Tampa Scale of Kinesiophobia

Original Editor - Khloud Shreif

Top Contributors - Angeliki Chorti, Khloud Shreif and Kim Jackson  

Introduction[edit | edit source]

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The Tampa Scale of Kinesiophobia (TSK) was first developed in 1991 by R. Miller, S. Kopri, and D. Todd. A year before, the developers had introduced the term kinesiophobia at the Ninth Annual Scientific Meeting of the American Pain Society to describe patient circumstances characterised by an "excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or reinjury".[1][2]

You can learn more about kinesiophobia and its clinical relevance here.

Objective[edit | edit source]

TSK is a self-reported questionnaire that quantifies fear of movement, or (re)injury.

Intended Population[edit | edit source]

The TSK was initially used to distinguish between non-excessive fear and phobia in patients with chronic musculoskeletal pain, i.e. the fear of movement in older people with chronic low back pain. [2] Later, its use expanded to other conditions and parts of the body, such as the neck, [2][3] the lower extremity, [4] temporomandibular disorders, [5] fibromyalgia.[6] Some factors of the scale (TSK-AA) have been recommended for use in adolescents with idiopathic scoliosis undergoing spinal surgery.[7]

Items, Categories and Versions[edit | edit source]

In its original form, the TSK is a 17 item assessment checklist. [1] It uses a 4 point Likert scale (Strongly Disagree-Disagree-Agree-Strongly Agree) with statements linked to the model of fear-avoidance, fear of work-related activities, fear of movement, and fear of re-injury.[8] The 17 item scale focuses on 2 areas of assessment:

  • Activity Avoidance – the belief that activity may result in (re)injury or increased pain. (TSK-AA)
  • Somatic Focus – the belief that pain is a sign of underlying and serious medical issues (TSK-SF)

Shorter and modified forms of this instrument varying from 4 to 14 items were also developed for routine assessments, specialised patient care and research.[9][10] Furthermore, the original TSK scale was written in English, but it has also been translated in Dutch, [11]Finnish, Spanish.[12]

Scoring[edit | edit source]

Individual item scores range from 1-4, with the negatively worded items (4,8,12,16) having a reverse scoring (4-1) The 17 item TSK total scores range from 17 to 68 where the lowest 17 means no or negligible kinesiophobia, and the higher scores indicate an increasing degree of kinesiophobia. [3] The shortened version TSK-11 maintains items 1, 2, 3, 5, 6, 7, 10, 11, 13, 15, and 17 from the original scale but dismisses items with poor psychmetric performance, and its score ranges from 11-44.[13]

Psychometric properties[edit | edit source]

Psychometric properties of the TSK are provided below. For more information on psychometric properties for tools used in health-related research and care, click here.

Reliability[edit | edit source]

The TSK shows a high level of internal consistency across all items and is positively associated with related measures of fear-avoidance, pain catastrophizing, pain-related disability[14].

In the Finnish version of TSK, the test-retest reliability (ICC) = 0.887[15].

Validity[edit | edit source]

Construct validity: moderate correlation coefficient with measures of pain-related fear, pain catastrophising, and disability in patients with CLBP.

Predictive validity: moderate correlation coefficient with physical performance tests[16].

Concurrent validity is moderate, ranging from r(s) =0.33 to 0.59[17].

[18][19]

There is also another valid, and reliable abbreviated version of the scale that consists of 11 items. [20]

Responsiveness[edit | edit source]

For patients with chronic low back pain, TSK was sensitive to detect clinical changes[21], it was also sensitive to detect changes after spinal fusion[22]. Unlike in patients with ACL injury, it isn't the best way to assess psychological factors according to the Japanese version[23].

Links[edit | edit source]

Tampa scale of kinesiophobia (TSK).

MDApp, TSK.

NovoPsych, TSK.

Free online TSK calculator

References[edit | edit source]

  1. ↑ 1.0 1.1 Miller R., Kori S., Todd D. The Tampa Scale: a measure of kinesiophobia. Clin J Pain. 1991;7(1):51–52.
  2. ↑ 2.0 2.1 2.2 Hudes K. The Tampa Scale of Kinesiophobia and neck pain, disability and range of motion: a narrative review of the literature. J Can Chiropr Assoc 2011 Sep;55(3):222.
  3. ↑ 3.0 3.1 Pool J., Hiralal S., Ostelo R., van der Veer K., Vlaeyen·J., Bouter L., de Vet H. The applicability of the Tampa Scale of Kinesiophobia for patients with sub-acute neck pain: a qualitative study. Qual Quant 2009; 43:773–780.
  4. ↑ Kortlever J., Tripathi S., Ring D., McDonald J., Smoot B., Laverty D. Tampa Scale for Kinesiophobia Short Form and Lower Extremity Specific Limitations. Arch Bone Jt Surg 2020 Sep; 8(5): 581–588.
  5. ↑ Visscher C., Ohrbach R., van Wijk A., Wilkosz M., Naeije M. The Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD). Pain. 2010 Sep;150(3):492-500.
  6. ↑ Goubert L., Crombez G., Van Damme S., Vlaeyen J., Bijttebier P., Roelofs J. Confirmatory factor analysis of the Tampa Scale for Kinesiophobia: invariant two-factor model across low back pain patients and fibromyalgia patients. Clin J Pain 2004;20:103–10.
  7. ↑ Ye DL, Plante I, Roy M, Ouellet JA, Ferland CE. The Tampa Scale of Kinesiophobia: Structural Validation among Adolescents with Idiopathic Scoliosis Undergoing Spinal Fusion Surgery. Physical & Occupational Therapy In Pediatrics. 2020 Feb 6:1-1.
  8. ↑ Vlaeyen J., Kole-Snijders A., Boeren R., van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995 Sep;62(3):363-372.
  9. ↑ Archer K., Phelps K., Seebach C., Song Y., Riley L. 3rd, Wegener S. Comparative study of short forms of the Tampa Scale for Kinesiophobia: fear of movement in a surgical spine population. Arch Phys Med Rehabil. 2012 Aug;93(8):1460-2.
  10. ↑ Vernon H., Guerriero R., Kavanaugh S., Puhl A. Is "fear of passive movement" a distinctive component of the Fear-Avoidance Model in whiplash? J Can Chiropr Assoc. 2015 Sep;59(3):288-93.
  11. ↑ Nijs J., De Meirleir K., Duquet W. Kinesiophobia in chronic fatigue syndrome: assessment and associations with disability. Arch Phys Med Rehabil. 2004 Oct;85(10):1586-92.
  12. ↑ La Touche R., Pardo-Montero J., Cuenca-Martínez F., Visscher C., Paris-Alemany A., López-de-Uralde-Villanueva I. Cross-Cultural Adaptation and Psychometric Properties of the Spanish Version of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders. J Clin Med. 2020 Sep 1;9(9):2831.
  13. ↑ Woby S., Roach N., Urmston M., Watson P. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain. 2005 Sep;117(1-2):137-44.
  14. ↑ French D., France C., Vigneau F., French J., Evans R. Fear of movement/(re) injury in chronic pain: a psychometric assessment of the original English version of the Tampa scale for kinesiophobia (TSK). Pain. 2007 Jan 1;127(1-2):42-51.
  15. ↑ Koho P, Aho S, Pohjolainen T, Hurri H. Reliability of Tampa Scale for Kinesiophobia Questionnaire and Comparability of Paper and Computer Versions in Chronic Pain Patients. InOrthopaedic Proceedings 2009 May (Vol. 91, No. SUPP_II, pp. 286-286). The British Editorial Society of Bone & Joint Surgery.
  16. ↑ Roelofs J, Goubert L, Peters ML, Vlaeyen JW, Crombez G. The Tampa Scale for Kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia. European Journal of Pain. 2004 Oct 1;8(5):495-502.
  17. ↑ Swinkels-Meewisse EJ, Swinkels RA, Verbeek AL, Vlaeyen JW, Oostendorp RA. Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Manual therapy. 2003 Feb 1;8(1):29-36.
  18. ↑ Lundberg M., Styf J., Carlsson S. A psychometric evaluation of the Tampa Scale for Kinesiophobia – from a physiotherapeutic perspective. Physiotherapy Theory and Practice. 2004;20(2):121–133.
  19. ↑ Bunketorp L., Carlsson J., Kowalski J., Stener-Victorin E. Evaluating the reliability of multi-item scales: a non-parametric approach to the ordered categorical structure of data collected with the Swedish version of the Tampa Scale for Kinesiophobia and the Self-Efficacy Scale. J Rehabil Med. 2005 Sep;37(5):330-4.
  20. ↑ Tkachuk GA, Harris CA. Psychometric properties of the Tampa Scale for Kinesiophobia-11 (TSK-11). The Journal of Pain. 2012 Oct 1;13(10):970-7.
  21. ↑ Monticone M, Ambrosini E, Rocca B, Foti C, Ferrante S. Responsiveness of the Tampa Scale of Kinesiophobia in Italian subjects with chronic low back pain undergoing motor and cognitive rehabilitation. European Spine Journal. 2016 Sep 1;25(9):2882-8.
  22. ↑ Monticone M, Ambrosini E, Rocca B, Foti C, Ferrante S. Responsiveness and minimal clinically important changes for the Tampa Scale of Kinesiophobia after lumbar fusion during cognitive behavioral rehabilitation. European Journal of Physical and Rehabilitation Medicine. 2017 Jun;53(3):351-8.
  23. ↑ Huang H, Nagao M, Arita H, Shiozawa J, Nishio H, Kobayashi Y, Kaneko H, Nagayama M, Saita Y, Ishijima M, Takazawa Y. Reproducibility, responsiveness and validation of the Tampa Scale for Kinesiophobia in patients with ACL injuries. Health and quality of life outcomes. 2019 Dec 1;17(1):150.
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