Tampa Scale For Kinesiophobia Scores Research Articles

Fear of movement and its effects on hand function after tendon repair

After tendon injuries, it has been observed clinically that patient-reported disability is more severe than the patient's actual performance. This is thought to result from a fear of movement (kinesiophobia) after surgery. The aim of this study was to investigate the presence of kinesiophobia in this patient population and its effects on the clinical outcomes. Patients (n=118) with tendon repairs were included. All the participants received early passive mobilization and were assessed at the end of the 8th week. Grip and pinch strengths were measured and the Nine-Hole Peg Test (9HPT) was conducted. Patients also filled out the Michigan Hand Outcomes Questionnaire (MHOQ) and Tampa Scale for Kinesiophobia (TSK). Patients were divided according to their kinesiophobia: Group 1 with low kinesiophobia (TSK<37) and Group 2 with high kinesiophobia (TSK≥37). The groups were compared on the assessed parameters. Fifty-nine percent of the patients had a high kinesiophobia level. The performance-based test results were similar between the groups (P>0.05). Patient-reported MHOQ and TSK scores were significantly lower in the high kinesiophobic group (P=0.001 and P=0.000, respectively). Patients with tendon repairs often develop kinesiophobia, which may contribute to difficulty when starting to re-use their hand in daily life. None of the objective results were affected by this fear of movement–only patient-reported disability. Clinicians should be aware that clinical outcomes may be affected by the patient's kinesiophobic thinking and must be cautious during treatment.

Efficacy and Tolerability of Peritendinous Hyaluronic Acid in Patients with Supraspinatus Tendinopathy

Introduction: Physical therapy and peritendinous hyaluronic acid (HA) injections have both shown promising results in the treatment of shoulder tendinopathies. However, the superiority of treatment combining physical therapy and HA is unclear. Objectives: In this parallel-group, randomized, controlled trial, we investigated the efficacy and safety of peritendinous injection of HA in patients with persistent supraspinatus tendinopathy. To this end, we compared the therapeutic outcome of treatment with HA as an adjuvant to physical therapy with that of physical therapy as sole therapeutic intervention. Methods: 84 Patients with ultrasound-confirmed supraspinatus tendinopathy were randomized to receive either physical therapy + subacromial HA injections or physical therapy only. Treatment efficacy was assessed using a Visual Analog Scale (VAS) for pain and an Activities of Daily Living (ADL) scale. Other measures were the number of rehabilitation sessions and days needed for recovery, the Tampa Scale for Kinesiophobia (TSK), and the physician and patient’s perception of efficacy and tolerability. Patients were followed up for 90 days. Results: Overall, VAS and ADL scores showed a progressive decrease during the follow-up ( P&lt;0.01 at all visits for both groups), without significant differences between groups. The TSK score decreased significantly more in the HA group than in the control group (3.6 vs. 2.4; P&lt;0.001). Patients in the control group needed more rehabilitation sessions (28 vs. 22 in the HA group; P=0.006) and more days for returning to their pre-injury activity (32 vs. 20 in the HA group; P=0.013). Both patients and investigators perceived higher efficacy in the HA group than in the control group ( P=0.034). Both treatments were safe and well tolerated. Conclusion: Subacromial HA injections combined with physical therapy have high efficacy in the treatment of supraspinatus tendinopathy, leading to an earlier return to pre-injury activity and the need for fewer rehabilitation sessions, which may benefit both patients and the healthcare system.

The Relationship Between Fear-Avoidance and Objective Biomechanical Measures of Function in Patients With Adult Degenerative Scoliosis.

A prospective cohort study. The current study utilized quantitative gait analysis to examine the relationship of fear-avoidance beliefs to gait patterns in patients with adult degenerative scoliosis (ADS). Among patients with chronic spine pain, fear-avoidance beliefs are predictive of behavioral deficiencies, poor work, and surgery outcomes. The impact of such beliefs on patients with major spinal deformity has yet to be investigated. Patients with ADS have previously been shown to have an altered gait pattern. Utilizing quantified gait analysis, this study aims to examine correlations between fear-avoidance and various aspects of gait in patients with ADS. Twenty-five ADS patients completed the Tampa Scale for Kinesiophobia (TSK) questionnaire and the Fear Avoidance Beliefs Questionnaire (FABQ). Each patient performed a series of overground gait trials at a self-selected comfortable speed. Pearson product correlation analysis was used to determine the relationship between the self-reported fear of movement measures and the objective gait analysis biomechanical data. TSK score correlated strongly with gait speed, stride, step, double support times, and step length, and correlated moderately with cadence, and stride length. The FABQ physical portion strongly correlated with stride length and step length. The FABQ physical portion was moderately correlated with gait speed and single support time. The FABQ work portion was correlated with stride length and step length. This study demonstrates a strong correlation between biomechanical gait parameters, as measured with gait analysis, and fear-avoidance of movement, as measured with the TSK and FABQ. Further, it demonstrates that quantified gait analysis can be a useful tool to evaluate patients with spine deformity and to assess the outcomes of treatments in this group of patients. This study extends previous research on the role of fear-avoidance to include patients with spinal deformity. 3.

The relationship between fear of movement, pain and fatigue severity, dyspnea level and comorbidities in patients with chronic obstructive pulmonary disease

Purpose: Dyspnea, sedentary lifestyle, and comorbid diseases may reduce the desire to engage in physical movement in chronic obstructive pulmonary disease (COPD). The aims of this study were to assess levels of kinesiophobia among stable COPD patients and evaluate the relationship between kinesiophobia and pain and fatigue severity, dyspnea level, and comorbidities in this patient group.Material and Methods: Thirty-one patients with moderate/severe COPD and thirty-one age- and sex-matched healthy controls participated in the study. All participants were assessed using Visual Analog Scale for pain severity, Fatigue Severity Scale, modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia.Results: Ninety-three percent of the patients with COPD had a high degree of kinesiophobia (Tampa Scale of Kinesiophobia score >37). The modified Medical Research Council Dyspnea Scale, Charlson Comorbidity Index, and Tampa Scale of Kinesiophobia scores of patients with COPD was significantly higher than those of healthy subjects (p < 0.001). Tampa Scale of Kinesiophobia score was significantly associated with modified Medical Research Council Dyspnea Scale score (r = 0.676, p < 0.001), Charlson Comorbidity Index score (r = 0.746, p < 0.001) and fatigue severity level (r = 0.524, p = 0.005).Conclusion: Most moderate/severe COPD patients express fear of movement. Kinesiophobia is strongly associated with dyspnea perception, fatigue severity, multisystemic comorbidities in COPD. Further studies are needed to determine the effects of kinesiophobia on the success of pulmonary rehabilitation.Implications for rehabilitationMost of moderate-to-severe chronic obstructive pulmonary disease patients have fear of movement.Increase fear of movement in moderate–severe chronic obstructive pulmonary disease is associated with increased dyspnea perception and fatigue severity and multisystemic comorbidities.

Determining Predictive Outcome Factors for a Multimodal Treatment Program in Low Back Pain Patients: A Retrospective Cohort Study

ObjectiveThe purpose of this study was to determine the factors predictive of outcomes in a multifaceted rehabilitation program for acute and chronic low back pain (LBP) patients. MethodsA retrospective cohort study was performed on 565 LBP patients (153 acute and 412 chronic) who participated in a multimodal treatment program at an outpatient clinic in Belgium between 2007 and 2010. The predictive value of several factors, including age, sex, body mass index, fat percentage, Oswestry Disability Index score, Beck Depression Index score, Numeric Pain Rating Scale score for back and leg pain intensity, and Tampa Scale for Kinesiophobia score on favorable treatment outcomes was examined using logistic regression analysis. ResultsThe results from the multivariate regression indicated that a higher score on the Tampa Scale for Kinesiophobia (odds ratio [OR] = 0.92) decreases the odds of a favorable outcome following a multimodal treatment program in acute LBP. Older age (OR = 0.97), low LBP intensity (OR = 1.191), and higher scores on the Beck Depression Index (OR = 0.96) and the Oswestry LBP Disability Index (OR = 0.93) decreased the odds of a favorable treatment outcome in chronic LBP. ConclusionsThe findings of this study indicate that factors predictive of a (un)favorable treatment outcome differ between acute and chronic LBP. Specifically, kinesiophobia is predictive of poor treatment outcome in acute LBP. In chronic LBP, older age, low LBP intensity, and higher degrees of depression and LBP-related disability are predictive of poor treatment outcome. Therapists should consider assessing these predictive factors at intake to tailor the content of the multimodal treatment program to individual patient needs.

Kinesiophobia is Strongly Associated with Altered Loading after an ACL Reconstruction: Implications for Re-injury Risk

Objectives:The effect of kinesiophobia (fear of movement) following an anterior cruciate ligament (ACL) reconstruction has recently received greater attention. Elevated kinesiophobia as measured on the Tampa Scale of Kinesiophobia (TSK) has been previously found to be associated with poorer outcomes. However, the effect of kinesiophobia in ACL reconstructed patients on high impact and challenging tasks associated with re injury risk such as jumping has not been investigated. Establishing the relationship between kinesiophobia and jump landing mechanics could result in the development of specific treatments to reduce fear of movement and improve jump landing mechanics after ACL reconstruction, resulting in a diminished re-injury risk. Therefore, the purpose of this study is to define the relationship between landing mechanics (axial loading rates and impact forces) with the TSK score in patients 6 months after ACL reconstruction.Methods:Twenty subjects, 6 months post ACL reconstruction, who had completed post-operative physical therapy, and were cleared by their physician to begin return to sport drills participated in the study. Subjects completed an instrumented drop vertical landing assessment with the ground reaction forces recorded while the subjects performed a drop vertical jump task off a 30.48 cm high box. Three trials were taken and the data were analyzed using custom Labview code and Visual 3D software during the period of time from foot contact until initial impact peak. The average loading rate was defined as the linear portion of the vertical ground reaction curve between 20-80% of foot contact to initial impact peak. Subjects also completed the TSK questionnaire. Associations between loading rate and vertical impact peak to the TSK scale were made with Pearson correlation coefficients with significant relationships defined as p<0.05.Results:20 subjects (11 female, 9 male, Ages 19 ± 3.3 yrs, H 1.73 ± 0.11 m, M 69.1 ± 12.2 kg) with bone patellar bone autografts completed the study. The mean loading rate was 56.96 ± 18.6 %bodyweight/sec, initial impact peak 0.88 ± 0.24 %bodyweight, and TSK value was 33.1 ± 6.8. There was a significant negative association between poorer responses on the TSK scale and initial impact peak forces (r=-0.624, p=0.003) but not average loading rate (r=-0.243, p=-0.302) (Figure 1).Conclusion:We found greater kinesiophobia to be associated with a lower weight-bearing in the ACL reconstructed limb. Potentially, subjects who are afraid of loading their reconstructed limb transfer weight to the uninjured limb, increasing the demand placed upon that limb. The greater forces that the contra lateral limb must absorb may in part be related to the elevated risk of injury associated with the non injured limb. The lack of relationship to loading rate suggests kinesiophobia is more related to the magnitude of the load and not the subject’s ability to control the load. These results suggest that in patients with elevated kinesiophobia, cognitive training may be needed before initiating movement retraining or other exercises to improve landing mechanics. Additional prospective studies are needed to assess if these relationships improve over time and determine the optimal time to intervene to reduce subsequent injury risk.

High Kinesiophobia and Pain Catastrophizing in People with Articular Cartilage Defects in the Knee

Objectives:Psychosocial factors, including kinesiophobia and pain catastrophizing, are increasingly recognized for the role they play in knee function and quality of life for people with anterior cruciate ligament reconstruction (ACLR), knee osteoarthritis (OA), and total knee arthroplasties (TKA). People with articular cartilage defects in the knee have impaired function and poor quality of life, however the extent to which they present with kinesiophobia and pain catastrophizing is not known. The purpose of this study is to compare kinesiophobia, i.e. fear of movement-related pain/reinjury, and pain catastrophizing of people with articular cartilage defects (ACD) in the knee to healthy controls.Methods:Thirty-five individuals (19M:16F, Age mean ± 95%CI 29.8 ± 2.8 years old, BMI 28.1 ± 1.44) seeking surgical consultation for an ACD in the knee confirmed with 3.0T MRI and 18 controls (9M:9F, Age 29.8 ± 3.0 years old, BMI 24.9 ± 1.3) without history of knee injury participated in the study. Exclusion criteria included; age >55 years, BMI >35kg/m2, recent surgery, current low back pain or unrelated lower extremity pain, and history of spine surgery or neurological injury and pathology. Kinesiophobia for all 53 subjects was measured with the Tampa Scale of Kinesiophobia (TSK). The TSK was scored using the original 17-item (TSK-17, Min 17 - Max 68) and modified 11-item (TSK-11, Min 11 - Max 44) scoring systems as both have been commonly used in the literature. Pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS, Min 0 - Max 52). Higher scores on these measures indicate greater kinesiophobia and pain catastrophizing. Independent t-tests were used to compare the ACD group to the healthy controls (α=0.05). Mean TSK and PCS scores (± 95% CI) were plotted alongside values published in samples with other knee pathologies for reference.Results:Participants with ACDs reported higher kinesiophobia (TSK-17 mean score ± 95%CI [range]: ACD 40.9 ± 1.7 [29-53], Healthy Control 29.9 ± 1.3 [26-35], p<0.001; TSK-11 score: ACD 27.0 ± 1.2[16-34], Healthy Control 15.8 ± 1.2 [11-20], p<0.001) and higher pain catastrophizing (PCS score: ACD 12.7 ± 3.5 [0-42], Healthy Control 4.0 ± 2.6 [0-14], p<0.001) than age-matched healthy controls. Greater kinesiophobia and pain catastrophizing were also observed in people with ACDs compared to values published in people after ACLR, people with knee OA, and similar to people with severe OA preparing for TKA (Figure 1).Conclusion:This is the first study to our knowledge to evaluate psychosocial factors in people with ACDs of the knee. Kinesiophobia and pain catastrophizing in people with knee ACDs were similar to people with severe knee OA preparing for TKA, and higher than healthy controls and people before and after ACLR. While higher kinesiophobia and pain catastrophizing are consistently associated with worse function and quality of life in these populations, understanding the relationship to outcomes and prognosis in people with knee ACDs remains unknown and is a target of our ongoing work.

Efficacy and Tolerability of Peritendinous Hyaluronic Acid in Patients with Supraspinatus Tendinopathy: a Multicenter, Randomized, Controlled Trial

BackgroundPhysical therapy and peritendinous hyaluronic acid (HA) injections have both shown promising results in the treatment of shoulder tendinopathies. However, the superiority of treatment combining physical therapy and HA is unclear.MethodsPatients with ultrasound-confirmed supraspinatus tendinopathy were randomized to receive either physical therapy + subacromial HA injections or physical therapy only. Treatment efficacy was assessed using a Visual Analog Scale (VAS) for pain and an Activities of Daily Living (ADL) scale. Other measures were the number of rehabilitation sessions and days needed for recovery, the Tampa Scale for Kinesiophobia (TSK), and the physician and patient’s perception of efficacy and tolerability. Patients were followed up for 90 days.ResultsOverall, VAS and ADL scores showed a progressive decrease during the follow-up (P < 0.01 at all visits for both groups), without significant differences between groups. The TSK score decreased significantly more in the HA group than in the control group (3.6 vs. 2.4; P < 0.001). Patients in the control group needed more rehabilitation sessions (28 vs. 22 in the HA group; P = 0.006) and more days for returning to their pre-injury activity (32 vs. 20 in the HA group; P = 0.013). Both patients and investigators perceived higher efficacy in the HA group than in the control group (P = 0.034). Both treatments were safe and well tolerated.ConclusionsSubacromial HA injections combined with physical therapy have high efficacy in the treatment of supraspinatus tendinopathy, leading to an earlier return to pre-injury activity and the need for fewer rehabilitation sessions, which may benefit both patients and the healthcare system.

The impact of pain-related fear on neural pathways of pain modulation in chronic low back pain

Pain-related fear plays a substantial role in chronic low back pain (LBP) by amplifying the experienced disability. Related dysfunctional emotions and cognitions may also affect sensory aspects of pain through a modulatory pathway in which the periaqueductal gray (PAG) and the amygdala play key roles. We therefore hypothesized a differential amygdala-PAG functional connectivity (FC) in patients with chronic LBP that is modulated by the degree of pain-related fear. We used data of a previously reported fMRI study where 20 chronic LBP patients (7 females, mean age = 39.35) and 20 healthy controls (12 females, mean age = 32.10) were asked to observe video clips showing potentially harmful and neutral activities for the back. Pain-related fear was assessed using the Tampa Scale of kinesiophobia (TSK) and Fear Avoidance Beliefs questionnaires (FABQ). Generalized psychophysiological interactions were used to reveal task-based FC. Compared to controls, patients exhibited a significant decrease in amygdala-PAG-FC (P = 0.022) during observation of harmful activities, but not of neutral activities. Furthermore, amygdala-PAG-FC correlated negatively with Tampa Scale of kinesiophobia scores in patients (R2 = 0.28, P = 0.01) but not with Fear Avoidance Beliefs questionnaires scores. Our findings might indicate a maladaptive psychobiological interaction in chronic LBP patients characterized by a disrupted amygdala-PAG-FC that is modulated by the degree of pain-related fear. These results shed new light on brain mechanisms underlying psychological factors that may have pronociceptive effects in chronic LBP.

Kinesiophobia and physical therapy-related pain in musculoskeletal pain: A national multicenter cohort study on patients and their general physicians

IntroductionPhysical therapy (PT) represents a major approach in musculoskeletal (MSK) pain. This study aimed to assess kinesiophobia, its impact and management, in patients with MSK pain treated by PT. MethodsA national multicenter, prospective study was conducted in France in patients with MSK pain referred to PT. Kinesiophobia was scored with the Tampa Scale of Kinesiophobia (TSK). Pain, satisfaction, analgesic intake and acceptability were assessed at the initial visit, at the 5th PT session, and at the end of PT. ResultsA total of 700 consecutive outpatients with MSK pain, 54.5% female, referred to PT were recruited by 186 GPs: 501 had significant levels of kinesiophobia (TSK score>40). Patients with kinesiophobia were significantly older, with less physical activity, more pain and less acceptability. Patients from GPs presenting with kinesiophobia had both higher pain and kinesiophobia levels. After 5 PT sessions, global satisfaction was significantly higher in patients without kinesiophobia. A significant increase of PT satisfaction was observed in patients who had been given preventive analgesics before PT sessions, in 25.6% of patients. Independent predictors for specific management of PT-induced pain were: patient's kinesiophobia (OR=2.02 [1.07–3.82]), current analgesics treatment (OR=2.05 [1.16–3.63]), GP with postgraduate course on pain (OR=2.65 [1.29–5.43]), GP's independent practice (OR=1.88 [1.01–3.48]). ConclusionKinesiophobia is frequent in patients with MSK pain, is associated to GPs’ kinesiophobia and decreases satisfaction of physical therapy. Preventive analgesic treatment before PT sessions improves patients’ satisfaction and should be proposed to improve MSK pain management.

Fear-avoidance beliefs are independently associated with the prevalence of chronic pain in Japanese workers.

Pain is a global public health problem with implications for both personal and social heath. Fear-avoidance beliefs (FABs) have been demonstrated to negatively impact and prolong pain in many Western countries, but little is known about the association between FABs and chronic pain (CP) in Asian countries, including Japan. We examined the relationship between FABs and CP in Japanese white-collar workers, a growing population with a high prevalence of CP. Questionnaires and company records were used to gather data from 433 Japanese white-collar workers. Data were related to experience of pain, participant sociodemographic/health/lifestyle characteristics, fear-avoidance beliefs [Tampa Scale for Kinesiophobia (TSK)], work-related psychosocial factors (Brief Job Stress Questionnaire), and depressive illness [Psychological Distress Scale (K6)]. Analysis of covariance and multilevel logistic regression modeling were used to analyze associations between the data while controlling for factors known to influence CP prevalence. Prevalence rate of CP was 11.1% (48 of 433 persons). Adjusted odds ratios for participants with CP significantly increased in participants with high TSK scores, even after adjusting for factors known to influence CP prevalence. We found a significant association between high TSK scores and CP in Japanese white-collar workers when controlling for other known factors that influence CP such as work-related psychosocial characteristics and depressive conditions. This finding suggests that FABs are independently associated with prevalence of CP.

Relationship between kinesiophobia and pain, quality of life, functional status, disease activity, mobility, and depression in patients with ankylosing spondylitis

Background/aim: Our aim was to investigate the association of kinesiophobia with pain, quality of life, clinical measures, and depression in patients with ankylosing spondylitis (AS). Materials and methods: Patients with AS (n: 163) were enrolled in the study. Kinesiophobia was evaluated with the Tampa Scale of Kinesiophobia (TSK), pain with a visual analog scale (VAS), mobility with Bath Ankylosing Spondylitis Metrology Index (BASMI), disease activity with the Bath AS Disease Activity Index (BASDAI), functional status with the Bath AS Functional Index (BASFI), depression level with Beck's Depression Inventory (BDI), and quality of life with the AS Quality of Life Questionnaire (ASQoL). Besides correlation analysis, outcome measures were compared between patients with (TSK ? 37) and without (TSK < 37) kinesiophobia. Results: Kinesiophobia was found to be common with a percentage of 66.6%. TSK scores were correlated with VAS, BASFI, ASQoL, and BDI scores (r = 0.259, r = 0.294, r = 0.392, and r = 0.398, respectively; P < 0.05 for each). There were no correlations between TSK and the BASDAI and BASMI scores (r = 0.142, r = 0.198, respectively; P > 0.05). Patients with kinesiophobia had more pain and poorer BASFI, ASQoL, and BDI scores than patients without kinesiophobia (P < 0.05).Conclusion: Our study is the first study that investigated the relationship between kinesiophobia and other clinical measures in AS patients. Pain and psychological status have an impact on fear of movement and thus functional status and quality of life.

Reliability and Validity of the Cross-Culturally Adapted Thai Version of the Tampa Scale for Kinesiophobia in Knee Osteoarthritis Patients.

The aim of this study was to develop a cross-culturally adapted Thai version of the Tampa Scale for Kinesiophobia (TSK) and investigate its reliability and validity among patients with knee osteoarthritis. The TSK was translated into Thai language and culturally adapted in line with the international standards. The Thai TSK questionnaire was then tested for internal consistency, test-retest reliability, and convergent validity by comparing it with the visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index, State-Trait Anxiety Inventory, and Timed Up and Go Test. Eighty patients with knee osteoarthritis were included in the study. The Thai version of the TSK was easily comprehended and completed within 6 minutes. The questionnaire showed a good internal consistency (α = 0.90) and high test-retest reliability {ICC (2,1) = 0.934}. Convergent validity showed high correlations with the visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index, and State-Trait Anxiety Inventory (r = 0.741, 0.856, and 0.817, respectively). However, there was no significant correlation between the Thai version of the TSK scores and the Timed Up and Go Test results. The Thai version of the TSK has satisfactory reliability and validity for the evaluation of pain-related fear of movement/(re)injury in patients with knee osteoarthritis.

Translation and cross-cultural adaptation of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Turkish.

To translate and culturally adapt the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Turkish (ACL-RSI-Tr) and examine and evaluate the psychometric properties of the Turkish version in individuals who have undergone anterior cruciate ligament (ACL) reconstruction. The ACL-RSI was forward- and back-translated, culturally adapted and validated on ninety-three Turkish individuals who had undergone ACL reconstruction (5 females, 88 males; age 28.7±8.6years; body mass 80.1±13.9kg; height 178.8±6.9cm; body mass index 25.0±3.7kg/m2). All patients completed the translated ACL-RSI, Tampa Scale of Kinesiophobia (TSK), Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentary Committee (IKDC) and Lysholm questionnaires. We then analysed the internal consistency, reliability and validity of the newly formed ACL-RSI-Tr scale. The ACL-RSI-Tr showed good internal consistency (Cronbach's alpha 0.86) and test-retest reliability (ICC 0.92) and was significantly correlated with the KOOS 'quality of life' (r=0.58, p<0.002), 'symptoms and stiffness' (r=0.35, p=0.001), 'pain' (r=0.49, p<0.001), 'sports' (r=0.44, p<0.001) and 'daily life' (r=0.42, p<0.001) subscales. The ACL-RSI-Tr also correlated significantly with the TSK (r=-0.45, p<0.001), Lysholm (r=0.45, p<0.001) and IKDC (r=0.44, p<0.001) scores. The Turkish version of the ACL-RSI scale was valid, discriminant, consistent and reliable in patients who had undergone ACL reconstruction. This score could be useful to evaluate the effect of psychological factors on return to sport following ACL surgery. Diagnostic study, Level I.

Comparison of pain, kinesiophobia and quality of life in patients with low back and neck pain.

[Purpose] The purpose of this study was to compare patients with low back and neck pain with respect to kinesiophobia, pain, and quality of life. [Subjects and Methods] Three-hundred patients with low back (mean age 43.2±11 years) and 300 with neck pain (mean age 42.8±10.2 years) were included in this study. Pain severity was evaluated by using the Short-Form McGill Pain Questionnaire, which includes a Visual Analogue Scale, quality of life by the Nottingham Health Profile, and kinesiophobia by the Tampa Scale for Kinesiophobia. [Results] Pain severity was similar in both groups, with a Visual Analogue Scale score of 6.7±2 in the low back pain and 6.8±2 in the neck pain group. Nottingham Health Profile pain [z=−4.132] and physical activity scores [z=−5.640] in the low back pain group were significantly higher. Kinesiophobia was also more severe in the low back pain group, with a mean 42.05±5.91 versus 39.7±6.0 Tampa Scale for Kinesiophobia score [z=−4.732]. [Conclusion] Patients with low back pain developed more severe kinesiophobia, regardless of the pain severity, and had greater pain perception and lower physical activity levels. Kinesiophobia adversely affects the quality of life and requires effective management of low back pain.

Decreased Range of Motion After Total Knee Arthroplasty Is Predicted by the Tampa Scale of Kinesiophobia

BackgroundRange of motion (ROM) is important for functional outcome after total knee arthroplasty (TKA); however, some patients hesitate to maximize their ROM postoperatively. The Tampa Scale of Kinesiophobia (TSK) measures patients' fear of movement. The primary purpose of this investigation was to determine whether TSK scores correlated with decreased ROM after primary TKA. A secondary purpose was to determine whether biofeedback could increase ROM after TKA. MethodsPatients were recruited from the senior author's practice between June 2011 and March 2013. A clinical photograph was taken of each patient’s knee in maximum passive flexion in the operating room immediately following closure. Patients were randomized to the control or photograph group before incision. A linear mixed model was implemented to determine whether the TSK score and viewing the photo correlated to ROM. ResultsSeventy-nine patients were analyzed for correlation between the TSK score and the knee ROM. Sixty patients were analyzed for correlation between viewing the clinical photograph and the knee ROM. The linear mixed model demonstrated a significant negative correlation between the TSK score and both active (β = −0.47, P < .01) and passive (β = −0.66, P < .001) knee flexions. There was a trend toward decreased knee flexion among patients shown their clinical photograph. ConclusionThe TSK was developed as a tool to identify patients at risk for maladaptive responses to painful stimuli. Our data suggest that the TSK may help arthroplasty surgeons identify patients at risk for decreased ROM after TKA. Showing patients a clinical photograph failed to increase ROM after TKA.

Establishing clinically meaningful severity levels for the Tampa Scale for Kinesiophobia (TSK-13).

Kinesiophobia is an excessive, irrational and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury. The Tampa Scale for kinesiophobia (TSK) is a patient-reported outcome (PRO) measure designed to help identify kinesiophobia. The original version of the TSK had 17 items. A 13-item version was later found to have better psychometric properties and was used in the present study. Although the TSK-13 has been widely studied, one shortcoming is the lack of clinically meaningful score categories. The objective of the present study was to develop severity levels to help aid clinical interpretation of TSK-13 scores. After creating four proposed TSK-13 severity ranges, a sample of chronic musculoskeletal pain disorder (CMPD) patients (N=912) was grouped by TSK-13 scores into: Subclinical (score=13-22, n=100; 11%), mild (23-32, n=271; 30%), moderate (33-42, n=385; 42%) and severe (43-52, n=156; 17%) levels of kinesiophobia. These severity groups were then validated by their associations with objective lifting performance (presumed to be highly related to one's level of kinesiophobia) and otherPRO questionnaires, assessing depressive symptoms, pain intensity, pain-related anxiety and perceived disability, which all have been shown in previous research to be associated with TSK scores. The TSK-13 severity level groups were significantly associated with all lifting performance and PRO variables (p<0.001). As TSK-13 severity levels increased, lifting performance decreased, while pain intensity, depressive symptoms, pain-related anxiety and perceived disability increased. TSK-13 severity levels were strongly associated with objective lifting performance variables and psychosocial PRO measures, providing support for these severity levels as a guideline for healthcare providers and researchers in interpreting TSK-13 scores.

The relationship between the Tampa Scale of Kinesiophobia and low back pain rehabilitation outcomes

BackgroundContextThe Tampa Scale for Kinesiophobia (TSK) is commonly used in clinical practice to quantify levels of pain-related fear of activity or re-injury in patients presenting with back pain. Patients with high levels of kinesiophobia are often considered at greater risk of developing long-term activity limitation and chronicity. There is, however, little evidence to support this assumption. PurposeThe purpose of this study was to assess the role of the TSK in determining eventual outcome in a cohort of low back pain patients completing a multidisciplinary rehabilitation program. Study Design/SettingA prospective cohort study was used. Patient SampleThe sample consisted of 313 low back pain patients treated at one of six rehabilitation clinics in New Zealand over a 4-year period. Outcome MeasuresThe outcome measures for this study are the TSK, Numeric Pain Scale (NPS), Modified Low Back Outcome Score (m-LBOS), and vocational status (working or not working). MethodsTSK questionnaire scores and three additional quality of life (QoL) measures (NPS, m-LBOS, and vocational status) were recorded at the initial assessment and after a 6- to 12-week period of rehabilitation. Statistical analysis was performed to determine the relationships between TSK scores and the QoL values recorded at initial assessment and postrehabilitation checkpoints. ResultsThe correlations between initial TSK, NPS, and m-LBOS values recorded at assessment were statistically significant, but the relationships were weak. More importantly, there was no correlation between baseline TSK scores and changes in the numeric pain rating, perceived function, or vocational status after a period of rehabilitation. Correlations between changes in TSK scores and changes in NPS and m-LBOS values after rehabilitation were statistically significant, but the relationships were weak. ConclusionsThe TSK provides no benefit as a screening tool to predict pain, functional and work outcomes following rehabilitation. Measured changes in TSK scores following rehabilitation do not correlate strongly with similar, concordant changes in pain scores, functional levels, or return-to-work outcomes.

Reliability and validity of the Persian versions of the fear avoidance beliefs questionnaire and Tampa Scale of Kinesiophobia in patients with neck pain.

Validation of 2 self-report questionnaires. To evaluate the internal consistency, reliability, and construct validity of the Persian versions of the fear avoidance beliefs questionnaire (FABQ) and the Tampa Scale of Kinesiophobia (TSK) in patients with acute and chronic neck pain. The FABQ and TSK are 2 important measures to evaluate fear of pain and fear avoidance beliefs in patients with spinal pain. To date, the psychometric properties of these questionnaires have not been demonstrated in Persian-speaking patients with neck pain in Iran. One hundred sixty-six patients with acute and chronic neck pain participated in the study. The construct validity of the questionnaires was evaluated by measuring convergent and known-groups validity. The visual analogue scale measure of pain, neck disability index, hospital anxiety and depression scale, and the physical (PCS-12) and mental (MCS-12) summary scores of the Short Form health survey (SF-12) were used to test construct validity of the Persian FABQ and TSK. In addition, 50 randomly selected patients with chronic neck pain were asked to complete the questionnaires 48 hours later for the second time. Cronbach α coefficient for the FABQ and TSK in patients with acute and chronic pain was in the range from 0.77 to 0.92 and 0.77 to 0.78, respectively. The Persian FABQ and TSK showed satisfactory test-retest reliability with intraclass correlation coefficient of more than 0.80. There were moderate to strong correlations between the Persian FABQ and TSK scores and the neck disability index (r = 0.44-0.55), Depression subscales of the hospital anxiety and depression scale (r = 0.42-0.48), and PCS-12 (r =-0.34 to -0.62). The Persian FABQ and TSK have acceptable reliability and validity for measuring pain related fear and avoidance beliefs among Persian-speaking patients with acute and chronic neck pain. However, considering the study limitations, the findings should be interpreted with caution. 3.

AB1442-HPR Fear of movement in ankylosing spondilitis patients: A pilot study

BackgroundAnkylosing spondilitis (AS) is a chronic, inflammatory disorder characterized by pain and stiffness especially on back and sacroiliac joint. Pain, reduced spine mobility, and decreased physical functioning are the major...