Changes in Pain-Related Fear Predict Shoulder Disability in Rotator Cuff Tendinopathy With Resistance Exercise

OBJECTIVE: To determine the trajectory of (1) change in pain-related fear and catastrophizing factors, (2) changes in pain-related fear and catastrophizing by treatment satisfaction groups, and (3) the relationship between pain-related fear trajectories, and catastrophizing factors and shoulder disability during an 8-week resistance exercise program. DESIGN: Prospective longitudinal observational study. METHODS: Sixty-four people with rotator cuff tendinopathy completed the exercise protocol. Outcomes of Penn Shoulder Score (Penn) shoulder disability and pain-related fear and catastrophizing via the Optimal Screening for Prediction of Referral and Outcome-Yellow Flag (OSPRO-YF) were assessed at baseline and at 2, 4, and 8 weeks. Patient Acceptable Symptom State (PASS) defined satisfaction with treatment at 8 weeks. RESULTS: All pain-related fear and catastrophizing measures changed over time during resistance exercise (P < .01) but differed by PASS-defined responder and nonresponder groups. For the Fear-Avoidance Beliefs Questionnaire-Work subscale (FABQ-W), nonresponders had an increase (0.63 pt) while responders had a decrease (-3.5 pt) (mean difference, 4.2 pt; 95% confidence interval [CI]: -7.6, -0.7; P = .02). For TSK-11, nonresponders had less of a decrease (-0.1) than responders (-3.2 pt) (mean difference, 3.1 pt; 95% CI: -5.9, -0.3; P = .03). Reduced shoulder disability was related to less pain-related fear and catastrophizing (P < .01), and differed by responder group. Nonresponders had no relationship between change in pain-related fear and catastrophizing and disability (P>.05); responders had an overall negative relationship (P < .04). CONCLUSION: Pain-related fear and catastrophizing changed over time for individuals with rotator cuff tendinopathy, and changes varied by participant. Those who were not satisfied at 8 weeks had higher levels of pain-related fear and catastrophizing, while those who were satisfied had reduced pain-related fear and catastrophizing. Less pain-related fear and catastrophizing was related to decreased disability. J Orthop Sports Phys Ther 2026;56(8):546-554. Epub 9 Jun 2026. doi:10.2519/jospt.2026.13563.