺖ ﺷﺪ :ﻛﻪ ﺗﺮ ﺣﺮﻛﺖ ﻧﺘﻴﺠﻪ ﺗﻮﻧﺒﺨﺸﻲ ﻛﻤﺮ ﺣﺎ ﻣﺰﻣﻦ ،ﺳــﻨﺪ Iﺧﺴﺘﮕﻲ ﻣﺰﻣﻦ ﺳــﻨﺪ Iﻓﻴﺒﺮﻣﻴﺎﻟﮋﻳﺎ ﺗﺄﺛﻴﺮ ﻣﻨﻔﻲ .ﻣﺠﻤﻮ Lﻣﻄﺎﻟﻌﺎ ﺧﻴﺮ ﻧﺸــﺎ* ﻣﻲﻫﻨﺪ ﻛﻪ ﻓﻴﺰﻳﻮﺗﺮﭘﻴﺴﺖﻫﺎ ﻫﻨﮕﺎ Iﺗﻮﻧﺒﺨﺸــﻲ ﻓﺮ ﻣﺒﺘﻼ ﺑﻪ ﻫﺎ ﻋﻀﻼﻧﻲ ـ ﺳــﻜﻠﺘﻲ ،ﻧﺒﺎﻳﺪ ﻧﻘﺶ ﻣﻬﻤﻲﻛﻪ ﺗﺮ ﻓﺘﺎﻫﺎ ﺣﺘﺮ ﻋﻤﻠﻜﺮ ﺑﻴﻤﺎ* ﻧﺪ، ﻏﺎﻓﻞ ﺷــﺪ :ﺑﺎﻳﺪ ﻳﻦ ﻋﻮﻣﻞ ﻓﺘﺎ ﺷــﻨﺎﺧﺘﻲ ﻣﻮ ﻳﺎﺑﻲ ﻗــﺮ ﻫﻨﺪ .ﺣﺎ Qﺣﺎﺿﺮ ﺷــﻮﻫﺪ ﻳﺎ ﻣﺒﻨﻲ ﺑﺮ ﻳﺎﺑﻲ ﺗــﺮ ﺑﻴﻤﺎ* ﻣﺒﺘﻼ ﺑﻪ ﻫﺎ ﻋﻀﻼﻧﻲ ـ ﺳــﻜﻠﺘﻲ ﺟﻮ .ﻳﺎﺑﻲ ﺑﺮﺳــﻲ ﺗﺮ ﺗﻮﺳﻂ ﭘﺮﺳﺶﻧﺎﻣﻪﻫﺎﻳﻲ ﺻﻮ ﻣﻲﮔﻴﺮ ﻛﻪ ﻋﺘﺒﺎ ﺗﻜﺮﭘﺬﻳﺮ 0ﻧﻬﺎ ﻣﻄﺎﻟﻌﺎ ﻣﺨﺘﻠﻒ ﺛﺒﺎ ﺷﺪ :ﺳﺖ .ﺑﺮﺳﻲﻫﺎ ﺧﻴﺮ ﻧﺸﺎ* :ﺷﺪ :ﻛﻪ ﻋﻼ :ﺑﺮ ﭘﺎﺳــﺨﻬﺎ ﺣﺘﺮ ﺗﺮ ،ﭘﺎﺳــﺦﻫﺎ ﺗﺤﻤﻠﻲ ﻛﻪ ﻃﺮﻳﻖ ﻓﻌﺎﻟﻴﺖ ﺑﻴﺶ ﺣﺪ ﻓﻴﺰﻳﻜﻲ ﻣﻨﺠــﺮ ﺑﻪ ﻣﺰﻣﻦ ﻣﻲﺷــﻮﻧﺪ ﻧﻴﺰ ﺗﺪ Iﻧﻘــﺶ ﻧﺪ .ﻫﻤﺎ*ﻃﻮﻛﻪ ﺑﻴﻤــﺎ* ﻣﺒﺘﻼ ﺑﻪ ﻫﺎ ﻋﻀﻼﻧﻲ ـ ﺳﻜﻠﺘﻲ ﺗﺮ ﺣﺮﻛﺖ ﺟﻮ ،ﺑﻴﻤﺎ* ﻣﺒﺘﻼ ﺑﻪ ﺑﻴﻤﺎﻫﺎ ﺳﺘﺮ ﻣﺰﻣﻦ ﺟﻮ ﺗﺮ ﺗﻼ Yﻓﻜﺮ ﺛﺒﺎ ﺷﺪ :ﺳﺖ. ﻧﺘﻴﺠﻪﮔﻴــﺮ :ﺗﺮ ﺑﺮﺧﻲ ﺑﻴﻤﺎ* ﻣﻲﺗﻮﻧﺪ ﺑﻪ ﻧﺪ :ﺧﻮ ﻧﺎﺗﻮ* ﻛﻨﻨﺪ :ﺑﺎﺷــﺪ. ﻧﺘﻴﺠﻪ ﺗﻼYﻫﺎ ﺳــﺘﻪ ﺟﻤﻌﻲ ﺑﺮ ﺻﻼ[ ﺗﻜﻨﻴﻚﻫﺎ ﻳﺎﺑﻲ ﺑﺮﺳﻲ ﻓﻌﻠﻲ ﮔﺴﺘﺮY ﻣﺪﺧﻼ ﻣﺎﻧﻲ ﻛﻪ ﺑﺘﻮﻧﻨﺪ ﺗﺮ ﺑﻪ ﻃﻮ ﻣﺆﺛﺮ ﻛﺎﻫﺶ ﻫﻨﺪ ،ﻻ Iﺳﺖ. ﻛﻠﻴﺪژﻫﺎ :ﺑﺎﻫﺎ ﺣﺘﺮ ﺗﺮ ،ﺗﺮ ﺣﺮﻛﺖ ،ﺗﺮ ،ﻋﻀﻼﻧﻲ ـ ﺳﻜﻠﺘﻲ ﺑﻬﻨﺎ ﺧﺒﺎ ﻫﻤﻜﺎ ﻣﻘﺪﻣﻪ ﺗﺮ ﻳﻚ ﺣﺴــﺎ ﻫﻤﮕﺎﻧﻲ ﻧﻴﺮﻣﻨﺪ ﺳــﺖ ﺑﻨﺎﺑﺮﻳﻦ ﻣﻲﺗﻮﻧﺪ ﺗﺄﺛﻴﺮ ﻳﺎ ﻓﺘﺎ ﻧﺴﺎ +ﺷﺘﻪ ﺑﺎﺷﺪ .ﺑﻴﺎﻧﺎ) ﺗﺎﻳﺨﻲ ﺑﻲ ﮔﻔﺘﻪ ﺷــﺪ 8ﻛﻪ ﻓﺘﺎﻫﺎﻳﻲ ﻛﻪ ﺳﺎﺳ ًﺎ ﺑﻪ ﻋﻠﺖ ﺗﺮ ﻳﺠﺎ ﻣﻲﺷﻮﻧﺪ ،ﺑﺎ ﺛﺮ) ﻳﺎ >+ﻫﻤﺮ 8ﻫﺴﺘﻨﺪ .ﺟﻤﻠﻪ ﻣﻌﺮ; Francois (1613-1680) La Rochefoucouldﭼﻨﻴﻦ >ﻣﺪ 8ﺳــﺖ ﻛﻪ »ﻣﺎ ﺑﺮﺳــﺎ ﻣﻴﺪﻫﺎﻳﻤﺎ +ﻗــﻮ ﻣﻲﻫﻴﻢ ﺑﺮ ﻃﺒــﻖ ﺗﺮﻫﺎﻳﻤﺎ +ﻋﻤﻞ ﻣﻲﻛﻨﻴﻢ« .ﺑﻪ ﻋﻼ ،Franklin Roasevelt 8ﺳﺨﻨﺮﻧﻲ ﻓﺘﺘﺎﺣﻲ ﻣﺸــﻬﻮ ﻛﻪ ﺳــﺎ 1933ﻳﺮ ﻛﺮ ،ﭼﻨﻴﻦ ﮔﻔﺖ» :ﺗﻨﻬﺎ ﭼﻴﺰ ﻛﻪ ﺑﺎﻳﺪ > +ﺑﺘﺮﺳــﻴﻢ ،ﺧﻮ ﺗﺮ ﺳﺖ .ﺑﺪﻳﻦ ﻣﻌﻨﻲ ﻛﻪ ﺗﺮ ﻳﺎ، ﻣﺠﻬــﻮ ،ﺑﻲﻟﻴــﻞ ﺑﻲﻣﻨﻄﻖ ﺑﻮ 8ﺗﻼQﻫــﺎ ﻻ Oﺑﺮ ﺗﺒﺪﻳﻞ ﻛﻨﺎ8ﮔﻴﺮ ﻋﻘﺐﻧﺸﻴﻨﻲ ﺑﻪ ﭘﻴﺸﺮﻓﺖ ﺗﺮﻗﻲ ﺑﻴﻦ ﻣﻲﺑﺮ«. ﺑﻨﺎﺑﺮﻳــﻦ ﺗﻌﺠﺐ> ﻧﻴﺴــﺖ ﻛﻪ ﻓﺘﺎﻫﺎ ﻧﺎﺷــﻲ ﺗﺮ ، ﻧﺘﺎﻳﺞ ﺗﻮﻧﺒﺨﺸــﻲ ﺑﻴﻤﺎ +ﻣﺒﺘﻼ ﺑﻪ ﻋﻀﻼﻧﻲ ـ ﺳﻜﻠﺘﻲ ،ﺛﺮ) ﻣﻨﻔﻲ ﺷــﺘﻪ ﺑﺎﺷــﻨﺪ .ﺳــﺎ ،1983ﮔﺮﻫﻲ +ﺷﻨﺎﺳــﺎ،+ ﻓﻴﺰﻳﻮﺗﺮﭘﻴﺴــﺖﻫﺎ ﻛﺎﻣﺎ+ﻫﺎ ،ﻳﻚ ﻣــﺪ ﻧﻈﺮ ﺋﻪ ﻧﺪ ﻛﻪ ﺛﺮ ﺗﺮ ﻧﺘﺎﻳﺞ ﺗﻮﺿﻴﺢ ﻣﻲ. ﺑﻪ ﺧﺼﻮ` Lethem ،ﻫﻤﻜﺎﻧﺶ ) (1 , 2ﻣﺪ ﺣﺘﺮ ﺗﺮ ﻣﺮﺑﻮ cﺑﻪ bﺑﻴﺶ ﺣﺪ (FAMEPP)1ﺑﺮ ﺗﻮﺿﻴﺢ ﭘﻴﺸﺮﻓﺖ ﻋﻼﻳﻢ ﻣﺰﻣﻦ ﺑﻪ ﻧﺒﺎ ﻳﻚ ﻓﺎ ﺣﺎ ﻛﻤﺮ ﻣﻌﺮﻓﻲ ﻧﻤﻮ8 ﭼﻨﻴﻦ ﻓﺮ dﻛﺮﻧﺪ ﻛﻪ ﺗﺮ ،ﻧﻘﺶ ﻣﻬﻤﻲ ﮔﺴــﺘﺮQ ﻋﻼﻳﻢ ﻋﻀﻼﻧﻲ ـ ﺳﻜﻠﺘﻲ ﻣﺰﻣﻦ . ﻣﺒﻨــﺎ ﺻﻠﻲ FAMEPPﻳﻦ ﺑﻮ ﻛــﻪ bﺣﺲ ،ﺟﺰ ﻛﻨﺸــﻲ ﺣﺴﻲ 2ﺣﺴﺎﺳﻲ . 3ﺟﺰء ﺣﺴﻲ ﺗﻮﺳﻂ ﻋﻮﻣﻞ ﻓﻴﺰﻳﻮﻟﻮژﻳﻜﻲ ﻣﺮﺑﻮ cﺑﻪ ﺳــﻄﺢ ﻧﺎ bﻳﺠﺎ ﻣﻲﺷــﻮ. ﺟﺰء ﻛﻨﺸــﻲ ﺣﺴﺎﺳــﻲ ﺗﻮﺳــﻂ ﻋﻮﻣﻞ ﻧــﻲ ﻛﻪ ﺑﻪ ﻃﻮ ﻋﻤﺪ 8ﻣﺮﺑﻮ cﺑﻪ ﺗﺮ ﻫﺴــﺘﻨﺪ ،ﺑﻪ ﺟﻮ ﻣﻲ >ﻳﺪ .ﻳﻦﻃﻮ ﻓﺮ dﺷــﺪ ﻛﻪ ﺑﻴﻤﺎﻧﻲ ﻛﻪ ﺗﺮ ﻛﻤﺘﺮ ﻧﺪ ،ﺗﺒﺎc ﻫﻤﺰﻣﺎﻧﻲ ﺑﻴﻦ ﺟﺰء ﻛﻨﺸــﻲ ﺣﺴــﻲ ﺣﺴﺎﺳﻲ ﺟﻮ . ﺷﻜﻞ -1ﻣﺪ ﻓﺘﺎ ـ ﺷﻨﺎﺧﺘﻲ ﺗﺮ ـ ﺣﺘﺮ 10ﻣﺰﻣﻦ 4- Cross-sectional 9- Disuse 3- Emotional 8- Catastrophizing 1- Fear-Avoidance Model of Exaggerated Pain Perception 2- Sensory 5- Longitudinal 6- Fear-avoidance beliefs 7- Fear-avoidance model 10- Cognitive-behavioral fear-avoidance model 85 ﺳﻮ ﭘﺎﻳﻴﺰ 1391ﺷﻤﺎ ﻣﺴﻠﺴﻞ 53 ﺳﻴﺰﻫﻢ ﺷﻤﺎ ﻮ ﺗﺒــﺎ cﻫﻤﺰﻣﺎ ،+ﻧﺘﻈﺎ ﻣﻘﺎﺑﻠﻪ ﺑﺎ ﻋﻼﻳﻢ ﺟﻮ ﻳﻦ ﻣﺮ ﻳﻚ ﭘﺎﺳــﺦ ﺗﻄﺎﺑﻘﻲ ﺳﺖ ﻛﻪ ﻣﻨﺠﺮ ﺑﻪ ﺑﺎﮔﺸﺖ ﺑﻪ ﻣﻮﻗﻊ ﺑﻪ ﺳﻄﻮj ﻋﻤﻠﻜﺮ ﻗﺒﻠﻲ ﻣﻲﺷــﻮ) .(1ﻣﻘﺎﺑــﻞ ،ﺑﻴﻤﺎﻧﻲ ﻛﻪ ﺗﺮ ﺑﻴﺸــﺘﺮ ﺳــﺖ ،ﺗﺒﺎ cﻏﻴﺮﻫﻤﺰﻣﺎﻧﻲ ﺑﻴــﻦ ﺟﺰء ﺟﻮ .ﺗﺒــﺎ cﻏﻴﺮﻫﻤﺰﻣﺎ ،+ﺟﺘﻨﺎ nﻋﻼﻳﻢ ﻧﺘﻈﺎ ﻓﺘﻪ ﻳﻦ ﻳﻚ ﭘﺎﺳﺦ ﻏﻴﺮﺗﻄﺎﺑﻘﻲ ﺳﺖ ﻛﻪ ﺑﺎ ﺣﺲ ﺑﻴﺶ ﺣﺪ ﻧﺘﻴﺠﻪ ﻧﺎﺗﻮﻧﻲ ﻣﺰﻣﻦ ﻫﻤﺮ 8ﺳﺖ).(1 , 2 ﻳﻦ ﺗﻮﺻﻴﻔــﺎ) ﻧﻈﺮ> FAMEPP ،ﻣﺎ> 8ﻣﻮ +ﻓﺮﺿﻴﻪ ﻛﺮ ﺑــﻪ ﻧﺒــﺎ > ،+ﻣﻄﺎﻟﻌﺎ) ﺗﺠﺮﺑﻲ ﻳﺎ ﻛــﻪ ﻣﻘﺎﻻ) ﻣﺮ ﮔﺰ Qﺷﺪﻧﺪ ،ﺳــﺎﺧﺘﺎ ﻧﻈﺮ ﻳﻦ ﻣﺪ ﺑﺮ ﺑﻴﻤﺎ +ﻣﺒﺘﻼ ﺑﻪ ﻋﻀﻼﻧﻲ ـ ﺳــﻜﻠﺘﻲ ﺣﻤﺎﻳﺖ ﻛﺮﻧﺪ .ﻣﻄﺎﻟﻌﺎ) ﻣﻘﻄﻌﻲ ۴ﺛﺎﺑﺖ ﻛﺮﻧﺪ ﻛﻪ ﺗﺒﺎ cﻣﺜﺒﺘﻲ ﺑﻴﻦ ﺗﺮ ﻳﺎ ﻓﺰﻳﺶ ﺷﺪ) ﻧﺎﺗﻮﻧﻲ ﺟﻮ ).(3-۵ ﺑــﻪ ﻋﻼ ،8ﻣﻄﺎﻟﻌﺎ) ﻃﻮﻟﻲ ۵ﻣﺘﻌﺪ ﻧﺸــﺎ +ﻧــﺪ ﻛﻪ ﺗﺮ ﻳﺎ ﻣﻘﺪﻣــﻪ ﺑﺮ ﻧﺘﺎﻳﺞ ﺑﺎﻟﻴﻨﻲ ﺿﻌﻴﻒ ﺳــﺖ) .(6-8ﺑﺮ ﻣﺜﺎ ﺑﺎﻫــﺎ ﺣﺘﺮ ﺗــﺮ 6ﻗﻮﻳﺘﺮﻳﻦ ﭘﻴﺶﺑﻴﻨﻲ ﻛﻨﻨــﺪ 8ﻧﺎﺗﻮﻧﻲ ﺑﻴﻤــﺎ +ﻣﺒﺘﻼ ﺑﻪ ﻛﻤﺮ ﺣﺎ ،ﻣﺎ 8ﺑﻌﺪ ﻣﺮﺟﻌﻪ ﺑﺮ ﻣﺎ+ ﺑﻮ 8ﺳــﺖ) .(7ﺑﻪ ﻋﻼ 8ﺑﻴﻤﺎ +ﻣﺒﺘﻼ ﺑﻪ ﻛﻤﺮ ﺣﺎ ﺑﺴﺘﻪ ﺑﻪ ﺷــﻐﻞ ،ﺑﻌﺪ ﻛﻨﺘﺮ ﺷﺪ) ،ﻧﺎﺗﻮﻧﻲ ﻧﻮ rﻣﺎ +ﻳﺎﻓﺖ ﺷﺪ ،8ﺑﺎﻫﺎ ﺣﺘﺮ ﺗﺮ ﭘﻴﺶﺑﻴﻨﻲ 4ﻫﻔﺘﻪ ﻧﺎﺗﻮﻧﻲ ﺑﻪ ﻃﻮ ﻗﺎﺑﻞﺗﻮﺟﻬﻲ ،ﺑﻬﻴﻨﻪ ﻧﻤﻮ).(6 ﻣﺪ ﺣﺘﺮ ﺗﺮ 7ﻣﺰﻣﻦ ﺗﻮﺳﻂ Lethemﻫﻤﻜﺎﻧﺶ ) (1983ﻣﻌﺮﻓﻲ ﺷﺪ؛ ﺑﺮ ﺗﻮﺿﻴﺢ ﻳﻨﻜﻪ ﭼﺮ ﺑﻌﻀﻲ >ﺳﻴﺐﻫﺎ ﻋﻀﻼﻧﻲ ـ ﺳﻜﻠﺘﻲ ﻣﻲﺗﻮﻧﻨﺪ ﻣﻨﺠﺮ ﺑﻪ ﻃﻮﻻﻧﻲ ﻣﺪ) ،ﻓﺴﺮﮔﻲ ﻧﺎﺗﻮﻧﻲ ﺷﻮﻧﺪ Valeyen .ﻫﻤﻜﺎﻧﺶ ) (199۵ﻣﺪ F-A ﺑﻪ ﻃﻮ ﻛﺎﻣﻞ ﺷــﺮ 8 jﺑﻪ ﻳﻦ ﻣﻄﻠﺐ ﺷﺎ 8ﻛﺮﻧﺪ ﻛﻪ ﺗﺮ ﺣﺮﻛﺖ> /ﺳــﻴﺐ )ﻣﺠﺪ( ،ﭘﺎﺳﺨﻲ ﺑﻪ ﻧﺸﺎ +ﻣﻲﻫﺪ ﻛﻪ ﺗﺤﺖ ﺗﺄﺛﻴﺮ ﻋﻘﺎﻳﺪ ﻓﻜﺎ ﻣﺨﺎﻃﺮ>8ﻣﻴﺰ 8ﻗﺮ ﻣﻲﮔﻴﺮ)) (9ﺷﻜﻞ .(1ﻳﻦ ﺗﺮ ﺑﻪ ﻓﺘﺎﻫﺎ ﺣﺘﺮ ﻋﺪ Oﻛﺎﺑﺮ ،9ﻓﺴــﺮﮔﻲ ﻧﺎﺗﻮﻧﻲ ﻣﺘﻌﺎﻗﺐ > +ﻛﻤﻚ ﻣﻲﻛﻨﺪ. ﺗﺮ ﺣﺮﻛﺖ /ﻫﺎ ﻋﻀﻼﻧﻲ ﺳﻜﻠﺘﻲ ﻳﻦ ﻣﺪ ﻧﺸــﺎ ﻣﻲﻫﺪ ﻛﻪ ﻣﺎﻧﻲﻛﻪ ،ﻏﻴﺮ ﺗﻬﺪﻳﺪ ﻛﻨﻨﺪ ﻗﻠﻤﺪ ﻣﻲﺷــﻮ ،ﻣﺮ& ﺗﻤﺎﻳﻞ ﻧﺪ ﻛﻪ ﺑﻪ ﻧﺠﺎ& ﻓﻌﺎﻟﻴﺖﻫﺎ! ﻣﺮ ﻣﻪ ﻫﻨﺪ .ﻣﻘﺎﺑﻞ ،ﻣﺎﻧﻲ ﻛﻪ ،ﻣﺨﺎﻃﺮ.ﻣﻴﺰ ﺗﻠﻘﻲ ﺷــﻮ ،ﻣﻲﺗﻮﻧﺪ ﻣﻨﺠﺮ ﺑﻪ ﺗــﺮ 5ﻓﺘﺎﻫﺎ! ﻣﻨﻴﺖﺟﻮﻳﺎﻧﻪ ﺷــﻮ .ﺣﻤﺎﻳﺖ ﻳــﻦ ﻣــﺪ ﻛﻪ .ﺗــﺮ 5ﺗــﺮ 5ﺣﺮﻛﺖ 1ﺑﺎ ﻫﻢ ﻃﺒﻘﻪﺑﻨﺪ! ﻣﻲﺷﻮﻧﺪ ،ﺣﺎ ﻓﺰﻳﺶ ﺳﺖ ) .(10ﺗﺮ 5ﺣﺮﻛﺖ ﻛﻪ ﺗﻮﺳــﻂ Koriﻫﻤﻜﺎﻧﺶ ) (11ﺳﺎ 1990ﻣﻌﺮﻓﻲ ﺷﺪ، ﻳــﻚ ﺗــﺮ 5ﺑﻴﺶ ﺣﺪ ،ﺑﻲﻣﻨﻄــﻖ ﻧﺎﺗﻮ ﻛﻨﻨــﺪ ﺣﺮﻛﺖ ﻓﻌﺎﻟﻴﺖ ﻓﻴﺰﻳﻜﻲ ﺑﻮ ﻛﻪ ﺣﺴﺎ. 5ﺳﻴﺐﭘﺬﻳﺮ! ﻧﺴﺒﺖ ﺑﻪ ﺻﺪﻣﻪ ﻳﺎ ﺻﺪﻣﻪ ﻣﺠﺪ ﻧﺎ Jﻧﺎﺷــﻲ ﻣﻲﺷــﻮ .ﺛﺎﺑﺖ ﺷﺪ ﻛﻪ ﺗﺮ 5 ﺣﺮﻛﺖ ﻧﺘﺎﻳﺞ ﺣﺎﺻﻠﻪ ﺗﻮﻧﺒﺨﺸــﻲ ﻋﻀﻼﻧﻲ ـ ﺳــﻜﻠﺘﻲ ﺗﺄﺛﻴــﺮ ﻣﻨﻔﻲ ) .(12ﻧﻘﺶ ﺗــﺮ 5ﺣﺮﻛﺖ ﺧﺘﻼﻻ O ﻋﻀﻼﻧﻲ ـ ﺳــﻜﻠﺘﻲ ﻣﻄﺎﻟﻌﺎ Oﻛﻤﺮ ﺣﺎ ) ،(1۴،13ﻛﻤﺮ ﻣﺰﻣﻦ ) (1۵،9-21ﺳــﻨﺪ& ﻓﻴﺒﺮﻣﻴﺎﻟﮋﻳﺎ ) (22،16ﺑﺮﺳــﻲ ﺷﺪ ﺳــﺖ .ﻫﻤﭽﻨﻴﻦ ﺗﺮ 5ﺣﺮﻛــﺖ ﮔﺮﻫﺎ! ﻳﮕﺮ ﺑﻴﻤﺎ ﻧﻴﺰ ﺑﺮﺳﻲ ﺗﻮﺻﻴﻒ ﺷﺪ ﺳﺖ).(23-27 86 ﻮ ﭘﺎﻳﻴﺰ 1391ﺷﻤﺎ ﻣﺴﻠﺴﻞ 53 ﺳﻴﺰﻫﻢ ﺷﻤﺎ ﺳﻮ ﺑﺤﺚ ﻧﺘﺎﻳﺞ ﻳﻦ ﻣﻄﺎﻟﻌﺎ Oﻧﻘﺶ ﺑﺴﺰﻳﻲ ﻛﻪ ﺗﺮ 5ﺣﺮﻛﺖ ﺗﻤﺪﻳﺪ ﻧﺎﺗﻮﻧﻲ ،ﺣﻤﺎﻳﺖ ﻣﻲﻛﻨﻨﺪ).(28 ﻣﻄﺎﻟﻌﺎ Oﺑﺎﻟﻴﻨﻲ ﻧﺸﺎ ﻣﻲﻫﻨﺪ ﻛﻪ ﺗﺮ 5ﺣﺮﻛﺖ. /ﺳﻴﺐ )ﻣﺠﺪ( ﻣﺨﺎﻃﺮ.ﻣﻴﺰ) 2ﺟﻬﺖﮔﻴﺮ! ﺑﺴــﻴﺎ ﻣﻨﻔﻲ ﻧﺴﺒﺖ ﺑﻪ ( ﻋﻠﺖﺷﻨﺎﺳــﻲ ﻛﻤﺮ ﻣﺰﻣﻦ ﻧﺎﺗﻮﻧﻲ ﻫﻤــﺮ ،.ﻫﻤﻴﺖ ﻧﺪ ).(6 , 12 ﻣﻄﺎﻟﻌﺎ Oﺧﻴﺮ ﻧﺸﺎ ﻣﻲﻫﺪ ﻛﻪ ﺗﺮ ، 5ﺑﺎ ﺗﻌﺎﺑﻴﺮ ﻣﺨﺎﻃﺮ.ﻣﻴﺰ ﺗﺒﺎ bﺗﻨﮕﺎﺗﻨﮓ .ﻳﺠﺎ ﻧﺎﺗﻮﻧﻲ ﻋﻤﻠﻜﺮ! ،ﻋﻼ ﺑﺮ ﺗﺮ5 ،ﺣﺘﻤﺎﻻً ﺷﺪ Oﻧﻴﺰ ﻧﻘﺶ ﻣﻬﻤﻲ ﻳﻔﺎ ﻣﻲﻛﻨﺪ).(29-33 ﻣﺠﻤﻮ ،eﻣﻄﺎﻟﻌﺎd Oﻛﺮ ﺷﺪ ﻧﺸﺎ ﻣﻲﻫﻨﺪ ﻛﻪ ﻓﻴﺰﻳﻮﺗﺮﭘﻴﺴﺖﻫﺎ ﺑﺎﻳــﺪ ﻫﻨﮕﺎ& ﺗﻮﻧﺒﺨﺸــﻲ ﺑﻌﻀﻲ ﻓﺮ ﻣﺒﺘﻼ ﺑــﻪ ﻋﻀﻼﻧﻲ ـ ﺳﻜﻠﺘﻲ ،ﺗﺮ 5ﻣﻮ ﻳﺎﺑﻲ ﻗﺮ ﻫﻨﺪ .ﺣﺎ ﺣﺎﺿﺮ، ﺷــﻮﻫﺪ ﺟﺎﻟﺒﻲ ﻣﺒﻨﻲ ﺑــﺮ ﻳﺎﺑﻲ ﺗــﺮ 5ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻛﻤﺮ) ،(3-3۴،18،8-39ﻣﺒﺘﻼﻳﺎ ﺑﻪ ﺳــﻨﺪ& ﺧﺴﺘﮕﻲ ﻣﺰﻣــﻦ) (37ﺟــﻮ .ﻫﻤﭽﻨﻴﻦ ﺷــﻮﻫﺪ ﻣﻘﺪﻣﺎﺗﻲ ﺑﺮ! ﭼﻨﻴﻦ ﭘﺪﻳﺪ! ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻧﻮ) (2۵ﮔﺮ) (39،38ﺟﻮ .ﻧﻈﺮ ﮔﺮﻓﺘﻦ ﻳﻦ ﻧﻜﺘﻪ ﻣﻬﻢ ﺳــﺖ ﻛﻪ ﺑﺮﺳﻲ ﺗﺮ 5 ﭼﻴﺰ! ﺑﻴﺸــﺘﺮ ﺗﻜﻴﻪ ﺑﺮ ﻣﻌﺎﻳﻨﻪ ﺷــﻬﻮ ﺑﺎﻟﻴﻨﻲ ﺳﺖ .ﻧﺸﺎ ﺷــﺪ ﻛﻪ ﺳﺘﻔﺎ ﭘﺮﺳــﺶﻧﺎﻣﻪﻫﺎﻳﻲ ﻛﻪ ﺗﻮﺳﻂ ﺧﻮ ﺑﻴﻤﺎ ﭘﺎﺳﺦ ﻣﻲﺷــﻮﻧﺪ 3ﺑﺮ! ﭘﻴﺶﺑﻴﻨﻲ ﻓﺸــﺎ ﻧــﻲ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻛﻤﺮ ،ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﻗﻀﺎ Oﺑﺎﻟﻴﻨﻲ ﺟﺮﺣﺎ ﺳﺘﻮ ﻓﻘﺮ(۴0)O ﻳﺎ ﻓﻴﺰﻳﻮﺗﺮﭘﻴﺴﺖﻫﺎ) ،(۴1ﻗﺖ ﺑﻴﺸﺘﺮ! ﺑﺮﺧﻮﻧﺪ. ﺧﻮﺷــﺒﺨﺘﺎﻧﻪ ،ﭼﻨﻴﻦ ﭘﺮﺳــﺶﻧﺎﻣﻪﻫﺎﻳﻲ ﻣﻌﺘﺒﺮ. ،ﻣﺎ ﺳﺘﺮ5 ﺑﻮ ﺑﻪ ﻧﻈﺮ ﻣﻲﺳــﺪ ۴ﭘﺮﺳــﺶﻧﺎﻣﻪ ﻣﺮﺑﻮ bﺑﻪ ﺗﺮ 5ﺑﻪ ﻃﻮ ﻣﻌﻤﻮ ﻣﻮ ﺳــﺘﻔﺎ ﻗﺮ ﻣﻲﮔﻴﺮﻧﺪ : :ﭘﺮﺳﺶﻧﺎﻣﻪ ﺗﺮ5 ،((FPQ-III ۴ﻛﻪ ﺗﺮ 5ﺷــﺮﻳﻄﻲ ﻛﻪ ﺑﻪ ﻃﻮ ﻃﺒﻴﻌﻲ ﻣﻨﺠﺮ ﺑﻪ ﺑﺮ ﻣﻲﺷــﻮﻧﺪ ،ﻳﺎﺑــﻲ ﻣﻲﻛﻨﺪ)(۴2؛ &، ﭘﺮﺳــﺶﻧﺎﻣﻪ ،۵TSKﻛﻪ ﺗﺮ 5ﻣﺮﺑﻮ bﺑﻪ ﺣﺮﻛﺖ ﻧﺎ ،Jﻓﻌﺎﻟﻴﺖ ﻓﻴﺰﻳﻜﻲ .ﺳــﻴﺐ ﻣﺠﺪ ﻳﺎﺑﻲ ﻣﻲﻛﻨﺪ) .(20ﻳﻦ ﭘﺮﺳﺸــﻨﺎﻣﻪ ﺷﺎﻣﻞ . 17ﻳﺘﻢ 4ﻣﺘﻴﺎ! ﺑﺎ ﺣﺪﻛﺜﺮ ﻣﺘﻴﺎ 68ﺑﻮ ﻛﻪ ﻣﺘﻴﺎ ﺑﺎﻻﺗﺮ ﻧﺸــﺎ ﻫﻨﺪ ﺗﺮ 5ﺑﻴﺸﺘﺮ ﻧﺴﺒﺖ ﺑﻪ ﺣﺮﻛﺎ. /Oﺳﻴﺐ ﻣﺠﺪ ﺳــﺖ .ﻣﻄﺎﻟﻌﺎ Oﻳﺎ! TSKﺑﺮ! ﻳﺎﺑﻲ ﺗﺮ 5ﺣﺮﻛﺖ .ﺳﻴﺐ )ﻣﺠﺪ( ﺳــﺘﻔﺎ ﻛﺮﻧﺪ) (2۵،18 ،28 ،۴3،39،37-۴9 7 ﻣﻄﺎﻟﻌﺎ Oﻣﺘﻌﺪ!) (۴ ، ٩ ، ٢٠، ۵0ﻋﺘﺒﺎ) 6ﻳﻌﻨﻲ ﻋﺘﺒﺎ ﻣﻔﻬﻮﻣﻲ ﻋﺘﺒﺎ ﭘﻴﺶﺑﻴﻨﻲ ﻛﻨﻨﺪ (8ﺗﻜﺮﭘﺬﻳﺮ!) 9ﻳﻌﻨﻲ ﺛﺒﺎ Oﻧﻲ 10 ﺗﻜﺮﭘﺬﻳﺮ! ﻓﻌﺎ. Oﻣﻮ (11ﻳﻦ ﭘﺮﺳﺶﻧﺎﻣﻪ ﺗﺄﻳﻴﺪ ﻛﺮﻧﺪ. ﺿﻤﻦ ﺟﺎﻣﻌﻪﻳﺮﻧﻲ Jafari ،ﻫﻤﻜﺎ ﺳــﺎ 2008ﺑﻪ ﺑﺮﺳﻲ ﺧﺼﻮﺻﻴﺎ Oﺳﻨﺠﻲ ﺳﺎﮔﺎ! ﻓﺮﻫﻨﮕﻲ ﭘﺮﺳﺶﻧﺎﻣﻪ TSKﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻛﻤﺮ ﭘﺮﺧﺘﻨﺪ).(۵1 ﺳــﻮ& ،ﻣﻌﻴﺎ ﻧﺸﺎﻧﮕﺎ ﻧﮕﺮﻧﻲ ،(PASS) 12ﻛﻪ ﺗﺮ 5 ﺣﻮﻫﺎ! ﺷــﻨﺎﺧﺘﻲ ،ﻓﺘﺎ! ﻓﻴﺰﻳﻮﻟﻮژﻳﻜﻲ ﻣﺆﺛﺮ ﻳﺎﺑﻲ 13 ﻣﻲﻛﻨــﺪ)(52؛ ﭼﻬﺎ& ،ﭘﺮﺳــﺶﻧﺎﻣﻪ ﺑﺎﻫﺎ! ﺣﺘــﺮ! ﺗﺮ5 ) (FABQﻛــﻪ ﺗﺮ 5ﻣﺮﺑﻮ bﺑــﻪ ﺣﺮﻛﺖ ،ﻓﻌﺎﻟﻴﺖ ﻓﻴﺰﻳﻜﻲ .ﺳــﻴﺐ ﻣﺠﺪ ﻳﺎﺑﻲ ﻣﻲﻛﻨﺪ). FABQ 16 .(۵ﻳﺘﻢ ﺷــﺘﻪ ﻛــﻪ ﻫﺮ ﻳﻚ ﺑﻴﻦ 0ﺗــﺎ 6ﻣﺘﻴﺎ ﺑﻪ ﺧﻮ ﺧﺘﺼــﺎ rﻣﻲﻫﻨﺪ ﻧﻤﺮ Oﺑﺎﻻﺗﺮ ﻧﺸــﺎ ﻫﻨﺪ ﺳﻄﻮ sﺑﺎﻻﺗﺮ ﺑﺎﻫﺎ! ﺣﺘﺮ! ﺗﺮ5 ﺳــﺖ .ﻣﻄﺎﻟﻌــﺎ Oﻳﺎ! FABQﺑــﺮ! ﻳﺎﺑﻲ ﺑﺎﻫﺎ! ﺣﺘﺮ! ﺗﺮ 5ﺳﺘﻔﺎ ﺷﺪ ﺳﺖ ) .(3۴،31-۵3،۴8،36-۵۵ﻳﻦ ﭘﺮﺳــﺶﻧﺎﻣﻪ ﺷــﺎﻣﻞ 2ﺧﺮ ﻣﻘﻴﺎ 1۴5ﺑﻮ ،ﺧﺮﻣﻘﻴﺎ 5ﺷــﻐﻠﻲ 1۵ FABQﻛــﻪ . 7ﻳﺘــﻢ )ﺑﺎ ﻧﻤﺮ 0ﺗــﺎ (۴2ﺧﺮﻣﻘﻴﺎ5 ﻓﻌﺎﻟﻴــﺖ ﻓﻴﺰﻳﻜﻲ 16 FABQﻛﻪ . 4ﻳﺘــﻢ )ﺑﺎ ﻧﻤﺮ 0ﺗﺎ .(2۴ ﺗﺎﻛﻨﻮ ﻣﻄﺎﻟﻌﺎ Oﻣﺘﻌﺪ! ﺗﻜﺮﭘﺬﻳــﺮ! ﻗﺎﺑﻞ ﻗﺒﻮﻟﻲ ﻣﻌﻴﺎﻫﺎ! FABQﮔﺰ uﻧﻤﻮﻧﺪ ).(۵6،۵-۵8 ﻋﺘﺒﺎ ﻳﻦ ﭘﺮﺳــﺶﻧﺎﻣﻪ ﺑــﺎ ﺗﻮﻧﺎﻳﻲ .ﭘﻴﺶﺑﻴﻨــﻲ ﻧﺎﺗﻮﻧﻲ 3- Self-report Questionnaires 4- The fear of pain Questionnaire 6- Validity 7- Construct validity 10- Internal Consistency 11- Test-retest reliability 13- The fear-avoidance Beliefs Questionnaire 16- FABQ physical activity subscale 1- Kinesiophobia 2- Pain catastrophizing 5- The Tampa Scale of Kinesiophobia 8- Predictive validity 9- Reliability 12- The Pain Anxiety Symptom Scale 14- Scale 15- FABQ work subscale ﺑﻬﻨﺎ ﺧﺒﺎ ﻫﻤﻜﺎ )2- Photograph Series of Daily Activities (PHODA 4- Straight Leg Raising 1- Behavioral Avoidance )3- Short Electronic Version (PHODA-SeV 87 ﺳﻮ ﭘﺎﻳﻴﺰ 1391ﺷﻤﺎ ﻣﺴﻠﺴﻞ 53 ﺳﻴﺰﻫﻢ ﺷﻤﺎ ﻮ ﺳــﺖ ﺷــﻐﻞ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻛﻤﺮ ﺛﺒﺎ ﺷﺪ ﺳﺖ ) .(58،34،6ﮔﺮﻫﻲ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻛﻤﺮ ﻛﻪ ﻛﻤﺮﺷﺎ ﺑﺴــﺘﻪ ﺑﻪ ﺷﻐﻞ ﻧﺒﻮ ،ﻣﻌﻴﺎ ﺷــﻐﻠﻲ FABQﻣﻘﺎﻳﺴﻪ ﺑﺎ ﻣﻌﻴﺎ ﻓﻌﺎﻟﻴﺖ ﻓﻴﺰﻳﻜﻲ ،FBAQﻗﺎﺑﻠﻴﺖ ﭘﻴﺶﺑﻴﻨﻲ ﺑﻬﺘﺮ ,ﺑﺮ ,ﻧﺘﺎﻳﺞ 6 ﻣﺎﻫﻪ ﺑﺮﺧﻮ ﺑﻮ) .(۵3ﭘﮋﻫﺸــﮕﺮ ﭘﻲ ﺑﺮﻧﺪ ﻛﻪ ﻣﻌﻴﺎ ﺷﻐﻠﻲ FBAQﺑﺎ ﺳــﺖ ﺷــﻐﻞ ﻧﺎﺗﻮﻧﻲ ﻓﻌﻠﻲ @ﻳﻨﺪ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻛﻤﺮ ﻣﺰﻣﻦ ) (۵9،۵،۴ﻛﻤﺮ ﺣﺎ) (6ﻣﺮﺗﺒﻂ ﺳﺖ. III-PASS, TSK, FPQﺑﺮ ,ﻃﻴﻒ ﺳــﻴﻌﻲ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻫﺎ ,ﻋﻀﻼﻧﻲ ـ ﺳﻜﻠﺘﻲ ﻣﻨﺎﺳﺐ ﺑﻮ ،ﺣﺎﻟﻲﻛﻪ FABQ ﻣﺨﺘﺺ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻛﻤﺮ ﺳﺖ).(60 ﻣﻄﺎﻟﻌﺎ ﺧﻴﺮ ﻧﺸﺎ ﻣﻲﻫﻨﺪ ﻛﻪ ﺟﺎﻣﻌﻴﺖ ،ﺣﺴﺎﺳﻴﺖ ﺗﻤﺮﻛﺰ ﻳﻦ ﺑﺰﻫﺎ ,ﻧﺪﮔﻴﺮ ,ﻗﺎﺑﻞ ﺗﻘﺎﺳﺖ ﺗﻤﺎﻳﺰ ﻗﺎﻳﻞ ﺷﺪ ﺑﻴﻦ ﺗﺮR ،ﺗﺮ@ Rﺳﻴﺐ ﻣﺠﺪ ،ﺗﺮ Rﺣﺮﻛﺖ ،ﺗﺮ Rﺗﻤﺮﻳﻨﺎ ﺗﻮﻧﺒﺨﺸﻲ ﺗﺮ Rﻓﻌﺎﻟﻴﺖ )ﺑﺮ ,ﻣﺜﺎ Tﻓﻌﺎﻟﻴﺖ ﺷﻐﻠﻲ( ﻃﻮT ﻫﺎ ,ﻣﻲﺗﻮﻧﺪ ﻳﻦ ﺑﻄﻪ ﻣﻔﻴﺪ ﻗﻊ ﺷــﻮ) .(61ﺑﺮ, ﻣﺜﺎ FABQ Tﺑﺎﻫﺎ ,ﺣﺘﺮ ,ﺗﺮ Rﻣﻮ ﻓﻌﺎﻟﻴﺖ ﻓﻴﺰﻳﻜﻲ ﻛﺎ ﻣــﻮ ﻳﺎﺑﻲ ﻗﺮ ﻣﻲﮔﻴﺮ ﻫﻴﭻ ﻧﺪﮔﻴﺮ ,ﺿﺤﻲ ﻣﻮ ﺗﺮ Rﺟﻮ ﻧﺪ .ﺑﺎ ﻳﻨﺤﺎ Tﻏﻠﺐ ﻳﻦ ﭘﺮﺳﺸﻨﺎﻣﻪ ﺑﺮ ,ﺑﺮﺳﻲ ﻳﮕﺮ ﻧﻮ^ ﺗﺮ Rﺳﺘﻔﺎ ﻣﻲﺷﻮ .ﻫﻤﭽﻨﻴﻦ TSK 2ﺧﺮ ﻣﻘﻴﺎ Rﺗﺸﻜﻴﻞ ﺷﺪ ﻛﻪ ﻳﻜﻲ @ﻧﻬﺎ ﺟﺘﻨﺎ_ ﻓﻌﺎﻟﻴﺖﻫﺎ ﺑﺮﺳــﻲ ﻧﻤﻮ ﻳﮕــﺮ ,ﻋﻘﺎﻳﺪ ,ﻛﻪ ﻧﺸــﺎ ﻫﻨﺪ ﺗﺮ R @ﺳــﻴﺐ ﻣﺠﺪ ﻫﺴــﺘﻨﺪ ﻣﻮ ﻳﺎﺑﻲ ﻗﺮ ﻣﻲﻫــﺪ .ﻣﺎ ﻳﻦ ﻣﻘﻴﺎ Rﺑﺠﺰ @ﻳﺘﻢ ﻛﻪ ﻣﺨﺼﻮ cﻓﻌﺎﻟﻴﺖ a/ﺳــﺖ ،ﺳــﺎﻳﺮ @ﻳﺘﻢﻫﺎ ﺑﺠﺎ ,ﺗﺮRﻫﺎ ,ﻓﺮ ،,ﻋﻘﺎﻳﺪ ﻋﻤﻮﻣﻲ ﻣﻲﺳﻨﺠﻨﺪ )ﺑﺮ, ﻣﺜــﺎ Tﻫﻴﭻ ﻛﺲ ﻧﺒﺎﻳــﺪ ﻣﺎﻧﻴﻜﻪ ،ﻓﻌﺎﻟﻴــﺖ ﻛﻨﺪ( .ﺑﻨﺎﺑﺮﻳﻦ ﻣﻤﻜﻦ ﺳــﺖ ﭼﻨﻴﻦ @ﻳﺘﻢﻫﺎﻳﻲ ﺗﻮﺳﻂ ﻓﺮ ﺗﺄﻳﻴﺪ ﺷﻮﻧﺪ ،ﺣﺎﻟﻴﻜﻪ ﺣﺴــﺎ Rﺗﺮ ،Rﺟﺘﻨﺎ_ ﻳــﺎ @ﻧﻬﺎ ﺟﻮ ﻧﺪ .ﻣﺤﺪﻳﺖ ﻳﮕﺮ ﻳﻦ ﭘﺮﺳﺸــﻨﺎﻣﻪ ﻳﻦ ﺳﺖ ﻛﻪ ﻣﻮ ﻓﻌﺎﻟﻴﺖﻫﺎ ﻳﺎ ﺣﺮﻛﺎ ﺧﺎﺻﻲ ﻛﻪ ﺷــﺨﺺ @ﻧﻬﺎ ﻣﻲﺗﺮﺳﺪ ﻳﺎ ﺟﺘﻨﺎ_ ﻣﻲﻛﻨﺪ ،ﻃﻼﻋﺎﺗﻲ ﺑﺪﺳــﺖ ﻧﻤﻲﻫﺪ .ﺑﻨﺎﺑﺮﻳﻦ ﻣﻤﻜﻦ ﺳــﺖ ﻓﺮ TSK ,ﻧﻤﺮ ﭘﺎﻳﻴــﻦ @ ﻣﺎ ﻫﻤﭽﻨﺎ ﻧﺴــﺒﺖ ﺑﻪ ﻳﻜﺴــﺮ ,ﺣــﺮﻛﺎ ﺧﺎ،c ﺑﺎﻫﺎ ,ﺗﺮ @ Rﺷــﺘﻪ ﺑﺎﺷــﺪ .ﻋﻼ ﺑﺮ ﻧﺪﮔﻴﺮ ,ﺗﺮ R ﻳﻦ ﻣﺸــﻜﻞ ﺟــﻮ ﻛﻪ ﺑﻪ ﻋﻠﺖ ﺗﺒــﺎ jﺑﻴﻦ ﺣﺮﻛﺖ ،ﻛﺴﺐ ﭼﻨﻴﻦ ﺗﺮRﻫﺎﻳﻲ ﻧﺎﺧﻮ@ﮔﺎ ﺑﺎﺷﺪ .ﻳﻦ ﺑﺪﻳﻦ ﻣﻌﻨﺎﺳﺖ ﻛﻪ ﭘﺮﺳﺸــﻨﺎﻣﻪﻫﺎ ﻣﻲﺗﻮﻧﻨﺪ ﺗﺮ Rﻧﺎﺧﻮ@ﮔﺎ ﻛﻤﺘﺮ ﺑﺮ@ ﻧﻤﻮ ﻳﺎ ﺑﺎ ﺷــﺘﺒﺎ ﮔﺮﻓﺘﻦ ﺗــﺮ Rﺑﺎ ﺑﺎﻫﺎ ,ﻋﻤﻮﻣﻲ ﺳــﻼﻣﺘﻲ @ ﺑﻴــﺶ ﺣﺪ ﺑﺮ@ ﻛﻨﻨﺪ .ﻣﺎﻧﻲ ﻛﻪ ﺑﻴﻤﺎ ﺗﺮ Rﺧﻮ @ﮔﺎﻫﻲ ﻧﺪﻧﺪ ،ﻧﺪﮔﻴﺮ ,ﺿﺢ ﻣﺸــﺨﺺ ﺟﺘﻨﺎ_ ﻓﺘﺎ 1,ﻣﻲﺗﻮﻧﺪ ﺗﺮﻛﻴﺐ ﺑﺎ ﭘﺮﺳﺸﻨﺎﻣﻪﻫﺎ ﻣﻔﻴﺪ ﺑﺎﺷﺪ. ﻫــﺮ ﭘﺮﺳﺸــﻨﺎﻣﻪ FABQ TSKﻛﺎﺑــﺮ ﺳــﻴﻌﻲ ﺷــﺘﻪ ﺣﺎﻟﻲﻛﻪ ﺑﺨﺸــﻲ ﻳﺎﻓﺘﻪﻫﺎ@ ,ﻧﻬﺎ ﻣﺘﻨﺎﻗﺾ ﻣﻲﺑﺎﺷــﻨﺪ .ﻟﺬ ﺑﺎﻳﺪ ﺣﺴﺎﺳﻴﺖ @ﻧﻬﺎ ﻧﺴﺒﺖ ﺑﻪ ﭘﺎﺳﺦﻫﺎ ,ﺑﻴﻤﺎ ﺗﻘﺎ ).(61 ﻳﻚ ﻧﻮ^ ﻧﺪﮔﻴﺮ ,ﻣﻔﻴﺪ ﻳﮕﺮ ﺑﺮ ,ﺗﺮ Rﺣﺮﻛﺖ ﻓﻌﺎﻟﻴﺖﻫﺎ ﺳــﺘﻔﺎ ﻣﺠﻤﻮﻋﻪ ﻋﻜﺲﻫﺎ ,ﻓﻌﺎﻟﻴﺖﻫﺎ ,ﻧﻪ 2ﺳــﺖ .ﻳﻦ aﺑﺰ ,ﺑﺮ ,ﺗﻌﻴﻴﻦ ﻣﻴﺰ ﻳﺎﺑﺨﺸــﻲ ﻓﻌﺎﻟﻴﺖﻫﺎ ,ﻣﺮ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻛﻤﺮ ﻣﺰﻣﻦ ﻣﻲﺑﺎﺷﺪ .ﻳﻦ aﺧﺼﻮﺻ ًﺎ ,ﻗﻀﺎﻫﺎ ,ﺑﻴﻤﺎ ﻣﻮ ﻧﺘﺎﻳﺞ ﻳﺎ ﺑﺎ ﺣﺮﻛﺎ/ﻓﻌﺎﻟﻴﺖﻫﺎ ﻛﻪ ﻫﺮ ﺗﺼﻮﻳﺮ ﻧﺸﺎ ﺷﺪ ﺳﺖ ،ﺗﻤﺮﻛﺰ ﻣﻲﺷﻮ .ﺧﻴﺮ ً ﻳﻚ ﻧﻮ^ ﻟﻜﺘﺮﻧﻴﻜﻲ ﻛﻮﺗﺎ @ 3ﺗﻮﻟﻴﺪ ﺷــﺪ ﺳﺖ .ﻳﻦ ﺑﺰ ﺷﺎﻣﻞ ۴0 ﺗﺼﻮﻳــﺮ ﺑﻮ ﻛﻪ ﻓﻌﺎﻟﻴﺖﻫﺎ ,ﻣﺨﺘﻠﻒ ﺟﻤﻠﻪ ﺑﻠﻨﺪ ﻛﺮ ﺷــﻴﺎء، ﺧﻢ ﺷــﺪ ،ﭼﺮﺧﻴﺪ ،ﺑﻪ ﺳــﻮ ,ﭼﻴﺰ ,ﺳــﺖ ﻛﺮ @ ﺑﺮﺷــﺘﻦ ،ﻓﺘﺎ ،ﺑﺎ ﻣﺘﻨﺎ_ ،ﺣــﺮﻛﺎ ﻧﺎﮔﻬﺎﻧﻲ ،ﺑﺎ ﻃﻮﻻﻧﻲ ﻣﺪ ﺣﺎﻟﺖ ﻳﺴــﺘﺎ ﻳﺎ ﻧﺸﺴﺘﻪ ﻧﺸﺎ ﻣﻲﻫﻨﺪ .ﺷﺨﺺ ﺑﺎﻳﺪ ﺣﺎﻟﻲﻛﻪ ﺧﻮ aﺣﺎ Tﻧﺠﺎ sﻫﻤﺎ ﺣﺮﻛﺎ ﺗﺼﻮ ﻣﻲﻛﻨﺪ، ﺑﻪ ﻫــﺮ ﺗﺼﻮﻳﺮ ) 0ﺑﻲﺿﺮ( ﺗﺎ ) 100ﺷــﺪﻳﺪ ً ﻣﻀﺮ( ﻧﻤﺮ ﻫﺪ. ﻧﻬﺎﻳﺖ ﻳﻚ ﺗﺒﻪﺑﻨﺪ ,ﺷــﺨﺼﻲ ﻣﻮ ﺗﺮ Rﻳﻦ ﻓﻌﺎﻟﻴﺖﻫﺎ ﺑﻪ ﺳﺖ ﻣﻲ@ﻳﺪ .ﻳﻦ aﺧﺼﻮﺻﻴﺎ ﺳﻨﺠﻲ ﺧﻮﺑﻲ ﺷﺘﻪ )ﺗﻜﺮﭘﺬﻳــﺮ ,ﻓﻌﺎ @ﻣﻮ ،ﺛﺒﺎ ،ﻋﺘﺒــﺎ ﻣﻔﻬﻮﻣﻲ ﺛﺒﺎ ﻧﻲ( ﻣﻘﺎﻳﺮ ﺳﺘﺎﻧﺪ @ ﻳﻪ ﺷﺪ ﺳﺖ) .(61ﭘﮋﻫﺶﻫﺎ, @ﻳﻨﺪ ﺑﺎﻳﺪ ,ﺗﻔﻜﻴﻚ ﭘﺎﺳﺦﻫﺎﻳﻲ ﻛﻪ ﺑﻪ ﺗﺼﺎﻳﺮ ﻣﻲﺷﻮ ، ﻣﻮ ﺗﺮ) Rﭼﻘﺪ ﻧﺠﺎ sﻳﻦ ﺣﺮﻛﺖ ﻣﻲﺗﺮﺳــﻴﺪ؟( ،ﺗﺨﺼﻴﺺ )ﻳﻦ ﺣﺮﻛﺖ ﭼﻪ ﻣﻘﺪ ﺷﻤﺎ ﻳﺠﺎ ﻣﻲﻛﻨﺪ؟( ﺟﺘﻨﺎ_ )ﭼﻪ ﺗﻌﺪ ﻳﻦ ﺣﺮﻛﺖ ﺟﺘﻨﺎ_ ﻣﻲﻛﻨﻴﺪ؟( ﺗﻤﺮﻛﺰ ﻛﻨﻨﺪ. ﻧﺪﮔﻴﺮ ,ﺟﺘﻨﺎ_ :ﭘﮋﻫﺶﻫﺎ ﺑﺎﻳﺪ ,ﻧﺪﮔﻴﺮ ,ﺑﻬﺘﺮ ﻣﻴﺰ ﺟﺘﻨﺎ_ ﻧﻴﺰ ﺗﻤﺮﻛﺰ ﻛﻨﻨــﺪ .ﺗﺎﻛﻨﻮ aﻫﺎ ,ﻣﺘﻌﺪ ,ﺑﺮ ,ﻳﻦ ﻣﺮ ﺳــﺘﻔﺎ ﺷﺪ ﻛﻪ ﺷــﺎﻣﻞ ﺳــﻨﺠﺶ ﺣﺮﻛﺎ ﺧﺎ) cﻣﺜﻞ ﺑﻠﻨﺪ ﻛﺮ ﻣﺴــﺘﻘﻴﻢ ﭘﺎ ،(۴ﻓﻌﺎﻟﻴﺖﻫﺎ ,ﻳﺞ )ﻣﺜــﻞ ﻓﺘﻦ( ،ﮔﺰa ﻣﻴﺰ ﺟﺘﻨﺎ_ ﻓﻌﺎﻟﻴﺖﻫﺎ ,ﻧﻪ ﻛﻪ ﺗﻮﺳﻂ ﺗﺼﺎﻳﺮ ﻳﻪ ﺷﺪ )ﻣﺜﻞ ﺗﻮ ﻛﺮ( ﺷــﺮﻳﻂ ﻳﮕﺮ )ﻣﺜﻞ ﻣﺮﺧﺼﻲ ﻛﺎ( ﻣﻲﺑﺎﺷﻨﺪ. ﻣﺸــﺨﺺ ﻛﺮ ﻟﻴﻞ ﺑﻴﻤﺎ ﺑﺮ ,ﺟﺘﻨــﺎ_ ﻫﺮ ﻳﻚ ﻣﻮ ﻳﺎ ﺷــﺪ ﻳﻨﻜﻪ ﺟﺘﻨﺎ_ ﻫﺮ ﻳــﻚ ﻳﻦ ﻣﻴﻨﻪﻫﺎ ﭼﻄﻮ , ﺟﺘﻨﺎ_ ﺳﺎﻳﺮ ﻣﻮ ﺗﺄﺛﻴﺮ ﻣﻲﮔﺬ ،ﻣﻔﻴﺪ ﺧﻮﻫﺪ ﺑﻮ).(61 ﻣﺪ Tﺣﺘــﺮ ,ﺗﺮ (FAM) (12)Rﻳﻚ ﻳﻜﺮ ﻧﻈﺮ ,ﺑﻮ ﻛﻪ ﻣﺴــﻴﺮ ,ﺑﻴﻦ ﭘﺎﺳﺦﻫﺎ ,ﺷﻨﺎﺧﺘﻲ ﻓﺘﺎ ,ﻣﺮﺑﻮ jﺑﻪ ،ﻋﺪs ﻛﺎﺑﺮ ﻣﺰﻣﻦ ﻓــﺮ wﻣﻲﻛﻨﺪ) .(62ﻋﻼ ﺑﺮ ﻣﺪ Tﺣﺘﺮ, ﺗــﺮ ،Rﻳﻚ ﻣﺪ Tﻣﻜﻤﻞ ﺑﻪ ﻧﺎ sﻣــﺪ Tﺣﺘﺮ-,ﺗﺤﻤﻠﻲ ﻣﺰﻣﻦ ﺗﺮ ﺣﺮﻛﺖ /ﻫﺎ ﻋﻀﻼﻧﻲ ﺳﻜﻠﺘﻲ 88 ﻮ ﭘﺎﻳﻴﺰ 1391ﺷﻤﺎ ﻣﺴﻠﺴﻞ 53 ﺳﻴﺰﻫﻢ ﺷﻤﺎ ﺳﻮ ﺟﻮ .ﻳﻦ ﻣﺪ ﺳــﺘﻪ ﻓﺮ ﻧﺸﺎ ﻣﻲﻫﺪ ﻛﻪ ﺳﻌﻲ ﻣﻲﻛﻨﻨــﺪ ﺑﺎ ﻣﻨﺤﺮ $ﻛــﺮ ﺗﻮﺟﻪ ،ﺣﺲ ﻧﺎﻳــﺪ ﮔﺮﻓﺘﻪ ﻋﻠﻴﺮﻏــﻢ ﺟﻮ ﺷــﺪﻳﺪ ﺗﻤــﺎ -ﻓﻌﺎﻟﻴﺖﻫﺎ ﺧــﻮ ﺑﻪ ﭘﺎﻳﺎ ﺑﺮﺳــﺎﻧﻨﺪ )ﺗﺤﻤﻞ ﻓﺘــﺎ .(6۴،63) (1ﭘﺎﺳــﺦﻫﺎ ﺣﺘﺮ ﺗﺮ@ ﭘﺎﺳﺦﻫﺎ ﺗﺤﻤﻠﻲ ﻧﻘﺶ ﻣﻬﻤﻲ ﻣﻪ ﻳﺎﻓﺘﻦ ﻛﻤﺮ ﻳﻔﺎ ﻣﻲﻛﻨﻨــﺪ .ﻣﺪ ﺣﺘﺮ ـ ﺗﺤﻤﻠــﻲ (AEM) 2ﺑﺮ ﻣﻄﺮ Aﻛﺮ ﭘﺎﺳﺦﻫﺎ ﺗﺤﻤﻠﻲ ﺗﺪ ، -ﻛﻨﺎ ﭘﺎﺳﺦﻫﺎ ﺣﺘﺮ ﺗﺮ@ ﻃﺮAﻳﺰ ﺷﺪ ﺳــﺖ .ﭘﺮﺳﺶﻧﺎﻣﻪ ﺣﺘﺮ ـ ﺗﺤﻤﻠﻲ(AEQ) 3 ﺑــﻪ ﻋﻨﻮ ﻳﻚ Iﻧﺪﮔﻴﺮ ﻣﻌﺘﺒﺮ ﺗﻜﺮﭘﺬﻳﺮ ﺑﺮ ﻳﺎﺑﻲ ﻟﮕﻮ ﭘﺎﺳﺦﻫﺎ ﻣﺮﺑﻮ Kﺑﻪ ﺗﺤﻤﻞ ﭘﺎﺳﺦﻫﺎ ﺣﺘﺮ ﺗﺮ@ ﺑﻪ ﻣﻌﺮﻓﻲ ﺷﺪ ﺳﺖ).(۴8 ﻓﻴﺰﻳﻮﺗﺮﭘﻴﺴــﺖﻫﺎ ﻣﺪOﻫﺎ ﭘﻴﺶ ﻣﻲﻧﺴﺘﻪﻧﺪ ﻛﻪ ﻋﻮﻣﻞ ﻧﻲ ﻧﺘﻴﺠﻪ ﻣﺎ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﺧﺘﻼﻻ Oﻋﻀﻼﻧﻲ ـ ﺳﻜﻠﺘﻲ، ﺑﺨﺼﻮ Uﻛﻤﺮ ﺛﺮ ﻳﺎ ﻧﺪ .ﻋﻠﻴﺮﻏﻢ ﻳﻦ ﻧﺶ ،ﺑﻪ ﻧﺪO ﺗﻼ Iﻣﺸﺨﺼﻲ ﺑﺮ ﻣﺸﺨﺺ ﻛﺮ ﺗﺄﺛﻴﺮ Oﻧﻲ ﺑﻴﻤﺎ ﻣﺎ ﺑﺎﻟﻴﻨﻲ ﻣﻲﺑﻴﻨﻴﻢ).(6۵-67 ﮔﺬﺷﺘﻪ ،ﻳﻦ ﻣﺮ ﺑﻪ ﻟﻴﻞ ﻳﻦ ﺑﻮ ﻛﻪ ﺗﺄﺛﻴﺮ Oﻧﻲ ﺧﻴﻠﻲ ﻣﺒﻬﻢ ﺑﻮ ﻳﺎ ﻧﺪﮔﻴﺮ ]ﻧﻬﺎ ﺧﻴﻠﻲ ﺷــﻮ ﺑﻮ .ﺣﺎ ﺣﺎﺿﺮ ،ﻳﻦ ﻳﻜﺮ ﺑﺎ ﺗﻤﺮﻛــﺰ ﺗﺄﺛﻴﺮ Oﻧﻲ ﺧﺎ Uﻣﺜﻞ ﺗﺮ@ ، ﻛﻪ ﻣﻌﺘﺒﺮ ﻟﺤﺎ` ﺑﺎﻟﻴﻨﻲ ﺳﺘﺮ@ ﻫﺴﺘﻨﺪ ،ﺻﻼ Aﺷﺪ ﺳﺖ. ﺑﺮ ﻣﺜﺎ ﺑﻪ ﻣﻨﻈﻮ ﺗﻌﻴﻴﻦ ﺳﻄﻮ Aﺑﺎﻻ ﺗﺮ@ ﻛﻠﻴﻨﻴﻚ، ﻳﻚ ﻣﺘﻴﺎ ﻣﺮ ﺑﺮ FABQﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷــﺪ ﺳــﺖ)(3۴ ﻫﻤﭽﻨﻴــﻦ ﺑــﺮ ﺗﻌﻴﻴﻦ ﺟــﺎ Oﺑﺎﻻ ﺗــﺮ@ ﺣﺮﻛﺖ ،ﻳﻚ ﻧﻤﺮ ﻣﺮ ﺑﺮ TSKﺗﻌﻴﻴﻦ ﺷــﺪ ﺳﺖ) .(9ﺗﺤﻘﻴﻘﻲ ﻛﻪ ﺗﻮﺳﻂ Fahlstrom Branstromﺳــﺎ 2008ﻧﺠــﺎ -ﮔﺮﻓــﺖ، ﻧﺸﺎ ﻛﻪ ﻣﻤﻜﻦ ﺳﺖ ﻣﺘﻴﺎ Oﻣﺮ ﻣﻄﻠﻮ fﺑﺮ TSKﺑﻴﻦ ﺑﻴﻤﺎ ﻣﺮ ﺗﻔﺎ Oﺷﺘﻪ ﺑﺎﺷﺪ).(۴۴ ﻣﻄﺎﻟﻌــﺎ Oﻣﺨﺘﻠــﻒ ﻫﻜﺎﻫﺎ ﻣﺎﻧﻲ ﻣﺆﺛﺮ ﺑــﺮ ﺑﻴﻤﺎﻧﻲ ﻛــﻪ ﺳــﻄﻮ Aﺑــﺎﻻ ﺗــﺮ@ ﻧــﺪ ،ﺷــﺮ Aﺷــﺪ ﺳــﺖ) .(68،۵۴،۴3،39،37،18ﻛﺎﻫــﺶ ﺗﺮ@ ﺣﺮﻛﺖ ﺗﻮﺳــﻂ Iﻫﺎ ﻣﺎﻧﻲ ،ﺑﺎ ﻧﺘﺎﻳﺞ ﺗﻮﻧﺒﺨﺸــﻲ ﻣﺜﺒﺖ ﺟﻤﻠﻪ ﺑﺎﮔﺸــﺖ ﺑﻪ ﻛﺎ ﺗﺒﺎ Kﺳــﺖ I .ﻣﺎﻧﻲ ﭘﻴﺸــﺮﻓﺖ ﺗﺪﻳﺠﻲ ۴ ﻣﻌﺮ kﻣﺎﻧﻲ ۵ﻣﺴــﺘﻘﻴﻤ ًﺎ ﺑﺎ ﻣﺪ ﺣﺘــﺮ ﺗﺮ@ ﻣﺮﺗﺒﻄﻨﺪ ﺑﻨﺎﺑﺮﻳــﻦ ﭘﺎﻳﻪ ﻧﻈﺮ ﻗــﻮ ﻋﺘﺒﺎ ﺻﻮ ﺧﻮﺑــﻲ ﻧﺪ .ﻫﺪ$ ﻫﺮ ﻣﺎ ﺑﻬﺒﻮ ﻋﻤﻠﻜﺮ ﻃﺮﻳﻖ ﻓﻌﺎ ﺳــﺎ ﻣﺠﺪ ﺳــﺖ. Iﻣﻌﺮ kﻣﺎﻧﻲ ﺗﻜﻨﻴﻚﻫﺎ ﻣﺎﻧﻲ ﺷــﻨﺎﺧﺘﻲ ﺳﺘﻔﺎ ﺷــﺪ ،ﺣﺎﻟﻲ ﻛﻪ ﭘﻴﺸﺮﻓﺖ ﺗﺪﻳﺠﻲ ﺻﻮ ﻳﺎﮔﻴﺮ ﻋﺎﻣﻞ 3- Avoidance-Endurance Questionnaire ﺳــﺘﻔﺎ ﻣﻲﺷــﻮ .ﻫﺮ ﻣﺎ ﺷــﺎﻣﻞ ﻣﺮ ﺑﺮ ﻣﺸــﻜﻼ O ﻓﺘﺎﻫﺎ ،ﻫﺪ$ﮔﺬ ،ﺟﻠﺴــﺎ] Oﻣﻮﺷــﻲ ﺗﻮﻧﺒﺨﺸﻲ ﺗﻤﺮﻳﻦ ﻫﺴﺘﻨﺪ. ﻣﻌﺮ kﻣﺎﻧﻲ ﺷــﺎﻣﻞ ﻧﻤﺮ ﺑﻪ ﻓﺘﺎﻫﺎ ﻧﺎﺷــﻲ ﺗﺮ@ ﺑﻪ ﻧﺒﺎ ﻧﺠﺎ -ﻃﺒﻘﻪﺑﻨﺪ ﺷــﺪ ﻣﻨﻈﻢ ﻓﻌﺎﻟﻴﺖﻫﺎ ﺗﺤﺮﻳﻚﻛﻨﻨﺪ ﺗﺮ@ ،ﺗﺤﺖ ﻧﻈﺎ Oﻣﺎﻧﮕﺮ ﺳــﺖ .ﻣﻘﺎﺑﻞ ،ﭘﻴﺸﺮﻓﺖ ﺗﺪﻳﺠﻲ ﻫﺪ $ﻣﺎﻧﻲ ﻣﺮﺑﻮ Kﺑﻪ ﻓﻌﺎﻟﻴﺖﻫﺎ ﻋﻤﻠﻜﺮ ﺧﺎ Uﻛﻪ ﺑﻪ ﺧﺎﻃﺮ ﻣﺸﻜﻞ ﻣﺤﺪ ﺷﺪﻧﺪ ،ﺗﻤﺮﻛﺰ ﻣﻲﻛﻨﺪ .ﺑﻴﻤﺎ ﺑﺮ ﻃﺒﻖ ﻣﻴــﺰ ﺗﺤﻤﻠﻲ ﻛﻪ ﻧﺪ ﻓﻌﺎﻟﻴﺖﻫــﺎ ﺗﻨﻈﻴﻢ ﻧﻤﻮ ﺑﺪﻳﻦﺗﺮﺗﻴﺐ ﺑﻪ ﺳــﻤﺖ ﻫﺪ $ﺗﻌﻴﻴﻦ ﺷﺪ ﭘﻴﺸــﺮﻓﺖ ﻣﻲﻛﻨﻨﺪ .ﻋﻤﻞ ،ﻫﺮ Iﺑــﺮ ﻋﻘﺎﻳﺪ ﻣﺨﺎﻃﺮ]ﻣﻴﺰ ﺑﻴﻤﺎ ﭼﺎﻟﺶﻫﺎ ﺷــﻨﺎﺧﺘﻲ ﻳﺠﺎ ﻣﻲﺷــﻮ .ﻣﻌﺮ kﻣﺎﻧﻲ ﺑﻴﻤــﺎ ﻋﻮ Oﻣﻲﻛﻨﺪ ﻛﻪ ﻣﺴﺘﻘﻴﻤ ًﺎ ﻳﻦ ﺗﺮ@ﻫﺎ ﻣﺨﺎﻃﺮ]ﻣﻴﺰ ﺗﺒﺎ Kﺑﺎ ﺣﺮﻛﺎ OﺧﺎU ﮔﺰ Iﻳﻦ ﻋﻘﺎﻳﺪ ﺑﻌﺪ ﻧﺠﺎ -ﺣﺮﻛﺎ Oﻧﺎﺷﻲ ﺗﺮ@، ﻳﺎﺑﻲ ﻣﻲﻛﻨﺪ .ﭘﻴﺸﺮﻓﺖ ﺗﺪﻳﺠﻲ ﻏﻠﺐ ﻛﻤﺘﺮ ﭼﺎﻟﺶ ﻋﻘﺎﻳﺪ ﻣﺨﺎﻃﺮ]ﻣﻴــﺰ ﺗﻤﺮﻛــﺰ ﻧﻤﻮ ﻣــﺎ ﻣﻲﺗﻮﻧﺪ ﻃــﻮ ﻣﺎ، ﺟﻠﺴﺎ Oﻓﻴﺪﺑﻚ ﺑﺎ ﺗﻐﻴﻴﺮ ﻋﻮﻣﻞ ﺷﻨﺎﺧﺘﻲ ﺷﺘﻪ ﺑﺎﺷﺪ. ﺗﺎ ﺑﻪ ﻣﺮ ﺳﺘﻔﺎ ﻳﻦ ﻣﺪﺧﻼ Oﻣﻄﺎﻟﻌﺎ Oﻣﺤﺪ ﺻﻮO ﮔﺮﻓﺘﻪ ﻋﻠﺖ ﻋﻤﺪ ] ﻣﺤﺪﻳﺖﻫﺎ Iﺷﻨﺎﺧﺘﻲ ﻗﺎﺑﻞ ﺗﻮﺟﻪ ﺳﺖ .ﻣﻄﺎﻟﻌﻪ ﺑﻴﻤﺎ ﻛﻤﺮ ﻣﺰﻣﻦ ﻛﻪ ﺑﻪ ﻃﻮ ﺗﺼﺎﻓﻲ ﺗﺤﺖ ﻣﺎ ﭘﻴﺸــﺮﻓﺖ ﺗﺪﻳﺠﻲ ،ﻣﻌﺮ kﻣﺎﻧﻲ ﻳﺎ ﻟﻴﺴﺖ ﻧﺘﻈﺎ ﻗﺮ ﮔﺮﻓﺘﻪ ﺑﻮﻧﺪ ،ﻫﻴﭻ ﺗﻔﺎﺗﻲ ﻣﻘﺎﻳﺮ ﻧﺎﺗﻮﻧﻲ ﻣﺮﺑﻮ Kﺑﻪ ﻳﺎﻓﺖ ﻧﺸﺪ .ﻃﺮﻓﻲ ﺑﻪ ﻋﻠﺖ ﻳﻦ ﻣﺤﺪﻳﺖﻫﺎ )ﻧﻈﻴﺮ ﻛﻢ ﺑﻮ ﺗﻮ ﺑﻪ ﻋﻠﺖ ﻛﻮﭼﻚ ﺑﻮ ﺣﺠﻢ ﻧﻤﻮﻧﻪ ﻳﺎ ﺑﻮ ﻧﺮ rﻳﺰ(I ﻧﻤﻲﺗﻮ ﺑﻪ ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ ﻳﻦ ﻣﻄﺎﻟﻌﺎ Oﺳــﺘﻨﺎ ﻧﻤﻮ ﻳﻜﻲ ﻳﻦ Iﻫﺎ ﻧﺴﺒﺖ ﺑﻪ ﻳﮕﺮ ﺟﺢ ﻧﺴﺖ .ﻣﺎ ﻳﻦ ﻋﻘﻴﺪ ﺣﺎ ﮔﺴــﺘﺮ Iﺳﺖ ﻛﻪ ﻳﺎﻓﺘﻪﻫﺎ ﻣﺤﺪ ﺣﺎﺻﻞ ﻣﺪﺧﻼ Oﺗﺎ ﺑﻪ ﻣﺮ ،ﺑﻪ ﻋﻠﺖ ﻋﺪ -ﺷﻨﺎﺧﺖ ﻛﺎﻓﻲ ﻣﺪ ﺣﺘﺮ ﺗﺮ@ ﻧﺎﺷﻲ ﺟﻮ ﮔﺮﻫﺎ ﻓﺮﻋﻲ ﺟﻤﻌﻴﺖ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻫﺎ ﻋﻀﻼﻧﻲ -ﺳــﻜﻠﺘﻲ ﺳﺖ .ﺑﻨﺎﺑﺮﻳﻦ ﻧﻴﺎ ﻣﺒﺮ -ﺑﺮ ﺷﻨﺎﺧﺖ ﺑﻬﺘﺮ ﺑﻴﻤــﺎ ﻣﻌﺮ kﺧﻄﺮ ﺑﻬﺒﻮ ﻣﺪﺧﻼ Oﺗﻮﺳــﻂ ﻧﻄﺒﺎ tﺑﻬﺘﺮ ]ﻧﻬﺎ ﺑﺎ ﻧﻴﺎﻫﺎ ﺑﻴﻤﺎ ﺣﺴــﺎ@ ﻣﻲﺷــﻮ .ﻳﺎﻓﺘﻪﻫﺎ ﺟﺪﻳﺪ ﻧﺸــﺎ ﻣﻲﻫﺪ ﻛﻪ ﻣﻴﺎ ﺳــﺎﻳﺮ ﻋﻮﻣﻞ )ﻧﻈﻴﺮ ﻋﻮﻣﻞ ﺷﻐﻠﻲ ﺟﺘﻤﺎﻋﻲ ـ ﻗﺘﺼــﺎ( ﺧﺼﻮﺻﻴﺎ Oﺑﻴﻤﺎ ﺻﺮ $ﻧﻈﺮ ﻧﻮ uﻣﺎ ، ﻧﺘﺎﻳﺞ ﺗﺤﻘﻴﻘﺎ Oﺛﺮ ﻣﻲﮔﺬ) .(61ﻣﻪ ﺑﻪ ﺳــﻪ ﮔﺮ ﻋﻤﺪ ﻳﻦ ﺑﻴﻤﺎ ﺷﺎ ﺧﻮﻫﺪ ﺷﺪ. 2- Avoidance-endurance model 5- Exposure Therapy 1- Pain-related Behavioral Endurance 4- Graded Activity ﺑﻬﻨﺎ ﺧﺒﺎ ﻫﻤﻜﺎ ﻫﻤﺎﻃﻮﻛﻪ ﮔﻔﺘﻪ ﺷــﺪ ،ﺛﺎﺑﺖ ﺷــﺪ ﻛﻪ ﺗﺮ ﺣﺮﻛﺖ ﻣﻴﺎ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﻋﻀﻼﻧﻲ ـ ﺳــﻜﻠﺘﻲ ،ﻓﺎﻛﺘﻮ ﻣﻬﻤﻲ ﺑﻪ ﺷــﻤﺎ ﻣﻲ ./ﺑﻴﺸــﺘﺮ ﭘﮋ/ﻫﺶﻫﺎ -ﻛﻪ ﻣﻮ ﺑﻴﻤﺎ ﻧﺠﺎ +ﺷــﺪ ، ﺑﻄﻪ ﺑﺎ ﻋﺪ +ﻛﺎﺑﺮ ﺑﻮ ﺳــﺖ .ﻣﺎ ﻣﻮ ﺗﺄﺛﻴﺮ ﻋﻮﻣﻞ ﻣﺆﺛﺮ ﺑﺮ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﺻﺪﻣﺎ 9ﻧﺎﺷﻲ ﻛﺎﺑﺮ ﺑﻴﺶ ﺣﺪ 1ﻛﻪ ﻧﺘﻴﺠﻪ @/ﻳﺠﺎ ﺷﺪ ﺳﺖ ،ﻣﺪ> ﻛﻤﻲ /ﺟﻮ .ﻣﻄﺎﻟﻌﻪ -ﻛﻪ ﺧﻴﺮ ً ﻧﺠﺎ +ﺷــﺪ) ،(۴9ﻳﺪ ﺷﺪ ﻛﻪ /ﻗﻮ Aﺗﺮ ﺣﺮﻛﺖ ﻣﻴﺎ ﻳﻦ ﺑﻴﻤﺎ ﻳﺎ ﺑﻮ ﺳﺖ ﻣﺎ Kﻧﻬﺎ ﺑﺎ ﮔﺮ /ﻣﺮﺟﻊ )ﻛﻤﺮ ﻣﺰﻣﻦ( ﻳﻦ ﻣﻴﻨﻪ ﺗﻔﺎ/ﺗﻲ ﻧﺪﺷــﺘﻨﺪ .ﻧﺘﺎﻳﺞ ﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎ ﻣﻲﻫﺪ ﻛﻪ ﻣــﻮ ﻣﻔﺎﻫﻴﻢ ﻛﺎﺑــﺮ ،ﻛﺎﺑﺮ ﺑﻴﺶ ﺣــﺪ /ﻋﺪ +ﻛﺎﺑﺮ ﺗﺒﺎ Qﺑﺎ ﻣﺪ F-A Pﻧﻴﺎ ﺑﻪ ﺑﺮﺳﻲ ﺑﻴﺸﺘﺮ/ -ﺟﻮ . / Martelliﻫﻤﻜﺎ ) (69) (1999ﻣﻔﻬﻮ +ﺗﺮ ﺣﺮﻛﺖ ﺑﻪ ﺗﺮ ﺷــﻨﺎﺧﺘﻲ 2ﺗﻌﻤﻴﻢ ﻧﺪ .ﺗﺮ ﺷﻨﺎﺧﺘﻲ ﺑﻪ ﺻﻮ 9ﻳﻚ ﺗﺮ 3- Post-traumatic headache 6- Self-efficacy ﻧﺘﻴﺠﻪﮔﻴﺮ ﭘﺎﻳــﺎ ،ﺑﻪ ﻧﻈﺮ ﻣﻲﺳــﺪ ﻳﻦ ﻣﻴﻨﻪ ﭘﮋ/ﻫﺶ ﺑــﻪ ﻧﺪ ﻛﺎﻓﻲ ﭘﻴﺸﺮﻓﺖ ﻛﺮ ﺳــﺖ ﻛﻪ ﺑﮕﻮﻳﻴﻢ ﺑﺮ -ﺑﺮﺧﻲ ﺑﻴﻤﺎ ،ﺗﺮ ﻣﻲﺗﻮﻧﺪ ﺑﻪ ﻧﺪﺧﻮ ﻧﺎﺗﻮ ﻛﻨﻨﺪ ﺑﺎﺷﺪ ) .(60ﻣﺤﻘﻘﺎ / ﭘﮋ/ﻫﺸﮕﺮﻧﻲ ﻛﻪ ﺑﻪ ﻛﺎﻫﺶ ﺗﺄﺛﻴﺮ ﺟﺘﻤﺎﻋﻲ ﻋﻀﻼﻧﻲ ـ ﺳﻜﻠﺘﻲ ﻣﺰﻣﻦ ﻋﻼﻗﻪ ﻣﻨﺪ ﻫﺴﺘﻨﺪ ،ﺗﻌﺎﻣﻞ ﺑﺎ ﻳﻜﺪﻳﮕﺮ ﺑﺎﻳﺪ ﺑﺘﻮﻧﻨﺪ ﻋﻬﺪ ﻣﺎ ﺗﺄﺛﻴﺮ/ 9ﻧﻲ ﻣﺮﺑﻮﻃﻪ ﻣﺜﻞ ﺗﺮ ،ﺑﺮKﻳﻨﺪ .ﺗﻼ@ﻫﺎ- ﺳﺘﻪ ﺟﻤﻌﻲ ﺑﺮ -ﻣﺤﻘﻖ ﻛﺮ ﻣﻮ ﻳﺮ ﺣﻴﻄﻪ /ﺳﻴﻊ ﻫﺎ- ﻋﻀﻼﻧﻲ ـ ﺳﻜﻠﺘﻲ ،ﺿﺮ -/ﺳﺖ: 1ـ ﺻــﻼ uﺗﻜﻨﻴﻚﻫﺎ -ﺑﺮﺳــﻲ /ﻳﺎﺑﻲ ﻓﻌﻠﻲ ﺑــﻪ ﻃﻮ -ﻛﻪ ﺻﺤﻴﺢﺗﺮ /ﻛﺎKﻣﺪﺗﺮ ﺷﻮﻧﺪ. 2ـ Kﻣﺎﻳﺶ /ﮔﺴــﺘﺮ@ ﻣﺪﺧــﻼ 9ﻣﺎﻧﻲ ﻛــﻪ ﺑﺘﻮﻧﻨﺪ ﺑﻪ ﻃﻮ ﻣﺆﺛﺮ -ﺗﺮ ﻛﺎﻫﺶ ﻫﻨﺪ. ﻃــﺮ wﻳﮕﺮ ،ﻛﻨﺘﺮ Pﺑﺪ /ﻧﺎﻣﻨﺎﺳــﺐ ﻳﻦ ﻋﻮﻣﻞ ﻣﺆﺛﺮ / ﻧﺎﺗﻮﻧﻲ ﺑﻴﻤﺎ ،ﺗﻮﺳــﻂ ﻫﻤﺎ ﻣﺘﺨﺼﺼﺎﻧــﻲ ﺻﻮ 9ﻣﻲﮔﻴﺮ ﻛﻪ ﺗﻼ@ ﺟﻠﻮﮔﻴﺮ -ﺷﺮﻳﻂ ﻣﺰﻣﻦ ﻧﺪ. ﻣﻴﺪ ﺳﺖ ﻳﻦ ﺷﻮﻫﺪ ﺣﺎ Pﮔﺴﺘﺮ@ ﻫﺮﭼﻪ /ﺗﺮ ﺑﻪ ﻣﺎﻫﺎ- ﺑﺎﻟﻴﻨﻲ ﻳﺞ ﺗﺒﺪﻳﻞ ﺷﻮﻧﺪ. 2- Cogniphobia 5- Cognitive avoidance behavior 1- Overuse 4- Mental Kinesiophobia 89 ﺳﻮ ﭘﺎﻳﻴﺰ 1391ﺷﻤﺎ ﻣﺴﻠﺴﻞ 53 ﺳﻴﺰﻫﻢ ﺷﻤﺎ ﻮ ﺑﻲﻟﻴــﻞ ﺗﻼ@ ﺷــﻨﺎﺧﺘﻲ ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﺳــﺮ ﻣﺘﻌﺎﻗﺐ ﺿﺮﺑﻪ 3ﺗﻌﺮﻳﻒ ﺷــﺪ ﺳــﺖ .ﻳﻦ ﺑﻴﻤﺎ ﺗﻤﺮﻛﺰ ﻳﺎ ﻳﺎ ﻓﻌﺎﻟﻴﺖ ]ﻫﻨﻲ ﻳﺎ ﺟﺘﻨﺎ\ ﻣﻲﻛﻨﻨﺪ؛ ﺑﻪ ﻟﻴﻞ ﻳﻨﻜﻪ ﺗﺼﻮ ﻣﻲﻛﻨﻨﺪ ﻣﻐﺰﺷﺎ ﭼﺎ Kﺳﻴﺐﭘﺬﻳﺮ -ﻳﻤﻲ ﺷﺪ ﺳﺖ .ﻣﺤﻘﻘﻴﻦ ﭼﻨﻴﻦ ﻧﺘﻴﺠﻪ ﮔﺮﻓﺘﻨﺪ ﻛﻪ ﻣﻔﻬﻮ +ﺗﺮ ﺷــﻨﺎﺧﺘﻲ ﺑﺮ -ﻳﻦ ﺑﻴﻤﺎ ،ﺳــﺖ ﻣﺜﻞ ﻣﻔﻬﻮ+ ﺗﺮ ﺣﺮﻛﺖ ﺑﺮ -ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑﻪ ﺳﺘﻮ ﻓﻘﺮ 9ﺳﺖ .ﻫﺮ /ﻗﺎﻧﺪ ﺑﻪ ﻃﻮ ﺟﺪ -ﻓﺮKﻳﻨﺪ ﺗﻮﻧﺒﺨﺸﻲ ﻣﺨﺘﻞ ﻛﻨﻨﺪ .ﺗﺮ ۵ ﺣﺮﻛﺖ ]ﻫﻨﻲ) ۴ﺗﺮ ﺗﻼ@ ﻓﻜﺮ ،-ﻓﺘﺎ ﺣﺘﺮ -ﺷــﻨﺎﺧﺘﻲ ﻳــﺎ ﺗﺮ ﺷــﻨﺎﺧﺘﻲ( ﺑﻴﻤﺎ ﻣﺒﺘﻼ ﺑــﻪ ﺑﻴﻤﺎ-ﻫﺎ -ﺗﻨﺶ ﻣﺰﻣﻦ /ﺟﻮ .ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﻣﻘﺪﻣﺎﺗﻲ ﻧﺸــﺎ ﺷﺪ ﻛﻪ ﻣﺮﺟﻌﻴﻦ ﻣﺒﺘﻼ ﺑﻪ ﺗﻨﺶ ﻣﺰﻣﻦ ﺑﺎ ﭘﺮﻛﺮ ﻳﻚ ﭘﺮﺳﺸﻨﺎﻣﻪ Kﻣﺎﻳﺸﻲ )Mental (Tampa scaleﻛﻪ ﺗﻤﺎﻳﻼ 9ﺣﺘﺮ -ﻣﻮ ﺗﻼ@ ﻓﻜﺮ - ﻳﺎﺑﻲ ﻣﻲﻛﺮ ،ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﻛﺎﻛﻨﺎ ﺧﻴﻠﻲ ﻓﻌﺎ ،Pﻣﺘﻴﺎ ﺑﻴﺸﺘﺮ /ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪﺗﺮ -ﺑﺮﺧﻮ ﺑﻮﻧﺪ. ] ﻳﻦ ﻣﻄﺎﻟﻌﻪ TSKﺑﻪ ﭘﺮﺳﺸــﻨﺎﻣﻪ -ﻛﻪ ﺣﺘﺮ ﺷــﻨﺎﺧﺘﻲ ﻣﺸﻜﻼ 9ﺳــﺘﺮ ﻣﺰﻣﻦ ﻳﺎﺑﻲ ﻣﻲﻛﻨﺪ ،ﺗﺒﺪﻳﻞ ﻧﻤﻮ /ﻳﻦ ﻧﺴــﺨﻪ ﺗﻐﻴﻴﺮ ﻳﺎﻓﺘﻪ MTS ،ﻧﺎﻣﻴﺪ ﺷــﺪ .ﺗﻨﻈﻴﻢ ﻳﻦ ﭘﺮﺳﺸــﻨﺎﻣﻪ ﻃﺮﻳﻖ ﺗﻄﺒﻴﻖ ﻗﻴﻖ ﺑﺎ TSKﺻﻮ 9ﮔﺮﻓﺖ ).[(70 ﻳﺮ ﮔﺮ/ﻫــﺎ -ﺑﻴﻤﺎ ﺑﺮ ﺳــﺎ ﻣﻄﺎﻟﻌﺎ 9ﺧﻴــﺮ ،ﺑﻴﻤﺎﻧﻲ ﻛﻪ ﺧﻮ ﻓﺘﺎﻫﺎ -ﺣﺘﺮ -ﻧﺸــﺎ ﻣﻲﻫﻨﺪ ﺑﻪ ﺳــﻪ ﺳــﺘﻪ ﺗﻘﺴﻴﻢ ﻣﻲﺷــﻮﻧﺪ)1 :(61ـ ﺟﺘﻨﺎ\ﻛﻨﻨﺪﮔﺎ ﻋﺎﻃﻔﻲ ـ ﻫﻴﺠﺎﻧﻲ :ﻓﺮ -ﻛﻪ ﻣﻀﻄﺮ\ ،ﻧﺪ/ﻫﮕﻴﻦ ،ﻓﺴﺮ /ﭼﺎ ﺗﺮ ﻫﺴﺘﻨﺪ ،ﻓﻜﺎ ﻣﺨﺮ\ ﺷــﺘﻪ ،ﺑﻪ ﺗﺠﺎ\ ﻣﺮﺑﻮ Qﺑﻪ ﻓﻜﺮ ﻧﻤﻮ /ﺣﺴــﺎ ﻋﺠﺰ / ﻧﺎﺗﻮﻧــﻲ /ﺗﺮ ﻧﺴــﺒﺖ ﺑﻪ ﺧﻮ ﻧــﺪ2 .ـ ﺟﺘﻨﺎ\ﻛﻨﻨﺪﮔﺎ ﮔﻤﺮ ﺷــﺪ :ﻓــﺮ -ﻛﻪ ﺑﺎ/ﻫﺎﻳــﻲ ﻧﺪ ﻣــﻮ ﺣﺮﻛﺎ/ 9 ﻓﻌﺎﻟﻴﺖﻫﺎﻳﻲ ﻛﻪ ﺑﺎﻋﺚ Kﺳﻴﺐ ﻣﺠﺪ /ﺑﻴﺸﺘﺮ ﻣﻲﺷﻮﻧﺪ .ﻣﻤﻜﻦ ﺳــﺖ ﻳﻦ ﺑﺎ/ﻫﺎ ﺗﻮﺳــﻂ ﺧﺎﻧﻮ /ﮔﺎﻫﻲ /ﻗﺎ 9ﻓﺮ ﻣﺎﻧﮕﺮ ﺗﺸــﺪﻳﺪ ﺷﻮﻧﺪ .ﻳﻦ ﺑﻴﻤﺎ ﻣﻤﻜﻦ ﺳــﺖ ﺧﻴﻠﻲ ﻣﺤﺘﺎ Qﺑﺎﺷﻨﺪ ﻣﺎ ﻟﺰ/ﻣــ ًﺎ ﻧﺎﺣﺖ /ﻣﻀﻄﺮ\ ﻧﻴﺴــﺘﻨﺪ /ﺧﻮ ﻛﺎKﻣــﺪ 6-ﭘﺎﻳﻴﻨﻲ ﮔﺰ@ ﻧﻤﻲﻛﻨﻨﺪ3 .ـ ﻣﺒﺘﻼﻳﺎ ﺑﻪ ﺟﺘﻨﺎ\ ﻓﺮﮔﺮﻓﺘﻪ ﺷــﺪ :ﺗﺌﻮ- ﻳﺎﮔﻴﺮ -ﻧﺸــﺎ ﻣﻲﻫﺪ ﻛﻪ ﻓﺘﺎ ﺣﺘﺮ -ﻣﻲﺗﻮﻧﺪ ﺑﺪK /ﮔﺎﻫﻲ /ﺑﻪ ﺳــﺎﮔﻲ ﻃﺮﻳﻖ ﺷﺮﻃﻲ ﺷﺪ ﺗﺒﺎ Qﺑﻴﻦ ﺣﺮﻛﺎ 9ﺧﺎ/ p ﺗﺠﺮﺑﻪ K ،ﻣﻮﺧﺘﻪ ﺷﻮ .ﻳﻦ ﺳﺘﻪ ﻓﺮ ﻧﻪ ﺗﺮ ﻳﺎ /ﻧﻪ ﺑﺎ/ﻫﺎ -ﻣﺸﺨﺺ ﻣﻮ ﺟﺘﻨﺎ\ /ﺟﻮ . ﻣﺎ ﻫــﺮ ﻳﻚ ﻳﻦ ﮔﺮ/ﻫﺎ ﺑﺎﻳﺪ -/ﻣﻮ ﻣﺘﻔﺎ/ﺗﻲ ﺗﺄﻛﻴﺪ ﺷــﻮ .ﻣﻨﻄﻘﻲ ﺳــﺖ ﻛﻪ ﺟﺘﻨﺎ\ﻛﻨﻨﺪﮔﺎ ﻋﺎﻃﻔﻲ ـ ﻫﻴﺠﺎﻧﻲ ﺑﻴﺸﺘﺮ ﻛﺸــﻒ /ﺑﺮﺳﻲ ﺧﺘﻼﻻ 9ﺷﻨﺎﺧﺘﻲ /ﻓﻜﺎ ﻣﺨﺎﻃﺮKﻣﻴﺰ ﺳﻮ ﻣﻲﺑﺮﻧﺪ .ﺟﺘﻨﺎ\ﻛﻨﻨﺪﮔﺎ ﮔﻤﺮ ﺷــﺪ ،ﺑﻴﺸﺘﺮ ﺟﻨﺒﻪﻫﺎK -ﻣﻮﺷﻲ ﻣﺎ ﺑﻬﺮ ﻣﻲﺑﺮﻧﺪ /ﺑﺮ -ﻣﺒﺘﻼﻳﺎ ﺑﻪ ﺟﺘﻨﺎ\ ﻓﺮﮔﺮﻓﺘﻪ ﺷــﺪ ، ﻣﻌﺮ tﻣﺎﻧﻲ ﻳﺎ ﭘﻴﺸــﺮﻓﺖ ﺗﺪﻳﺠﻲ ﻣﻔﻴــﺪ ﺧﻮﻫﺪ ﺑﻮ .ﻫﻤﭽﻨﻴﻦ ﺣﺘﻤﺎﻻً ﺟﺘﻨﺎ\ ﻓﻌﺎﻟﻴﺖ ﺷﻐﻠﻲ ﺑﻴﺸﺘﺮ ﺑﺎﻳﺪ -/ﻣﺪﺧﻼﺗﻲ ﻛﻪ -/ﺟﻨﺒﻪﻫﺎ -ﻣﺨﺘﺺ ﺑﻪ ﺷﻐﻞ ﺗﻤﺮﻛﺰ ﻣﻲﻛﻨﻨﺪ ،ﺗﺄﻛﻴﺪ ﺷﻮ).(61 ﻫﺎ ﻋﻀﻼﻧﻲ ﺳﻜﻠﺘﻲ/ﺗﺮ ﺣﺮﻛﺖ ﻣﻨﺎﺑﻊ 24-de Jong JR, Vlaeyen JWS, Onghena P, Cuypers C, Hollander M, Ruijgrok J. 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Kinesiophobia and Cogniphobia: Assessment of Avoidance Conditioned Pain Related Disability (ACPRD). 70-Schmidt AJM. Does 'mental kinesiophobia exist? Behav Res Ther. 2003; 41 (10): 1243-9. The Fear of Movement/Pain in Musculoskeletal Pain-A Review *Akhbari B. (Ph.D.)1, MohammadiRad S. (M.Sc.)2, Salavati M. (Ph.D.)3 Abstract 1- Ph.D. of Physical Therapy, Associate professor of University of Social Welfare & Rehabilitation Sciences, Tehran, Iran 2- M.Sc. Student of Physical Therapy, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran 3- Ph.D. of Physical Therapy, Professor of University of Social Welfare & Rehabilitation Sciences, Tehran, Iran *Correspondent Author Address: Physiotherapy Dep., University of Social Welfare & Rehabilitation Sciences Koodakyar st. , Daneshjoo Blv. Evin, Tehran, Iran. *Tel: +98 (21) 22180039 *E-mail: akhbari@uswr. ac.ir 92 Vol. 13 No. 3 20 2013 13 Fall Serial No. 53 Receive date: 24/04/2010 Accept date: 14/01/2012 Objective: To investigate and review psychological influences of pain such as kinesiophobia and painrelated fear on patients with musculoskeletal pain and on rehabilitation outcomes. Discussion: Fear is a universal and powerful emotion and, as a result, it can have a profound impact on human behavior. the fear-motivated behavior has the potential to adversely impact rehabilitation outcomes for patients with musculoskeletal pain. Cross-sectional studies consistently documented a positive association between elevated pain-related fear and increased pain intensity and disability. in addition, several longitudinal studies indicated that elevated pain-related fear is a precursor to poor clinical outcomes. existence of catastrophizing in patients effect on the fear of movement/ (re)injury. this fear contributes to avoidance behaviors and subsequent disuse, depression, and disability. It has been established that kinesiophobia plays a negative role in the outcome of the rehabilitation of acute and chronic low back pain, chronic fatigue syndrome and fibromyalgia syndrome. Collectively, the recent studies suggest that physical therapists should consider the role of pain-related fear and avoidance behaviors in patients' function and they should assess these cognitive and behavioral factors. or (physical therapists should assess pain-related fear when rehabilitating certain individuals with musculoskeletal pain.) currently, there is a lot of evidence for the assessment of pain-related fear in patients with musculoskeletal pain. self-report questionnaires are readily available for assessment and investigation of pain-related fear and several studies have found support for their validity and reliability. Recent research indicated that besides fear-avoidance responses, endurance-related responses lead to chronic pain via physical overload. The existence of mental kinesiophobia has been established in patients with chronic stress complaints, and this concept is as relevant as the concept of kinesiophobia for back pain patients. Conclusion: For certain patients, fear of pain can be as disabling as pain itself. in conclusion, collaborative efforts are necessary to refine current screening techniques and develop interventions that effectively reduce pain-related fear. Keywords: Fear-avoidance beliefs, Kinesiophobia, Musculoskeletal pain, Pain-related fear
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