Abstract
Objectives: (1) Validate thresholds for minimal, low, moderate, and high fear of movement on the 11-item Tampa Scale of Kinesiophobia (TSK-11), and (2) Establish a patient-driven minimal clinically important difference (MCID) for Achilles tendinopathy (AT) symptoms of pain with heel raises and tendon stiffness.Methods: Four hundred and forty-two adults with chronic AT responded to an online survey, including psychosocial questionnaires and symptom-related questions (severity and willingness to complete heel raises and hops). Kinesiophobia subgroups (Minimal ≤ 22, Low 23–28, Moderate 29–35, High ≥ 36 scores on the TSK-11), pain MCID subgroups (10-, 20-, 30-, >30-points on a 0- to 100-point scale), and stiffness MCID subgroups (5, 10, 20, >20 min) were described as median [interquartile range] and compared using non-parametric statistics.Results: Subgroups with higher kinesiophobia reported were less likely to complete three heel raises (Minimal = 93%, Low = 74%, Moderate = 58%, High = 24%). Higher kinesiophobia was associated with higher expected pain (Minimal = 20.0 [9.3–40.0], Low = 43.0 [20.0–60.0], Moderate = 50.0 [24.0–64.0], High = 60.5 [41.3–71.0]) yet not with movement-evoked pain (Minimal = 25.0 [5.0–43.0], Low = 31.0 [18.0–59.0], Moderate = 35.0 [20.0–60.0], High = 43.0 [24.0–65.3]). The most common pain MCID was 10 points (39% of respondents). Half of respondents considered a 5-min (35% of sample) or 10-min (16%) decrease in morning stiffness as clinically meaningful.Conclusions: Convergent validity of TSK-11 thresholds was supported by association with pain catastrophizing, severity of expected pain with movement, and willingness to complete tendon loading exercises. Most participants indicated that reducing their pain severity to the mild range would be clinically meaningful.
Highlights
Kinesiophobia is defined as fear of movement and re-injury and may interfere with non-operative care for musculoskeletal pain including participation in exercise programs
The new findings of this study are that psychosocial factors are associated with other symptoms, including Achilles tendon stiffness. These findings indicate that higher kinesiophobia and pain catastrophizing are associated with more severe symptoms specific to the Achilles tendon region
Respondents who selected the largest minimal clinically important differences (MCIDs) had higher pain catastrophizing than respondents who selected the smallest MCIDs
Summary
Kinesiophobia is defined as fear of movement and re-injury and may interfere with non-operative care for musculoskeletal pain including participation in exercise programs. Kinesiophobia is associated with disability for a wide range of musculoskeletal pain conditions [1,2,3,4,5]. The original 17-item Tampa Scale of Kinesiophobia (TSK-17) was initially validated by demonstrating that individuals with elevated kinesiophobia performed a shorter duration of a lifting task that was maintained until “pain or discomfort made it impossible for the patient to continue” when compared to a group without elevated kinesiophobia [6]. To improve feasibility of clinical implementation, the 11-item Tampa Scale of Kinesiophobia (TSK-11) was developed by removing six items from the TSK17 that had poor psychometric performance [7]. Validation is needed to determine if TSK-11 scores are associated with task performance, similar to the original TSK-17
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