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] cardiac conditions, [6] fibromyalgia.[7] Some factors of the scale have been recommended for use in adolescents with idiopathic scoliosis undergoing spinal surgery.[8]

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 that have been later linked to the model of fear-avoidance, fear of work-related activities, fear of movement, and fear of re-injury.[9]

Shorter and modified forms of this instrument varying from 4 to 14 items were also developed for routine assessments, specialised patient care and research.[10][11] So far, the TSK scale, originally written in English, has been translated into multiple languages such as Dutch, [12] Italian, [13] Japanese, [14] Finnish, [15] Swedish, [16] Turkish, [6] Greek, [17] Chinese, [18] Norwegian, [19]and Spanish.[20]

Most factor-analytic studies of the TSK favour 2 generally accepted areas of assessment (subscales) across various pain conditions:[21][22][23]

  • 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)

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 which is the most common, [24] dismisses items with poor psychometric performance, and its score ranges from 11-44.[25]

Scores above 37 (17-item) are generally considered to indicate kinesiophobia. [24] However, gender and pain diagnosis seem to correlate with TSK scoring, thus affecting the norming of this scale. [23] Roelofs et al. [23] provide norms for scoring across different populations and versions of the TSK.

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 .[26]

In the Finnish version of TSK, the test-retest reliability (ICC) = 0.887. [27]

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. [21] In whiplash patients, higher scores on the TSK (Dutch version) were associated with a longer duration of neck symptoms, without reaching statistical significance for improving the ability to predict the duration of neck symptoms after motor vehicle collisions.[28] However, it must be noted that the sample follow-up and available for analysis was small.

Concurrent validity is moderate, ranging from r(s) =0.33 to 0.59. [29] [30][31]

There is also another valid, and reliable abbreviated version of the scale that consists of 11 items. [32]

Responsiveness[edit | edit source]

For patients with chronic low back pain, TSK was sensitive to detect clinical changes [33], it was also sensitive to detect changes after spinal fusion. [34] Unlike in patients with ACL injury, it isn't the best way to assess psychological factors according to the Japanese version. [35]

Links[edit | edit source]

Tampa scale of kinesiophobia (TSK) (modified version, NovoPsych, TSK.)

MDApp, 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. 6.0 6.1 Acar S., Savci S., Keskinoğlu P., Akdeniz B., Özpelit E., Özcan Kahraman B., Karadibak D., Sevinc C. Tampa Scale of Kinesiophobia for Heart Turkish Version Study: cross-cultural adaptation, exploratory factor analysis, and reliability. J Pain Res. 2016 Jun 23;9:445-51.
  7. 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.
  8. Ye D., Plante I., Roy M., Ouellet J., Ferland C. The Tampa Scale of Kinesiophobia: Structural Validation among Adolescents with Idiopathic Scoliosis Undergoing Spinal Fusion Surgery. Physical & Occupational Therapy In Pediatrics. 2020;40(5):546-556.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. Monticone M., Giorgi I., Baiardi P., Barbieri M., Rocca B., Bonezzi C. Development of the Italian Version of the Tampa Scale of Kinesiophobia (TSK-I): Cross-Cultural Adaptation, Factor Analysis, Reliability, and Validity. Spine 2010, May 20; 35(12):1241-1246.
  14. Huang H., Nagao M., Arita H., Shiozawa J., Nishio H., Kobayashi Y., Kaneko H., Nagayama M., Saita Y., Ishijima M., Takazawa Y., Ikeda H., Kaneko K. Reproducibility, responsiveness and validation of the Tampa Scale for Kinesiophobia in patients with ACL injuries. Health Qual Life Outcomes. 2019 Sep 11;17(1):150.
  15. Koho P., Aho S., Kautiainen H., Pohjolainen T., Hurri H. Test-retest reliability and comparability of paper and computer questionnaires for the Finnish version of the Tampa Scale of Kinesiophobia. Physiotherapy. 2014 Dec;100(4):356-62.
  16. Larsson C., Hansson E., Sundquist K., Jakobsson U. Psychometric properties of the Tampa Scale of Kinesiophobia (TSK-11) among older people with chronic pain. Physiother Theory Pract. 2014 Aug;30(6):421-8.
  17. Georgoudis G., Papathanasiou G., Spyropoulos P. Physiotherapy Assessment in Painful Musculoskeletal Conditions: Validity and Reliability of the Greek Tampa Scale of Kinesiophobia. Conference: International Forum on Pain Medicine. World Institute of Pain: European Federation of IASP Chapters. May 2005
  18. Cai L., Liu Y., Woby S., Genoosha N., Cui M., Guo L. Cross-Cultural Adaptation, Reliability, and Validity of the Chinese Version of the Tampa Scale for Kinesiophobia-11 Among Patients Who Have Undergone Total Knee Arthroplasty. J Arthroplasty. 2019 Jun;34(6):1116-1121.
  19. Haugen A., Grøvle L., Keller A., Grotle M. Cross-cultural adaptation and validation of the Norwegian version of the Tampa scale for kinesiophobia. Spine (Phila Pa 1976). 2008 Aug 1;33(17):E595-601.
  20. 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.
  21. 21.0 21.1 Roelofs J., Goubert L., Peters M., Vlaeyen J., 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.
  22. Roelofs J., Sluiter J., Frings-Dresen M., Goossens M., Thibault P., Boersma K., Vlaeyen J. Fear of movement and (re)injury in chronic musculoskeletal pain: Evidence for an invariant two-factor model of the Tampa Scale for Kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples. Pain. 2007 Sep;131(1-2):181-90.
  23. 23.0 23.1 23.2 Roelofs J., van Breukelen G., Sluiter J., Frings-Dresen M., Goossens M., Thibault P., Boersma K., Vlaeyen J. Norming of the Tampa Scale for Kinesiophobia across pain diagnoses and various countries. Pain. 2011 May;152(5):1090-1095.
  24. 24.0 24.1 Liu H., Huang L., Yang Z., Li H., Wang Z., Peng L. Fear of Movement/(Re)Injury: An Update to Descriptive Review of the Related Measures. Front Psychol. 2021 Jul 7;12:696762.
  25. 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.
  26. 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.
  27. Koho P., Aho S., Kautiainen H., Pohjolainen T., Hurri H. Test-retest reliability and comparability of paper and computer questionnaires for the Finnish version of the Tampa Scale of Kinesiophobia. Physiotherapy. 2014 Dec;100(4):356-62.
  28. Buitenhuis J., Jaspers J., Fidler V. Can kinesiophobia predict the duration of neck symptoms in acute whiplash? Clin J Pain. 2006 Mar-Apr;22(3):272-7.
  29. Swinkels-Meewisse E., Swinkels R., Verbeek A., Vlaeyen J., Oostendorp R. 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.
  30. 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.
  31. 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.
  32. Tkachuk G., Harris C. Psychometric properties of the Tampa Scale for Kinesiophobia-11 (TSK-11). J Pain. 2012 Oct 1;13(10):970-7.
  33. 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.
  34. 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. Eur J Phys Rehabil Med. 2017 Jun;53(3):351-8.
  35. 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.