Tampa Scale of Kinesiophobia (TSK)

The TSK is a 17-item self report checklist using a 4-point Likert scale that was developed as a measure of fear of movement or (re)injury.

Kinesiophobia is defined by the developers as “an irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury” (Kori et al., 1990).
The scale has two subsales:

  • Activity Avoidance – the belief that activity may result in (re)injury or increased pain.
  • Somatic Focus – the belief in underlying and serious medical problems

The scale is based on the model of fear avoidance, fear of work related activities, fear of movement and fear of re-injury (Vlaeyan et al., 1995). The TSK has also been linked to elements of catastrophic thinking (Burwinkle et al., 2005). The scale can be useful in measuring unhelpful thoughts and beliefs about pain in people with chronic pain or fibromyalgia.

Validity and Reliability

Roelofs et al (2004) conducted a validation study with individuals with chronic low back pain (CLBP) and fibromyalgia patients, validating the two-factor model of the Tampa Scale for Kinesiophobia (TSK) by means of confirmatory factor analysis.

Construct and predictive validity of the TSK subscales were also examined. Results clearly indicated that a two-factor model fitted best in both pain samples. Construct validity of the TSK and its subscales was supported by moderate correlation coefficients with self-report measures of pain-related fear, pain catastrophising, and disability, predominantly in patients with CLBP. Predictive validity was supported by moderate correlation coefficients with performance on physical performance tests (i.e., lifting tasks, bicycle task) mainly in CLBP patients.

Scoring and Interpretation

Results consist of a total raw score (range between 17 and 68) and two subscale scores.

  • Activity Avoidance – this subscale reflects the belief that activity may result in (re)injury or increased pain.
  • Somatic Focus – reflects the belief in underlying and serious medical problems

Additionally, scores are presented in percentile terms in comparison to patients with chronic back pain (CBP Percentile) and Fibromyalgia (FM Percentile) using data from Roelofs et al (2004). Percentiles are useful to contextualise the respondents score in comparison to typical responses among particular groups. For example, a percentile of 50 compared to the Fibromyalgia sample represents an average level of kinesiophobia compared to others with Fibromyalgia.

A high value on the TSK indicates a high degree of kinesiophobia, and a cutoff score was developed by Vlaeyen (1995), where a score of 37 or over is considered as a high score and are predictive of poorer health outcomes. Use of a total score (including all 17 items) is recommended, although practitioners may wish to interpret results using two subscales.

Developer

The original Tampa Scale of Kinesiophobia (TSK) was developed by R. Miller, S. Kopri, and D. Todd, in 1991. This represents a modified version.

References

Vlaeyen, J. W. S., Kole-Snijders, A. M. J., Boeren, R. G. B., & Van Eek, H. (1995). Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. Pain, 62(3), 363-372.

Burwinkle, T., Robinson, J. P., & Turk, D. C. (2005). Fear of movement: factor structure of the Tampa Scale of Kinesiophobia in patients with fibromyalgia syndrome. The Journal of Pain, 6(6), 384-391.

Lundberg, M. K. E., Styf, J., & Carlsson, S. G. (2004). A psychometric evaluation of the Tampa Scale for Kinesiophobia-from a physiotherapeutic perspective. Physiotherapy Theory and Practice, 20(2), 121-133.

Roelofs, J., Goubert, L., Peters, M. L., Vlaeyen, J. W. S., & Crombez, G. (2004). The Tampa Scale for Kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia. European Journal of Pain, 8(5), 495-502.