Tampa Scale for Kinesiophobia (TSK)

About Tampa Scale for Kinesiophobia

The concept of kinesiophobia was introduced in 1990 at the Ninth Annual Scientific Meeting of the American Pain Society with reference to fear of pain with movement and defined 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 Tampa Scale for Kinesiophobia (TSK) was developed by Miller, Kori and Todd in 1991 as a self-report checklist that measures fear of movement or re(injury) as linked to thoughts and beliefs about pain.

The scale is based on the model of fear avoidance, fear of work-related activities, movement or re-injury:

1. I’m afraid that I might injury myself if I exercise.
2. If I were to try to overcome it, my pain would increase.
3. My body is telling me I have something dangerously wrong.
4. My pain would probably be relieved if I were to exercise.
5. People aren’t taking my medical condition seriously enough.
6. My accident has put my body at risk for the rest of my life.
7. Pain always means I have injured my body.
8. Just because something aggravates my pain does not mean it is dangerous.
9. I am afraid that I might injure myself accidentally.
10. Simply being careful that I do not make any unnecessary movements is the safest thing I can do to prevent my pain from worsening.
11. I wouldn’t have this much pain if there weren’t something potentially dangerous going on in my body.
12. Although my condition is painful, I would be better off if I were physically active.
13. Pain lets me know when to stop exercising so that I don’t injure myself.
14. It’s really not safe for a person with a condition like mine to be physically active.
15. I can’t do all the things normal people do because it’s too easy for me to get injured.
16. Even though something is causing me a lot of pain, I don’t think it’s actually dangerous.
17. No one should have to exercise when he/she is in pain.

Scoring is based on a 4-point Likert scale where:

• Items 1, 2, 3, 5, 6, 7,9, 10, 11, 13, 14, 15 and 17 are scored as follows: Strongly disagree (1), Disagree (2), Agree (3), Strongly agree (4).
• Items 4, 8, 12 and 16 are scored on the inverted scale: Strongly disagree (4), Disagree (3), Agree (2), Strongly agree (1).

The final TSK score is formed by adding the points from all 17 items. TSK scores range from 17 to 68, where scores of 17 indicate no kinesiophobia and scores of 68 indicate extreme fear of pain with movement.

In their 1995 study, Vlaeyen et al. introduced a cut off of 37 for high scores, with scores below this value considered low.

Some practitioners consider useful to also use the scores from two subscales:

• Activity Avoidance subscale – which reflects the beliefs that activity may cause injury or increased pain (adds points from items 1, 2, 7, 9 – 12);
• Somatic Focus subscale – which reflects beliefs in underlying serious medical problems (adds points from items 3, 4, 5, 6 and 8).

A shortened 11-item version was also published by Woby et al. in 2005. The TSK-11 retains items: 1, 2, 3, 5, 6, 7, 10, 11, 13, 15 and 17 from the original scale and their scoring.

TSK-11 scores range from 11 to 44, where the higher the score, the greater the fear of pain with movement.

Whilst originally developed to assess fear of movement in patients with lower back pain, the score was subsequently validated to assess kinesiophobia in a variety of conditions, chronic pain or knees or shoulders or fibromyalgia.

Roelofs et al. validated the TSK in patients with chronic low back pain (CLBP) and fibromyalgia. Construct validity of the TSK and its subscales was proven by moderate correlation coefficients with self-report measures of pain-related fear, pain catastrophising, and disability.

References

Original references

Miller RP, Kori S, Todd D. The Tampa Scale: a measure of kinesiophobia. Clin J Pain. 1991; 7(1):51–52.

Woby SR, Roach NK, Urmston M, Watson PJ. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain. 2005; 117(1-2):137-144.

Validation

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. Eur J Pain. 2004; 8(5):495-502.

French DJ, France CR, Vigneau F, French JA, Evans RT. 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; 127(1-2):42-51.

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. Man Ther. 2003; 8(1):29-36.

Other references

Kori SH, Miller RP, Todd DD. Kinesiophobia: A new view of chronic pain behavior. Pain Management. 1990; 3:35–43.

Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995; 62(3):363-372.

Mintken PE, Cleland JA, Whitman JM, George SZ. Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with shoulder pain. Arch Phys Med Rehabil. 2010; 91(7):1128-1136.