Differences in Psychological Factors Between People With Persistent Tendinopathy and Those Without Tendinopathy: A Systematic Review With Meta-Analysis

OBJECTIVE: To compare psychological factors between those with tendinopathy and nontendinopathy controls. STUDY DESIGN: Prognosis systematic review with meta-analysis (PROSPERO:CRD42023489445). LITERATURE SEARCH: Seven databases were searched until September 24, 2024. STUDY SELECTION CRITERIA: Studies comparing psychological factors between people with and without tendinopathy were included. We excluded studies that exclusively evaluated participants with tendon tears, tendon ruptures, systemic conditions, fibromyalgia, or psychiatric disorders. DATA SYNTHESIS: Data were pooled across tendinopathy sites for each psychological factor. Meta-analyses were performed for each psychological factor, using a random-effects model to calculate effect sizes and 95% confidence intervals (95% CIs). Upper-limb and lower-limb tendinopathy sites were separated for subgroup analysis. The methodological quality of each study was appraised using Joanna Briggs Institute checklists, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation criteria. RESULTS: People with tendinopathy had higher pain catastrophizing (n = 7, mean difference [MD] = 4.01, 95% CI = 0.6, 7.41) than those without tendinopathy. Depression (n = 5, standard mean difference [SMD] = 0.46, 95% CI = 0.11, 0.8) and anxiety (n = 4, SMD = 0.45, 95% CI = 0.01, 0.89) were higher in those with lower-limb tendinopathy compared to nontendinopathy controls. We detected poorer mental health in people with lower-limb tendinopathy (n = 2, MD = 72, 95% CI = −6.68, −0.75) and no differences in kinesiophobia (n = 4), general self-efficacy (n = 2), extraversion (n = 2), or neuroticism (n = 2). CONCLUSION: People with tendinopathy had different psychological profiles than people without tendinopathy. J Orthop Sports Phys Ther 2025;55(12):752-769. Epub 5 November 2025. doi:10.2519/jospt.2025.13307