Article

Confirmatory Factor Analysis of the Tampa Scale for Kinesiophobia: Invariant Two-Factor Model Across Low Back Pain Patients and Fibromyalgia Patients

March 2004
Clinical Journal of Pain 20(2):103-10

March 2004
20(2):103-10

DOI:10.1097/00002508-200403000-00007

Source
PubMed

Authors:

Liesbet Goubert

Ghent University

Geert Crombez

Ghent University

Stefaan Van Damme

Ghent University

Johannes W Vlaeyen

KU Leuven

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(1) To investigate the factor structure of the Tampa Scale for Kinesiophobia (TSK) in a Dutch-speaking sample of chronic low back pain (CLBP) patients using confirmatory factor analysis, (2) to examine whether the internal structure of the TSK extends to another group of fibromyalgia (FM) patients, and (3) to investigate the stability of the factor structure in both patient groups using multi-sample analysis. TSK-data from 8 studies collected in Dutch and Flemish chronic pain patients were pooled. For 188 CLBP patients and 89 FM patients, complete data were available. Confirmatory factor analyses were performed to assess 4 models of kinesiophobia, and to examine which factor model provided the best fit. Furthermore, a multi-sample analysis was performed to investigate the stability of the factor structure in both patient groups. For both CLBP and FM patients, the 2-factor model containing the factors "activity avoidance" and "pathologic somatic focus" was superior as compared with the 4-factor model containing the factors "harm," "fear of (re)injury." "importance of exercise," and "avoidance of activity". Moreover, the 2-factor model was found to be invariant across CLBP and FM patients, indicating that this model is robust in both pain samples. As the 2-factor structure provided the best fit of the data in both patient samples, we recommend to use this version of the TSK and its 2 subscales in both clinical practice and research. Based on the content of the items, the subscales were labeled "Harm" and "Fear-avoidance."

The Tampa Scale of Kinesiophobia: A Systematic Review of Its Psychometric Properties in People With Musculoskeletal Pain

Article

Mar 2023
CLIN J PAIN

Objective: The aims of this systematic review were to identify the different versions of the TSK and to report on the psychometric evidence relating to these different versions for people suffering from musculoskeletal pain. Methods: Medline [Ovid] CINAHL and Embase databases were searched for publications reporting on psychometric properties of the TSK in populations with musculoskeletal pain. Risks of bias were evaluated using the COSMIN risk of bias assessment tool. Results: Forty-one studies were included, mainly of low risk of bias. Five versions of the TSK were identified: TSK-17, TSK-13, TSK-11, TSK-4 and TSK-TMD (for temporomandibular disorders). Most TSK versions showed good to excellent test-retest reliability (ICC 0.77-0.99) and good internal consistency (ɑ=0.68-0.91), except for the TSK-4 as its reliability has yet to be defined. The minimal detectable change was lower for the TSK-17 (11-13% of total score) and the TSK-13 (8% of total score) compared to the TSK-11 (16% of total score). Most TSK versions showed good construct validity, although TSK-11 validity was inconsistent between studies. Finally, the TSK-17, -13 and -11 are highly responsive to change, while responsiveness has yet to be defined for the TSK-4 and TSK-TMD. Discussion: Clinical guidelines now recommend that clinicians identify the presence of kinesiophobia among patients as it may contribute to persistent pain and disability. The TSK is a self-report questionnaire widely used, but five different versions exist. Based on these results, the use of TSK-13 and TSK-17 is encouraged as they are valid, reliable and responsive.

The Interaction Between Psychosocial Factors and Exercise-Induced Hypoalgesia in Pain-Free Nurses

Article

Full-text available

Feb 2023

Purpose: This cross-sectional study aimed to investigate whether psychosocial factors were predictive for exercise-induced hypoalgesia (EIH) in pain-free adults. Methods: A sample of 38 pain-free nurses with a mean (SD) age of 26 (6) years were included in this study. Participants completed psychosocial questionnaires prior to physical tests. Pressure pain threshold (PPT) was assessed bilaterally at the calves (local), lower back (semi-local) and forearm (remote) before and immediately after a maximal graded cycling exercise test. Separate linear mixed effects models were used to determine change in PPT before and after cycling exercise (EIH). Multiple linear regression for all psychosocial variables and best subset regression was used to identify predictors of EIH at all locations. Results: The relative mean increase in PPT at the forearm, lumbar, calf, and globally (all sites pooled) was 6.0% (p<0.001), 10.1% (p<0.001), 13.9% (p<0.001), and 10.2% (p=0.013), respectively. Separate best subset multiple linear regression models at the forearm (predictors; Multidimensional Scale of Perceived Social Support (MSPSS) total), lumbar (predictors; MSPSS total, Pain Catastrophizing Scale (PCS) total, Depression Anxiety Stress Scale (DASS) depression), calf (predictors; MSPSS friends, PCS total), and global (predictors; MSPSS friends, PCS total) accounted for 7.5% (p=0.053), 13% (p=0.052), 24% (p=0.003), and 17% (p=0.015) of the variance, respectively. Conclusion: These findings confirm that cycling exercise produced EIH in young nurses and provided preliminary evidence to support the interaction between perceived social support, pain catastrophizing and EIH. Further investigation is required to better understand psychological and social factors that mediate EIH on a larger sample of adults at high risk of developing chronic musculoskeletal pain.

Clinical phenotypes and prognostic factors in persons with hip osteoarthritis undergoing total hip arthroplasty: protocol for a longitudinal prospective cohort study (HIPPROCLIPS)

Article

Full-text available

Mar 2023
BMC MUSCULOSKEL DIS

Background: Large heterogeneity exists in the clinical manifestation of hip osteoarthritis (OA). It is therefore not surprising that pain and disability in individuals with hip OA and after total hip arthroplasty (THA) cannot be explained by biomedical variables alone. Indeed, also maladaptive pain-related cognitions and emotions can contribute to pain and disability, and can lead to poor treatment outcomes. Traumatic experiences, mental disorders, self-efficacy and social support can influence stress appraisal and strategies to cope with pain, but their influence on pain and disability has not yet been established in individuals with hip OA undergoing THA. This study aims (1) to determine the influence of traumatic experiences and mental disorders on pain processing before and shortly after THA (2) to identify preoperative clinical phenotypes in individuals with hip OA eligible for THA, (3) to identify pre- and early postoperative prognostic factors for outcomes in pain and disability after THA, and (4) to identify postoperative clinical phenotypes in individuals after THA. Methods: This prospective longitudinal cohort study will investigate 200 individuals undergoing THA for hip OA. Phenotyping variables and candidate prognostic factors include pain-related fear-avoidance behaviour, perceived injustice, mental disorders, traumatic experiences, self-efficacy, and social support. Peripheral and central pain mechanisms will be assessed with thermal quantitative sensory testing. The primary outcome measure is the hip disability and osteoarthritis outcome score. Other outcome measures include performance-based measures, hip muscle strength, the patient-specific functional scale, pain intensity, global perceived effect, and outcome satisfaction. All these measurements will be performed before surgery, as well as 6 weeks, 3 months, and 12 months after surgery. Pain-related cognitions and emotions will additionally be assessed in the early postoperative phase, on the first, third, fifth, and seventh day after THA. Main statistical methods that will be used to answer the respective research questions include: LASSO regression, decision tree learning, gradient boosting algorithms, and recurrent neural networks. Discussion: The identification of clinical phenotypes and prognostic factors for outcomes in pain and disability will be a first step towards pre- and postoperative precision medicine for individuals with hip OA undergoing THA. Trial registration: ClinicalTrials.gov: NCT05265858. Registered on 04/03/2022.

The development and measurement properties of the Dutch version of the Fear-Avoidance Component Scale (FACS-D) in persons with chronic musculoskeletal pain

Article

Dec 2022

Objectives The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument assessing different constructs related to the fear-avoidance model of pain. The aim was to translate the original English FACS into Dutch (FACS-D) and assess its measurement properties in persons with chronic musculoskeletal pain. Methods The original English FACS (20 item-scale, range: 0–100) was translated in Dutch through standard forward-backward translation methodology. The FACS-D’s measurement properties were evaluated in 224 persons with chronic musculoskeletal pain. Internal consistency, test-retest reliability and measurement error were assessed with the Cronbach’s alpha coefficient (α), intraclass correlation coefficient (ICC), and standard error of measurement (SEM). Construct validity was assessed through inter-item correlation analyses, exploratory factor analysis, association with other fear-avoidance-related constructs, and hypothesis testing. Results Internal consistency, test-retest reliability and hypotheses testing were good (α=0.92; ICC=0.92, CI 0.80–0.96; 7/8 hypotheses confirmed). Similar to the original FACS and other translated versions, a two-factor model best fit the data. However, the item distribution differed from other versions. One factor represented “pain-related cognitions and emotions” and a second factor represented “avoidance behaviour.” In contrast to the original FACS, low inter-item correlations for item 12 were found. The FACS-D was more strongly associated with fear-avoidance-related constructs of pain severity, perceived disability, feelings of injustice, and depressive/anxiety symptoms than the other fear-avoidance-related scales studied here. Conclusions The FACS-D demonstrated good reliability and construct validity, suggesting that it may be a useful measure for Dutch-speaking healthcare providers. Two clinically relevant factors, with a different item distribution than the original FACS, were identified: one covering items on pain-related cognitions and emotions, and one covering items on avoidance behaviour. The stronger association between FACS-D and fear-avoidance related constructs suggests that the FACS-D may be more effective in evaluating the cognitive, emotional and behavioural constructs of pain-related fear-avoidance than other similar measures.

Plantarflexor neuromuscular performance in Insertional Achilles tendinopathy

Article

Oct 2022

Background Insertional Achilles tendinopathy (IAT) is a common and painful musculoskeletal condition. The management of IAT commonly involves strengthening of the plantarflexors, although there is currently a paucity of research investigating plantarflexor neuromuscular performance specific to people with IAT. Objectives To compare plantarflexor neuromuscular performance between men with IAT and controls, and to investigate the relationship between plantarflexor neuromuscular performance and patient reported outcome measures for men with IAT. Design Case control. Method 34 men with IAT (age 43.7 years [SD 10.02], weight 89.6kg [16.3]) were matched with 34 healthy men (age 42.8 years [SD 8.9], weight 87.2kg [9.7]). Participants underwent a plantarflexion maximal voluntary isometric contraction (MVIC) task, and a target force matching task. Neuromuscular variables from these tasks include; MVIC, rate of torque development (RTD), electromechanical delay (EMD), and muscle force steadiness. Participants also completed questionnaires regarding; pain and function, and psychological factors. Results The IAT group had reduced MVIC (p < 0.01) and RTD, (p < 0.01) compared to controls, however no significant difference in plantarflexor force steadiness (p = 0.08), or EMD (p = 0.71) was observed. Low strength correlations were detected between the VISA-A and RTD (r = 0.37, p = 0.04), kinesiophobia and EMD (r = 0.45, p = 0.03). Conclusions This study established impairments in plantarflexor strength and RTD among people with IAT. Plantarflexor force steadiness and EMD is not altered in IAT, which is in contrast to evidence from mid-portion Achilles tendinopathy. Plantarflexor RTD was the only neuromuscular outcome measure linked to symptom severity, which may indicate it is an important rehabilitation finding.

Reliability and Validity of the Tampa Scale of Kinesiophobia Questionnaire in Individuals with Non-specific Low Back Pain

Article

Full-text available

Oct 2021

Background: The Tampa Scale of Kinesiophobia (TSK) is considered a valid and reliable tool to assess the fear-avoidance behavior in patients. There is a valid and reliable Persian version of the TSK-17. Objectives: The present study aimed to assess the internal consistency as a measurement for the test reliability and factor (domain) validity of the Persian version of the TSK-17 to determine whether a modified form can be proposed. Methods: This study analyzed the data of 295 individuals with non-specific low back pain (NSLBP). Cronbach’s alpha was used to assess internal consistency (reliability). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied to evaluate factor validity which is an aspect of the construct validity. The Chi-square divided by the degrees of freedom, the goodness of fit index (GFI), the confirmatory fit index (CFI), and the root mean square error of approximation (RMSEA) indices were utilized as the goodness-of-fit criteria. Data analysis was performed using SPSS software (version 18), AMOS software (version 20), and EQS software (version 6.2). Results: Two factors were extracted for the TSK-17 questionnaire using EFA, and then the structure was confirmed with CFA. Cronbach’s alpha as an internal consistency index was 0.949 for the entire questionnaire, 0.931 for the 11-item fear-of-movement factor, and 0.971 for the 6-item belief factor. The evaluation of the inappropriate items demonstrated that no items were selected for the deletion; therefore, a modified version of the TSK was not presented. The goodness-of-fit indices were reported as GFI = 0.882, RMSEA=0.066 (90% CI: 0.055-0.076), CFI = 0.983, and minimum discrepancy per degree of freedom = 2.27. Conclusions: The Persian version of the TSK-17 can be considered a valid and reliable tool to assess the fear of movement and avoidance behavior in individuals with NSLBP.

Lower education is an associated factor with the combination of pain catastrophizing and kinesiophobia in patients with knee osteoarthritis?

Article

Nov 2020

Objectives To analyze if socioeconomic characteristics as lower education and lower family income are associated factors with the combination of pain catastrophizing and kinesiophobia in patients with knee osteoarthritis (KOA).Methods This cross-sectional study included 140 participants aged 40 years or older with KOA grades II and III. Based on the Pain Catastrophizing Scale (PCS) and the Tampa Scale of Kinesiophobia (TSK), four groups were identified: non-catastrophic/non-kinesiophobic (NC/NK), non-catastrophic/non-kinesiophobic (NC/K), catastrophic/non-kinesiophobic (C/NK), and catastrophic/kinesiophobic (C/K). Pain intensity was measured using the visual analog scale (VAS). The 30-s chair stand test was performed to access physical function. Sociodemographic characteristics included age, sex, years of formal education (0 to 11 and > 11), and family income (up to 2 minimum wages and > 2). Multinomial regression analysis adjusted for age, radiographic severity, physical function, and pain intensity was used to determine the association between lower education and lower family income with the combination of pain catastrophizing and kinesiophobia.ResultsOnly lower education was independently associated with the combination of pain catastrophizing and kinesiophobia (OR = 3.96 CI 95% 1.01–15.51).Conclusions Lower education but not lower family income was an important associated factor with the combination of pain catastrophizing and kinesiophobia in individuals with knee osteoarthritis. Thus, physician and physical therapist must pay attention on this important socioeconomic characteristic while conducting the treatment, since specific strategies of approach could be necessary for those patients. Key points • Lower education is an important associated factor with the combination of pain catastrophizing and kinesiophobia in individuals with knee osteoarthritis. • Physician and physical therapist must pay attention on patients schooling while conducting the treatment.

Does movement preparation enhance attending to bodily sensations in the back in people with persistent low back pain?

Article

Full-text available

Apr 2024
PLOS ONE

Attention has been proposed to play an important role in persisting pain, with excessive attentional processes towards pain information leading to worse pain outcomes and maladaptive behaviors. Nevertheless, research on somatosensory attending during the anticipation of pain-related movements is still scarce. This study investigated if individuals with chronic and recurrent lower back pain compared to pain-free controls, show enhanced attending to somatosensory information in the back while anticipating back-recruiting movements. 43 healthy control, 33 recurrent (RLBP) and 33 chronic low back (CLBP) pain sufferers were asked to perform back-recruiting movements. Before the movement initiation cue, a task-irrelevant tactile stimulus was administered to participants’ lower back to elicit somatosensory evoked potentials (SEPs), used as an index of somatosensory attending. In contrast to our hypothesis, most identified SEP components did not differ across groups. The only exception was the P175 amplitude which was larger for the CLBP group compared to individuals with RLBP and healthy controls. The current study did not find robust evidence of enhanced somatosensory attending to the back in people with persisting lower back pain. The finding that CLBP, but not RLBP individuals, had larger amplitudes to the P175 component, is discussed as possibly reflecting a higher state of emotional arousal in these patients when having to prepare the back-recruiting movements.

Relationship between kinesiophobia, isometric hip and knee torques to pelvic, hip and knee motion during the single-leg drop jump in women with patellofemoral pain: A cross-sectional study

Article

Apr 2023

Background: Individuals with patellofemoral pain (PFP) have kinesiophobia and hip and knee strength deficits. These factors may be related to kinematic alterations of pelvic, hip and knee during a more demanding functional activity, such as jumping landing. The aim was to investigate the relationships between kinesiophobia and hip/knee torque to pelvic/hip/knee kinematics during the single-leg drop vertical jump in women with PFP. Method: Thirty women with PFP were assessed with Tampa Scale for Kinesiophobia; isokinetic dynamometry of the hip extensor, hip abductor, and knee extensor; and three-dimensional motion analysis system during the single-leg drop vertical jump. A Pearson correlation matrix was used to investigate relationship among variables. Results: Fair correlations were found between increased kinesiophobia and increased peak hip internal rotation angle (r = 0.43; p = 0.018) as well as between greater peak knee extensor torque and greater peak knee flexion (r = 0.41; p = 0.022). Moderate to good correlation was found between increased peak hip abductor torque and increased peak contralateral pelvic drop (r = 0.52; p = 0.003). No other significant correlations were found between variables. Conclusions: Kinesiophobia is associated with hip kinematics, but not with knee kinematics, during the single-leg vertical drop jump in women with PFP. The greater hip abductor torque is associated with greater contralateral pelvic drop. The positive relationship between knee extensor torque and knee flexion indicates that rehabilitation programs involving quadriceps muscle strengthening may assist women with PFP in control knee flexion and improve load absorption during jumping landing.

Effects of A Gentle Gymnastics Program on the Quality of Walking and Quality of Life of Patients with Regional Painful Knee Complex Type I Pain Syndrome: Case Study

Article

Dec 2019

Relationship between Kinesiophobia, Fall Risk and Activity Level among Elderly Females after Total Knee Arthroplasty

Article

Full-text available

Dec 2022

Effect of stabilization exercise combined with respiratory resistance and whole body vibration on patients with lumbar instability: A randomized controlled trial

Article

Full-text available

Nov 2022
MEDICINE

Background: Lumbar stability exercise promotes deep muscle functions, and it is an effective intervention method for increasing proprioceptive sensation. This study aims to explore and compare the effects of lumbar stability exercise with respiratory resistance and whole body vibration on patients with lumbar instability. Methods: This study is a 3-group randomized control trial. Through screening tests, 48 patients with lumbar instability were selected and randomly assigned to SE group (n = 16), stabilization exercise program using respiratory resistance (SER) group (n = 16), and stabilization exercise program using respiratory resistance and whole body vibration (SERW) group (n = 16). In order to compare the effects depending on the intervention methods, quadruple visual analogue scale (QVAS), Functional Ability Roland-Morris low back pain and disability questionnaire ([RMDQ], center of pressure path length, velocity, and area), Korean version of fear-avoidance beliefs questionnaire, and Pulmonary Function were used for measurement. Results: All of the groups showed significant improvements in QVAS, RMDQ, Korean version of fear-avoidance beliefs questionnaire, and balance abilities before and after the interventions. The SER group and SERW group showed a significant difference in QVAS and RMDQ than the SE group (P < .05). In addition, balance ability showed a significant difference in SERW group (P < .05), where only the SER group showed a significant difference in pulmonary function indexes including forced vital capacity, forced expiratory volume in 1 second, maximum inspiratory pressure, and maximum expiratory pressure (P < .05). Conclusion: Stabilization exercise program using respiratory resistance and whole-body vibration administered according to the purpose of intervention methods may be effective exercise programs for people with lumbar instability.

Kinesiophobia and Fear Avoidance in Older Adults: A Systematic Review on Constructs and Related Measures

Article

Aug 2022
J Geriatr Phys Ther

Background and purpose: In light of the fear avoidance model, kinesiophobia and fear avoidance (FA) can lead to physical inactivity and disability. Previous studies regarding kinesiophobia and FA in older adults have reported conflicting results. The purpose of this review was to identify the reported constructs and assessment instruments used in published studies on kinesiophobia and FA in older adults and to verify the alignment between the instruments used and the constructs under study. Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement (PRISMA-2020), 4 databases were searched from January 2005 to March 2020. All study types, except qualitative, were eligible for inclusion. The participants were 65 years and older. Studies were excluded in the absence of sufficient data on participant age. Study characteristics, constructs related to kinesiophobia, fear and/or avoidance, and instruments used were extracted independently by 2 reviewers. Results: Fourteen articles were selected for inclusion in the study, in which 7 constructs were identified. The most reported constructs were "fear avoidance beliefs" (FAB) (50%; n = 7), "kinesiophobia" (35.7%; n = 5), and "fear of falling" (14.3%; n = 2). The remaining constructs were only approached, each in 7.1% (n = 1) of the included studies. Seven instruments were used to assess the constructs. The Fear Avoidance Beliefs Questionnaire (FABQ) was the most used instrument (n = 3) to evaluate "FAB," and the Tampa Scale for Kinesiophobia-11 (TSK-11) was the most reported (n = 3) to assess "kinesiophobia." Conclusion: This review identified a large diversity in the constructs and instruments used to study kinesiophobia and FA among older adults. Some constructs are used interchangeably although they do not share the same conceptual definition. There is poor standardization in the use of assessment tools in accordance with the construct under study. Clinical evaluation and study results can be biased owing to this ambiguity.

Neuromuscular and structural tendon adaptations after 6 weeks of either concentric or eccentric exercise in individuals with non-insertional Achilles tendinopathy: protocol for a randomised controlled trial

Article

Full-text available

Jul 2022

Introduction There is limited evidence on the neural strategies employed by the central nervous system to control muscle force in the presence of non-insertional Achilles tendinopathy (NIAT). Additionally, the neuromuscular mechanisms by which exercise may help to resolve tendon pain remain unclear. Objective This study aims to first establish changes in the gastrocnemius-soleus motor unit firing properties after applying a training protocol of 6 weeks based on either controlled eccentric or concentric contractions in individuals with NIAT. Second, we want to determine changes in the level of pain and function and mechanical and structural properties of the Achilles tendon after applying the same training protocol. Additionally, we want to compare these variables at baseline between individuals with NIAT and asymptomatic controls. Methods and analysis A total of 26 individuals with chronic (>3 months) NIAT and 13 healthy controls will participate in the study. Individuals with NIAT will be randomised to perform eccentric or concentric training for 6 weeks. Motor unit firing properties of the medial gastrocnemius, lateral gastrocnemius and soleus muscles will be assessed using high-density surface electromyography, as well as Achilles tendon length, cross-sectional area, thickness and stiffness using B-mode ultrasonography and shear wave elastography. Moreover, participants will complete a battery of questionnaires to document their level of pain and function. Ethics and dissemination Ethical approval (ERN-20-0604A) for the study was obtained from the Science, Technology, Engineering and Mathematics Ethical Review Committee of the University of Birmingham. The results of the study will be published in peer-review journals. Trial registration number ISRCTN46462385.

Active Virtual Reality for Chronic Primary Pain: Mixed Methods Randomized Pilot Study

Article

Full-text available

Jul 2022

Background The modern management of chronic pain is largely focused on improving functional capacity (often despite ongoing pain) by using graded activation and exposure paradigms. However, many people with chronic pain find functional activation programs aversive, and dropout rates are high. Modern technologies such as virtual reality (VR) could provide a more enjoyable and less threatening way for people with chronic pain to engage in physical activity. Although VR has been successfully used for pain relief in acute and chronic pain settings, as well as to facilitate rehabilitation in conditions such as stroke and cerebral palsy, it is not known whether VR can also be used to improve functional outcomes in people with chronic pain. Objective This study aimed to assess the feasibility of conducting an adequately powered randomized controlled trial (RCT) to test the efficacy of VR in a chronic pain treatment center and assess the acceptability of an active VR treatment program for patients in this setting. Methods For this mixed methods pilot study, which was designed to test the feasibility and acceptability of the proposed study methods, 29 people seeking treatment for chronic pain were randomized to an active VR intervention or physiotherapy treatment as usual (TAU). The TAU group completed a 6-week waitlist before receiving standard treatment to act as a no-treatment control group. The VR intervention comprised twice-weekly immersive and embodied VR sessions using commercially available gaming software, which was selected to encourage movement. A total of 7 VR participants completed semistructured interviews to assess their perception of the intervention. Results Of the 99 patients referred to physiotherapy, 53 (54%) were eligible, 29 (29%) enrolled, and 17 (17%) completed the trial, indicating that running an adequately powered RCT in this setting would not be feasible. Despite this, those in the VR group showed greater improvements in activity levels, pain intensity, and pain interference and reported greater treatment satisfaction and perceived improvement than both the waitlist and TAU groups. Relative effect sizes were larger when VR was compared with the waitlist (range small to very large) and smaller when VR was compared with TAU (range none to medium). The qualitative analysis produced the following three themes: VR is an enjoyable alternative to traditional physiotherapy, VR has functional and psychological benefits despite continued pain, and a well-designed VR setup is important. Conclusions The active VR intervention in this study was highly acceptable to participants, produced favorable effects when compared with the waitlist, and showed similar outcomes as those of TAU. These findings suggest that a confirmatory RCT is warranted; however, substantial barriers to recruitment indicate that incentivizing participation and using a different treatment setting or running a multicenter trial are needed.

The Impact Of Brand Image On Behavioral Loyalty

Article

Full-text available

Jun 2022

This study aims to investigate the effect of brand image through the product related attributes on behavioral loyalty in the sports shoes market to algeria, this work falls within the field of consumer behavior and starts from the assumption that consumers tend to focus on the product related attributes, which fall to their needs and preferences in repurchasing the same brand, a questionnaire tool were adopted to collect the data, the exploratory factor analysis and confirmatory factor analysis were used in order to verify the study model that emphasized the strength of the relationship between the two variables.

The Efficacy of Pain Neuroscience Education on Active Rehabilitation Following Arthroscopic Rotator Cuff Repair: A CONSORT-Compliant Prospective Randomized Single-Blind Controlled Trial

Article

Full-text available

Jun 2022
BSRCCS

Pain neuroscience education (PNE), a modern educational therapy, has been reported to be effective in pain control by reducing fear of movement. This study investigated the effects of additional PNE on a physical therapy rehabilitation protocol (PTRP) following arthroscopic rotator cuff repair (ARCR). In this single-blind, randomized controlled trial, 34 patients who had undergone ARCR were randomly allocated (1:1) into two groups: PNE (PTRP plus PNE) and PTRP. PTRP was performed five times a week, for four weeks, 115 min per session (physical agents, manual therapy, and exercises), and PNE was performed twice at the beginning (face-to-face PNE) and end (non-face-to-face) of the PTRP. The outcome measures were measured four times for pain intensity, pain cognition, and shoulder function; two times for a range of motion; and once for satisfaction. No significant difference in pain intensity was observed between the groups. However, in pain cognition, the Tampa Scale for Kinesiophobia avoidance showed a significant interaction between time and group, and PNE showed a higher effect size than PTRP in the post-test and follow-up in several variables. In conclusion, the significant improvement in avoidance in postoperative rehabilitation suggests that there is a partially positive benefit in terms of pain, range of motion, and shoulder function in ARCR patients.

From hands-on to remote: Moderators of response to a novel self-management telehealth programme during the COVID-19 pandemic

Article

Full-text available

May 2022
EUR J PAIN

Background: In March 2020, state- wide lockdowns were declared in many countries, including Spain. Citizens were confined to their homes and remotely supported activities were prioritized as an alternative to in- person interactions. Previous data suggest that remote and self-management interventions may be successful at reducing pain and related psychological variables. However, individual factors influencing the effectiveness of these interventions remain to be identified. We aimed to investigate the psychological and motivational factors moderating changes in pain observed in chiropractic patients undertaking a novel telehealth self-management programme. Methods: A cohort of 208 patients from a chiropractic teaching clinic was recruited to participate in the study. Patients received telehealth consultations and individualized self- management strategies tailored for their current complaint. They were encouraged to make use of these strategies daily for 2– 4 weeks, whilst rating their pain intensity, motivation and adherence. Validated questionnaires were completed online to assess catastrophizing, kinesiophobia and anxiety. Results: A total of 168 patients completed the first 2 weeks of the programme, experiencing significant reductions in all variables. Kinesiophobia emerged as a key factor influencing pain reduction and moderating the association between motivation and pain relief. In turn, adherence to the programme was associated with lower pain intensity, although moderated by the degree of motivation. Conclusions: In the context of COVID- 19, when introducing remote and self- management strategies, pain cognitions and motivational factors should be taken into consideration to foster adherence and yield better pain outcomes.

Kinesiophobia Predicts Physical Function and Physical Activity Levels in Chronic Pain-Free Older Adults

Article

Full-text available

Apr 2022

Advanced aging is associated with a general decline in physical function and physical activity. The current evidence suggests that pain-related fear of movement (i.e., kinesiophobia) is increased in the general older adult population and impacts physical activity levels in patients with chronic pain. However, whether kinesiophobia could impact physical activity and function in relatively healthy, chronic pain-free older adults remain unclear. Thus, the purpose of this study was to examine whether fear of movement due to pain predicted self-reported and objective levels of physical function and physical activity in healthy older adults without chronic pain. Fifty-two older adults were enrolled in this study. The participants completed the International Physical Activity Questionnaire (IPAQ) and wore an accelerometer on the hip for 7 days to measure physical activity. Measures of sedentary time, light physical activity, and moderate to vigorous physical activity were obtained from the accelerometer. Measures of physical function included the Physical Functioning subscale of the Short Form-36, Short Physical Performance Battery (SPPB), the 30-s Chair Stand test, and a maximal isometric hand-grip. The Tampa Scale of Kinesiophobia (TSK) was used to measure fear of movement or re-injury associated with pain. Potential covariates included self-reported activity-related pain and demographics. Hierarchical linear regressions were conducted to determine the relationship of kinesiophobia with levels of physical activity and physical function while controlling for activity-related pain and demographics. TSK scores did not predict self-reported physical activity on the IPAQ. However, TSK scores predicted self-reported physical function (Beta = −0.291, p = 0.015), 30-s Chair Stand test scores (Beta = −0.447, p = 0.001), measures from the SPPB (Gait speed time: Beta = 0.486, p < 0.001; Chair stand time: Beta = 0.423, p = 0.003), percentage of time spent in sedentary time (Beta = 0.420, p = 0.002) and light physical activity (Beta = −0.350, p = 0.008), and moderate to vigorous physical activity (Beta = −0.271, p = 0.044), even after controlling for significant covariates. These results suggest that greater pain-related fear of movement/re-injury is associated with lower levels of light and moderate to vigorous physical activity, greater sedentary behavior, and worse physical function in healthy, chronic pain-free older adults. These findings elucidate the potential negative impact of kinesiophobia in older adults who don't report chronic pain.

Effects of Pain Neuroscience Education Combined with Lumbar Stabilization Exercise on Strength and Pain in Patients with Chronic Low Back Pain: Randomized Controlled Trial

Article

Full-text available

Feb 2022

Chronic low back pain that lasts more than 12 weeks causes mental and physical distress. This study investigated the effects of pain neuroscience education combined with lumbar stabilization exercises on strength, pain, flexibility, and activity disorder index in female patients with chronic low back pain. Thirty-five female patients with chronic low back pain were randomly divided into two groups: the pain neuroscience education (PNE) combined with lumbar stabilization exercises (LSEs) group (n = 18, experimental group) and the lumbar stabilization exercises alone group (n = 17, control group). The experimental group underwent PNE combined with LSEs for 30 min per session, twice per week for 8 weeks, and the control group underwent LSEs only. The primary outcomes were strength (sit-up and back-up movements), Numerical Pain Rating Scale (NPRS), Korean Pain Catastrophizing Scale (K-PCS), and Tampa Scale of Kinesio-phobia-11 (TSK-11) for pain. The secondary outcomes were modified–modified Schober’s test (MMST) and finger to floor test (FFT) for flexibility and activity disorder (Roland–Morris Disability Questionnaire index). A significant difference was observed in the primary outcomes after intervention in the abdominal muscle strength (group difference, mean, −7.50; 95% CI, −9.111 to –5.889, F = 9.598; ANCOVA p = 0.005), the back muscle strength (group difference, mean, −9.722; 95% CI, −10.877 to –8.568, F = 7.102; ANCOVA p = 0.014), the NPRS (group difference, mean, 1.89; 95% CI,1.65 to 2.12, F = 24.286; ANCOVA p < 0.001), K-PCS (group difference, mean, 7.89; 95% CI, 7.02 to 8.76, F = 11.558; ANCOVA p = 0.003), and TSK-11 (group difference, mean, 16.79; 95% CI, 13.99 to 19.59, F = 13.179; ANCOVA p = 0.014) for pain. In the secondary outcomes, there was a significant difference in the FFT (group difference, mean, −0.66; 95%CI, −0.99 to −0.33, F = 4.327; ANCOVA p = 0.049), whereas the difference in flexibility (MMST) and activity disorder index of the secondary outcomes did not reach significance. Therefore, this study confirmed that PNE combined with LSEs is an effective intervention compared to LSE alone in improving muscle strength and pain in female patients with chronic low back pain.

The association between work-related physical and psychosocial factors and musculoskeletal disorders in healthcare workers: Moderating role of fear of movement

Article

Full-text available

Jan 2022
J OCCUP HEALTH

Objectives: Knowledge is lacking on the interaction between fear of movement (FOM) and work-related physical and psychosocial factors in the development and persistence of musculoskeletal disorders (MSDs). Methods: In this cross-sectional study, 305 healthcare workers from several Belgian hospitals filled out a questionnaire including sociodemographic factors, work-related factors (social support, autonomy at work, workload, and physical job demands), FOM, and MSDs for different body regions during the past year. Path analysis was performed to investigate (1) the association between the work-related factors, FOM and MSDs, and (2) the moderating role of FOM on the association between the work-related factors and MSDs among healthcare workers. Results: Complaints were most frequently located at the neck-shoulder region (79.5%) and lower back (72.4%). Physical job demands (odds ratio [OR] 2.38 and 95% confidence interval [CI] 1.52-3.74), autonomy at work (OR 1.64 CI [1.07-2.49]) and FOM (OR 1.07 CI [1.01-1.14] and OR 1.12 CI [1.06-1.19]) were positively associated with MSDs. Healthcare workers who experienced high social support at work (OR 0.61 CI [0.39-0.94]) were less likely to have MSDs. Fear of movement interacted negatively with workload (OR 0.92 CI [0.87-0.97]) and autonomy at work (OR 0.94 CI [0.88-1.00]) on MSDs. Conclusions: Work-related physical and psychosocial factors as well as FOM are related to MSDs in healthcare workers. FOM is an important moderator of this relationship and should be assessed in healthcare workers in addition to work-related physical and psychosocial factors to prevent or address MSDs.

Development of the Prevent for Work Questionnaire (P4Wq) for the assessment of musculoskeletal risk factors in the workplace: part 2-pilot study for questionnaire development and validation On behalf of the Prevent for Work Study Group

Article

Full-text available

Dec 2021

Objective The aim of this study was to develop a multifactorial, self-report questionnaire: Prevent for Work Questionnaire (P4Wq). The questionnaire is intended for screening for risk factors in work-related musculoskeletal disorders (WMSDs). Design Data were collected from otherwise healthy workers employed in three service areas at a specialist hospital in Italy: healthcare, administration and ancillary services. Setting and participants In all, 115 participants were enrolled (67% women; average age 41.5±9.94 years). The content of the tool for WMSDs was derived from three participation rounds of analysis involving a select group of experts who identified the questionnaire domains and items. Participants responded to 89 items in addition to the EuroQol 5 Dimensions Questionnaire (EQ-5D-5L), Fear-Avoidance Beliefs Questionnaire (FABq) and Oswestry Disability Index (ODI). The proportion of missing data and the distribution of responses were analysed for each item. Items with a discrimination index >0.40 and an interitem correlation <0.80 were retained. Factor analysis was performed using the VARIMAX rotation method, factor extraction, and identification, assignment of items to subscales, and assignment of scores to items. Internal consistency, reliability, construct validity and face validity were also assessed. Results A total of 52 items were included in the factor analysis and four subscales identified: Physical Stress Subscore (six items); Mental Stress Subscore (six items); Job Satisfaction Subscore (four items) and Kinesiophobia/Catastrophizing Subscore (four items). The items in the final questionnaire version had a factor loading >0.7. The questionnaire consisted of 20 items with good internal consistency (Cronbach’s alpha 0.81–0.91), reliability (weighted kappa coefficient 0.617–1.00), good construct validity (EQ-5D-5L, r=−0.549, p<0.001; ODI, r=0.549, p<0.001; FABq work, r=0.688, p<0.001) and satisfactory face validity (universal validity index 96.04%). Conclusion The P4Wq is a 20-item, multifactorial self-report risk assessment questionnaire. It may provide a useful tool for screening for WMSDs by specifically addressing back disorders. It investigates risks for individual workers and may inform educational programmes and preventive strategies tailored to a worker’s needs. Trial registration number NCT04192604

Adding muscle power exercises to a strength training program for people with patellofemoral pain: protocol of a randomized controlled trial

Article

Full-text available

Nov 2021
TRIALS

Background Strong evidence supports the proximal combined with quadriceps strengthening for patellofemoral pain (PFP) rehabilitation. However, most reported rehabilitation programs do not follow specific exercise prescription recommendations or do not provide adequate details for replication in clinical practice. Furthermore, people with PFP have power deficits in hip and knee muscles and it remains unknown whether the addition of power exercises would result in superior or more consistent outcomes. Therefore, this study is designed to verify whether the benefits of a rehabilitation program addressing proximal and knee muscles comprising power and strength exercises are greater than those of a program consisting of strength exercises only. Method This study will be a randomized controlled trial that will be conducted at university facilities. A minimum of 74 people with PFP between the ages of 18 and 45 years will be included. The experimental group will engage in a 12-week resistance training program focusing on proximal and knee muscles using power and strength exercises. The control group will engage in a 12-week resistance training program focusing on proximal and knee muscles using strength exercises only. Primary outcomes will be pain intensity and physical function; and secondary outcomes will be kinesiophobia, self-reported improvement, quality of life, peak hip and knee torque, and hip and knee rate of force development. The primary outcomes will be evaluated at baseline, and after 6 weeks, 12 weeks, 3 months, 6 months, and 1 year. The secondary outcomes will be evaluated at baseline and immediately after the interventions. Therapists and participants will not be blinded to group allocation. Discussion This randomized clinical trial will investigate if adding power exercises to a progressive resistance training may lead to more consistent outcomes for PFP rehabilitation. The study will provide additional knowledge to support rehabilitation programs for people with PFP. Trial registration ClinicalTrials.gov NCT 03985254. Registered on 26 August 2019.

Several low back pain‐related misbeliefs are still around in 2020: A cross‐sectional survey in Belgium

Article

Oct 2021

Background and purpose: Low back pain (LBP)-related misbeliefs are known to be among risk factors for LBP chronification and for persistence of chronic pain. The main objective of this study was to investigate the current LBP-related beliefs in the general population in Belgium, considering the fact that the last survey in Belgium about the topic was conducted more than 15 years ago. Methods: A cross-sectional study design was used. Belgian adults (>17 years old) were recruited in the three regions of the country by means of non-probabilistic recruitment methods. Participants were invited to fill in a battery of questionnaires including demographic questions as well as questions about their LBP history and the LBP Beliefs Questionnaire (LBPBQ). Results: A total of 3724 individuals participated in the study. The LBPBQ scores indicated several LBP-related misbeliefs. About 15%-25% of participants still think that imaging tests can always identify the cause of pain and that bed rest is the mainstay of therapy. The majority of the participants think that "unnecessary" movements should be avoided when having LBP (58% of the respondents), and that they should "take it easy" until the pain goes away (69%). Most respondents also had maladaptive/wrong expectations, for example, a systematic worsening with time (65%) and a need for surgery in case of disc herniation (54%). Conclusions: The present study suggests that in 2020 several LBP-related misbeliefs are still current in Belgium, particularly regarding the vulnerability of the spine. Therefore, further efforts to improve LBP-related beliefs/knowledge in the general population are necessary.

The Relationship of Cogniphobia to Performance Validity and Symptom Validity in Neuropsychological Assessment

Article

Full-text available

Sep 2021

Objective: Emerging research suggests that fear and avoidance are associated with not only physical symptoms, but also cognitive functioning. The concept of cogniphobia describes the fear and avoidance of cognitively effortful tasks to avoid the onset or worsening of symptoms. Extant studies provide preliminary evidence for associations between cogniphobia and validity testing. However, less is known about the subcomponents of cogniphobia. This study investigated the relationship of cogniphobia subcomponents to validity testing and psychological presentations. Method: Participants included 171 adults from an archival database who had completed measures of cogniphobia and psychological symptom reports as part of a larger neuropsychological study. The sample was classified as scoring above or below published cutoffs on performance validity tests (PVTs) and symptom validity tests (SVTs), consistent with current research/recommendations. Results: Confirmatory factor analysis (CFA) supported a two-factor model of cogniphobia, with Avoidance and Dangerousness as subcomponents. Logistic regression analyses identified Avoidance as the strongest predictor of scores falling in the invalid range on PVTs and SVTs, as well as the presence of external incentives. After excluding participants who fell in the invalid range on SVTs, only Avoidance significantly predicted report of somatic complaints. Conclusions: Cogniphobia, especially the avoidance of cognitive exertion component, is associated with performance in the invalid range on both PVTs and SVTs and is also related to report of somatic concerns when controlling for beliefs that cognitive exertion is dangerous. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Article

Full-text available

Mar 2022
QUAL LIFE RES

Purpose The primary goal of this study was to compare the health-related quality of life (HRQoL) of people with lumbar radiculopathy to age- and sex-adjusted population norms. Additionally, it aimed to explore the associations between the HRQoL difference scores and measures related to pain cognitions, pain intensity, and endogenous nociceptive modulation. Methods Using answers from the Short Form 36-item Health Survey and UK population norms, SF-6D difference scores were calculated. A one-sample t test was used to assess the SF-6D difference scores. Univariate and multivariate regression analyses were used to assess the associations between SF-6D difference scores and pain intensity [Visual Analogue Scale (VAS) for back and leg pain], pain cognitions [Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Pain Vigilance and Awareness Questionnaire (PVAQ)], and correlates for endogenous nociceptive modulation using quantitative sensory testing. Results One hundred and twenty people with lumbar radiculopathy scheduled for surgery were included in this study. The mean SF-6D difference score of − 0.26 [SD = 0.09] was found to be significantly less than 0 [95%CI: − 0.27 to − 0.24]. Univariate analyses showed a significant influence from PCS, TSK, and PVAQ on the SF-6D difference scores. The final multivariate regression model included PCS and PVAQ, with only PCS maintaining a statistically significant regression coefficient [b = − 0.002; 95% CI: − 0.004 to − 0.001]. Conclusion People diagnosed with lumbar radiculopathy report significantly lower HRQoL scores when compared with age- and sex-adjusted UK norm values. Even though all examined pain cognitions were found to have a significant association, pain catastrophizing showed the most significant relation to the SF-6D difference scores. Clinical trial registration ClinicalTrials.gov Identifier No. NCT02630732. Date of registration: November 25, 2015.

Adding Muscle Power Exercises To A Strength Training Program For People With Patellofemoral Pain: Protocol Of A Randomized Controlled Trial

Preprint

Full-text available

May 2021

Background: Strong evidence supports the proximal combined with quadriceps strengthening for patellofemoral pain (PFP) rehabilitation. However, most reported rehabilitation programs do not follow specific exercise prescription recommendations or do not provide adequate details for replication in clinical practice. Furthermore, people with PFP have power deficits in hip and knee muscles and remains unknown whether the addition of power exercises would result in superior or more consistent outcomes. Therefore, this study is designed to verify whether the benefits of a rehabilitation program addressing proximal and knee muscles composed by power and strength exercises are greater than those of a program composed by strength exercises only. Method: This study will be a randomized controlled trial, that will be conducted at university facilities. A minimum of 74 people with PFP between the ages of 18 and 45 years will be included. The experimental group will engage in a 12-week resistance training program focusing on proximal and knee muscles using power and strength exercises. The control group will engage in a 12-week resistance training program focusing on proximal and knee muscles using strength exercises only. Primary outcomes will be pain intensity and physical function; and secondary outcomes will be kinesiophobia, self-reported improvement, quality of life, peak hip and knee torque, and hip and knee rate of force development. The primary outcomes will be evaluated at baseline, and after six weeks, twelve weeks, three months, six months and one year. The secondary outcomes will be evaluated at baseline and immediately after the interventions. Therapists and participants will not be blinded to group allocation. Discussion: This randomized clinical trial will investigate if adding power exercises to a progressive resistance training may lead to more consistent outcomes for PFP rehabilitation. The study will provide additional knowledge to support rehabilitation programs for people with PFP. Trial registration: ClinicalTrials.gov NCT 03985254. Registered on 26 August 2019.

Kinesiophobia in Skiers with Knee Injuries

Article

Full-text available

Mar 2021

Introduction. Alpine skiing is one of the most dangerous winter sports that entails a high number of injuries, most commonly affecting the knee. Kinesiophobia is a condition in which an individual experiences fear of physical movement and activity as a result of feeling susceptible to injuries or recurrent injuries. The objective was to examine the level of kinesiophobia in skiers who have sustained knee injuries. Material and methods. The sample consisted of 22 female and 11 male professional skiers, with the average age of 24 ± 7.391 years. For the purpose of the assessment, the Tampa scale for kinesiophobia (TSK) was employed. Results. The number of knee injuries in skiers totals at least 1 and 11 at most, on average 2.45, most commonly involving the anterior cruciate ligament and meniscus. There were no significant differences between the left and the right knee or bilateral injuries. The average score in the TSK totals 36 points, which is close to the critical threshold of 37 points. 36% of the participants possess a high level of kinesiophobia. With respect to the general level of kinesiophobia, no significant differences were found in relation to gender, with regard to the number of surgeries or whether one or both knees were affected by injuries. Older skiers have also been found to have significantly lower fear of recurrent injuries. Conclusions. The number of knee injuries in skiing is high and aggravating, in such a way that almost one third of skiers that have sustained knee injuries experience a critical level of kinesiophobia, and that requires intervention. During rehabilitation, psychological support should also be provided to athletes in order to prevent or reduce kinesiophobia and thus prevent recurrent or new injuries.

New Factor Structure of the Tampa Scale for Kinesiophobia in Older Japanese Adults After Lumbar Surgery

Article

Full-text available

Mar 2021

Purpose: The Tampa Scale for Kinesiophobia (TSK) has been used worldwide as a measure of kinesiophobia, but its factor structure in older Japanese adults after lumbar surgery is unknown. The purpose of this study was to fill this research gap by identifying the factors that comprise TSK in older Japanese adults after lumbar surgery. Patients and methods: Participants were older Japanese adults who had undergone surgery for lumbar spinal stenosis. Clinicodemographic data, TSK, intensity of low back pain and leg pain, dysesthesia (using an 11-point numerical rating scale), and HRQOL (using the EQ-5D-5L) were collected. After supplementing the missing values by the multiple assignment method, the hypothetical model of TSK was developed by categorical exploratory factor analysis (weighted least squares method, promax rotation). Confirmatory factor analysis (WLSMV method, promax rotation) was used to compare the hypothetical model and the traditional one-factor and two-factor models. Furthermore, we confirmed the relationship between factors extracted from the hypothetical model and HRQOL, pain, and dysesthesia. Results: Questionnaires were mailed to 302 individuals, and responses were obtained from 211 (72.4±4.2 years [range: 65-88]; 115 men and 96 women; 804±343.1 [380-1531] days after surgery; 137 who had undergone decompression and fixation surgery, 74 who had undergone decompression surgery) (response rate: 69.9%). The hypothesized model consisted of "somatic focus," "activity avoidance," and "efficacy of physical activities," all of which were highly consistent. The fit of the hypothetical model was slightly inferior to that of the traditional two-factor model, but the hypothetical model met the criteria for fit. Somatic focus in the hypothetical model was significantly associated with HRQOL, pain, and dysesthesia. Conclusion: In older Japanese adults after lumbar surgery, the goodness of fit of the TSK model was maintained by adding efficacy of physical activities as a third factor to the traditional two factors.

Influence of Baseline Kinesiophobia Levels on Treatment Outcome in People With Chronic Spinal Pain

Article

Feb 2021

Background Pain neuroscience education (PNE) combined with cognition-targeted exercises is an effective treatment for people with chronic spinal pain (CSP). However, it is unclear as to why some patients benefit more from this treatment. We expect that patients with more pronounced maladaptive pain cognitions, such as kinesiophobia, might show poorer treatment responses. Objective The objective of this study was to assess the influence of baseline kinesiophobia levels on the treatment outcomes of PNE combined with cognition-targeted exercises in people with CSP. This study was a secondary analysis of a multicenter, double-blind randomized controlled trial. Methods Outcome measures included a numeric rating scale for pain (NRS), the Pain Disability Index (PDI), quality of life (Medical Outcomes Study 36-Item Health Survey [SF-36]), Pain Catastrophizing Scale (PCS), and Pain Vigilance and Awareness Questionnaire (PVAQ). Regression models were built using treatment (PNE plus cognition-targeted exercises or neck/back school plus general exercises), baseline scores on the Tampa Scale for Kinesiophobia (TSK), and time (in months) as independent variables. Results A significant three-way interaction effect was found for the models of PDI, PCS, PVAQ, and the SF-36 mental domain, with estimates of −0.01, −0.01, −0.01, and 0.07, respectively. A significant effect of baseline TSK scores was found for the physical domain of the SF-36 (estimate = −3.16). For the NRS, no significant effect of baseline TSK scores was found. Conclusions Our findings indicate that PNE plus cognition-targeted exercises can successfully decrease the unfavorable influence of pretreatment kinesiophobia on disability, mental health, pain catastrophizing, and hypervigilance over time in people with CSP. Nevertheless, higher scores in pretreatment kinesiophobia might still be a key factor for the lack of improvement in pain catastrophizing and hypervigilance following treatment. Regardless of the followed treatment program, pretreatment kinesiophobia was also shown to significantly influence physical health in people with CSP. Impact This study provides novel insight into the unfavorable influence of kinesiophobia on treatment outcomes in people with CSP, and how PNE plus cognition-targeted exercises can limit this impact. As this is one of the first studies to research possible predictors of this experimental treatment, its findings motivate further exploration of other possible influencing factors for treatment success of PNE plus cognition-targeted exercises.

Physical activity and sleep in patients with hypermobile Ehlers–Danlos syndrome and patients with generalized hypermobility spectrum disorder

Article

Jan 2020

Aims: Research objectively evaluating physical activity (PA) and sleep in adults with hypermobile Ehlers–Danlos syndrome (hEDS) and generalized hypermobility spectrum disorder (G-HSD) is lacking. Furthermore, it is not clear to what extent frequently occurring symptoms in these patients are related to their PA and sleep. Therefore, a cross-sectional study was performed to objectively evaluate, and identify factors contributing to, PA and sleep in adults with hEDS and G-HSD. Methods: Twenty female adults with hEDS, 23 with G-HSD, and 32 healthy controls participated. Physical activity and sleep were measured using two tri-axial ActiGraphs worn over seven consecutive days. Furthermore, questionnaires evaluating frequently occurring symptoms were completed. Regression analysis was performed to determine major contributors to PA and sleep. Results: Daily step counts were significantly lower in both patient groups compared to the control (CTR) group (p<0.04) and to the recommended 7500 steps (p≤0.001). Other PA and sleep variables did not differ between the groups. In the hEDS group, body mass index and kinesiophobia were related to PA, explaining 53% of the variance in step counts. In the G-HSD group, 18.5% of the variance in step counts could be attributed to the variance in pain impact. Conclusion: Adults with hEDS and G-HSD had lower step counts than healthy peers, which may be partially due to kinesiophobia and the impact of pain respectively. No differences in objectively measured sleep parameters were identified. Treatment focusing on fear-avoidance beliefs and pain relief could potentially increase daily step counts and benefit overall health in these patients. Keywords: Hypermobile Ehlers–Danlos syndrome, Hypermobility spectrum disorder, Physical activity, Sleep

Psychometric Features of the Polish Version of TSK Heart in Elderly Patients with Coronary Artery Disease

Article

Full-text available

Sep 2020

Background and objectives: Recommendations for the control of stable patients with coronary artery disease (CAD) related to an adequate level of physical activity (PA). Practical experience shows that the PA level in most people with CAD is definitely too low in relation to the guidelines. The cause may be psychological factors and among them the fear of movement-kinesiophobia. The aim of this project was to examine the evaluation of psychometric features of the Polish version of the Tampa Scale for Kinesiophobia Heart (TSK Heart), used in people with CAD. Materials and methods: The study involved 287 patients with stable CAD: 112 women and 175 men. Age: 63.50 (SD = 11.49) years. Kinesiophobia was assessed using TSK Heart, physical activity (PA)-using the International Physical Activity Questionnaire (IPAQ), and anxiety and depression was examined using the Hospital Anxiety and Depression Scale (HADS). The structure of TSK was examined using principal component analysis (PCA), internal cohesion (Cronbach's alpha, AC), and content validity was calculated by linear regression. Results: PCA showed a three-factor TSK structure. One-dimensionality and satisfactory reliability were found: TSK Heart: AC = 0.878. Kinesiophobia as a predictor of PA: R2 = 0.162 (p = 0.000000). Anxiety and depression-TSK: R2 = 0.093 (p = 0.00000). Conclusions: The Polish version of TSK Heart for cardiac patients is characterized by good psychometric features. The use of it can improve the cooperation of rehabilitation teams for patients with CAD.

Flourishing with Chronic Pain in Adolescence. A Mixed-Methods Investigation of the Adolescents' Resources.

Thesis

Full-text available

Feb 2020

Annina Riggenbach

GENERAL ABSTRACT Chronic pain impairs the life of many children and adolescents, impacting their physical, psychological and social development. Surprisingly, some adolescents with chronic pain still continue to engage into an active life and their development is not impacted by the pain. Yet we do not clearly know what makes it possible for some individuals to continue engaging in an active life, while others are highly impacted by the pain. This PhD research aimed to understand the resource factors that help some adolescents succeed and flourish despite chronic pain. To this end, we drew upon the Self-Determination Theory, a theoretical framework of human development, which has rarely been used in research on paediatric chronic pain. This theory posits the existence of three basic human psychological needs, namely, the need for autonomy, relatedness and competence. The satisfaction of the three basic needs is essential for psychological growth and well-being, while their frustration is associated with ill-being, psychological imbalance and psychopathology. With this in mind, we hypothesised that basic psychological need satisfaction might be a resource for adolescents for living adaptively with chronic pain. This dissertation research used a multi-method design to advance our understanding of the development of resources in adolescents with chronic pain. More specifically, this study aimed to understand the role of need satisfaction in chronic pain outcomes. The first paper of this dissertation is a topical review of the literature, which highlights the impact of chronic pain on adolescent need satisfaction, and in turn, the positive effects of need satisfaction on chronic pain outcomes. The second paper is a quantitative study of 120 adolescents with chronic pain. Structural equation modelling and path analyses showed that satisfaction of the need for autonomy and competence is associated with lower levels of functional disability, through the mediation of fear and avoidance of pain. The third paper presents a qualitative study of 15 adolescents. The interpretative phenomenological analyses provided an in-depth understanding of the development of resources and a concrete illustration of the interplay between the basic needs and chronic pain. This dissertation discusses the theoretical and clinical implications of assessing the basic psychological needs because their satisfaction is a resource for helping people to live with chronic pain.

Cross-Cultural Adaptation and Psychometric Properties of the Spanish Version of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders

Article

Full-text available

Sep 2020

The aim was to perform a translation, cross-cultural adaptation, and psychometric evaluation of the Spanish version of the Tampa Scale of Kinesiophobia for Temporomandibular Disorders (TSK-TMD-S). The study sample included 110 patients with TMD. We translated and cross-culturally adapted the TSK-TMD-S using standard methodology and analysed its internal consistency, test-retest reliability, construct validity, floor and ceiling effects, and discriminant validity. Confirmatory factor analysis extracted two factors and 10 items deemed essential for the scale. The TSK-TMD-S demonstrated good internal consistency (Cronbach’s α of 0.843, 0.938, and 0.885 for the entire scale, activity avoidance subscale, and somatic focus subscale, respectively; intraclass correlation coefficient, 0.81–0.9). No floor or ceiling effects were identified for this final version of the scale. The TSK-TMD-S total score showed moderate positive correlation with the craniofacial pain and disability inventory, visual analogue scale, general TSK and pain catastrophizing scale, and a moderate negative correlation with maximal mouth-opening. The receiver operating characteristic curve analysis showed that the subclassification employed for the TSK-TMD-S discriminates different kinesiophobia levels with a diagnostic accuracy between sufficient and good. The optimal cut-off point for considering kinesiophobia is 23 points. TSK-TMD-S appears to be a valid and reliable instrument for measuring kinesiophobia in patients with TMD.

The Mediating Role of Pain Cognitions and Pain Sensitivity in the Treatment Effect of Perioperative Pain Neuroscience Education in People Undergoing Surgery for Lumbar Radiculopathy

Article

Apr 2024
J PAIN

Neuromuscular Control and Resistance Training for People With Chronic Low Back Pain: A Randomized Controlled Trial

Article

Mar 2024
J ORTHOP SPORT PHYS

OBJECTIVE: To determine if adding lumbar neuromuscular control retraining exercises to a 12-week program of strengthening exercises has greater effect for improving disability than 12 weeks of strengthening exercises alone in people with chronic low back pain (LBP). DESIGN: Single centre, participant and assessor-blinded, comparative effectiveness randomized controlled trial. METHODS: 69 participants (31 females; 29 males; mean age 46.5 years) with non-specific chronic LBP were recruited for a twelve-week program involving lumbar extension neuromuscular retraining in addition to resistance exercises (intervention) or 12 weeks of resistance exercises alone (control). The primary outcome measure was the Oswestry Disability Index. Secondary outcome measures included the Numeric Rating Scale, Tampa Scale for Kinesiophobia, Pain Self-efficacy Questionnaire, and the International Physical Activity Questionnaire. Outcomes were measured at baseline, 6 and 12 weeks. RESULTS: Forty-three participants (22 control; 21 intervention) completed all outcome measures at 6 and 12 weeks. Fourteen participants were lost to follow-up and 12 participants discontinued due to COVID-19 restrictions. Both groups demonstrated clinically important changes in disability, pain intensity and kinesiophobia. The difference between groups with respect to disability was imprecise and not clinically meaningful (mean difference, -4.4, 95% CI [-10.2, 1.4]) at 12 weeks. Differences in secondary outcomes at 6 or 12 weeks were also small with wide confidence intervals. CONCLUSIONS: Adding lumbar neuromuscular control retraining to a series of resistance exercises offered no additional benefit over resistance exercises alone over a 12-week period.

A scientometric analysis and visualization of kinesiophobia research from 2002 to 2022: A review

Article

Nov 2023
MEDICINE

Kinesiophobia is an excessive, irrational, debilitating fear of physical movement and activity caused by a sense of vulnerability to pain or re-injury, which can have a direct impact on physical functioning and mental well-being of patients. This paper aims to provide reliable support for future in-depth research on kinesiophobia through scientometrics and historical review. Studies on kinesiophobia published from 2002 to 2022 were retrieved from the Web of Science Core Collection. CiteSpace and VOSviewer were used to conduct bibliometric analysis of the included studies and map knowledge domains. Keywords were manually clustered, and the results were analyzed and summarized in combination with a literature review. A total of 4157 original research articles and reviews were included. Research on kinesiophobia is developing steadily and has received more attention from scholars in recent years. There are regional differences in the distribution of research. Chronic pain is the focus of research in this field. A multidisciplinary model of pain neuroscience education combined with physical therapy based on cognitive-behavioral therapy and the introduction and development of virtual reality may be the frontier of research. There is a large space for the study of kinesiophobia. In the future, to improve regional academic exchanges and cooperation, more attention should be given to the clinical applicability and translation of scientific work, which will be conducive to improving the quality of life and physical and mental health outcomes of kinesiophobia patients.

Initial Validation of the 12-Item Tampa Scale of Kinesiophobia in a Retrospective Sample of Adults with Chronic Headache

Article

Nov 2023
PAIN MED

Introduction An area of emerging interest in chronic pain populations concerns fear of pain and associated fear of movement (kinesiophobia)—a cognitive appraisal pattern that is well-validated in non-headache chronic pain. However, there is limited research on whether this construct can be measured in a similar manner in headache populations. Methods The current project details a confirmatory factor analysis of the 12-Item Tampa Scale of Kinesiophobia (TSK-12) using a clinical data set from 210 adults with diverse headache diagnoses presenting for care at a multidisciplinary pain clinic. One item (concerning an “accident” that initiated the pain condition) was excluded from analysis. Results Results of the confirmatory factor analysis for the remaining 12 items indicated adequate model fit for the previously established 2-factor structure (activity avoidance and bodily harm/somatic focus subscales). In line with previous literature, total TSK-12 scores showed moderate correlations with pain severity, pain-related interference, positive and negative affect, depressive and anxious symptoms, and pain catastrophizing. Discussion The current study is the first to examine the factor structure of the TSK-12 in an adult headache population. The results support the relevance of pain-related fear to the functional and psychosocial status of adults with chronic headache, although model fit of the TSK-12 could be characterized as adequate rather than optimal. Limitations of the study include heterogeneity in headache diagnosis and rates of comorbid non-headache chronic pain in the sample. Future studies should replicate these findings in more homogenous headache groups (eg, chronic migraine) and examine associations with behavioral indices and treatment response.

Fear of Movement in People With CRPS: A Psychometric Evaluation of the Tampa Scale-11 for Kinesiophobia

Article

Oct 2023
CLIN J PAIN

Background People with complex regional pain syndrome (CRPS) commonly report a fear of movement that can worsen symptoms and increase disability. The Tampa Scale of Kinesiophobia (TSK) is used to evaluate fear of movement and (re)injury, but findings have been inconsistent in different populations. Objective To evaluate the psychometric properties of the Persian version of TSK-11 in individuals with upper limb CRPS. Specifically, to determine if the factor structure aligns with the original two-factor model, consisting of “activity avoidance” and “somatic focus.” Methods People with CRPS ( n =142, mean age=42, 54% female) completed the TSK. The psychometric testing included internal consistency and test-retest reliability (intra-class correlation coefficient), and convergent construct validity. Confirmatory and Exploratory factor analyses (CFA, EFA) were performed to evaluate the structural validity. Results The TSK-11 showed acceptable internal consistency (Cronbach alpha 0.93) and excellent test-retest reliability (ICC=0.93, 95% CI: 0.92 to 0.94). The Standard Error of Measurement and Minimal Detectable Change were 4.3 and 11.7, respectively. The results also demonstrated excellent criterion validity (r=0.81). CFA demonstrated that the original two-factor model did not fit. EFA derived a two-factor solution with different items. The factor structure accounted for 64.91% of the variance, and the internal consistency of the factors was acceptable (>0.90). Expert consensus suggested naming these two factors as Fear-avoidance, Magnification & Helplessness. Discussion The TSK-11 demonstrates excellent retest reliability in people with CRPS. The original two-factor structure was not confirmed, and a new 2-factor structure of the TSK-11 proposed consisting of subscales for Fear Avoidance beliefs and Magnification/Helplessness. Given the overlap between these constructs and the construct of pain catastrophizing, further study is needed to clarify both measures’ content validity and relative uniqueness.

Exploring Interactions Between Sex, Pain Characteristics, Disability, and Quality of Life in People With Chronic Spinal Pain: A Structural Equation Model

Article

Oct 2023
J PAIN

Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain: A Secondary Analysis of a Randomized Clinical Trial

Article

Full-text available

Sep 2023

Importance In primary chronic back pain (CBP), the belief that pain indicates tissue damage is both inaccurate and unhelpful. Reattributing pain to mind or brain processes may support recovery. Objectives To test whether the reattribution of pain to mind or brain processes was associated with pain relief in pain reprocessing therapy (PRT) and to validate natural language–based tools for measuring patients’ symptom attributions. Design, Setting, and Participants This secondary analysis of clinical trial data analyzed natural language data from patients with primary CBP randomized to PRT, placebo injection control, or usual care control groups and treated in a US university research setting. Eligible participants were adults aged 21 to 70 years with CBP recruited from the community. Enrollment extended from 2017 to 2018, with the current analyses conducted from 2020 to 2022. Interventions PRT included cognitive, behavioral, and somatic techniques to support reattributing pain to nondangerous, reversible mind or brain causes. Subcutaneous placebo injection and usual care were hypothesized not to affect pain attributions. Main Outcomes and Measures At pretreatment and posttreatment, participants listed their top 3 perceived causes of pain in their own words (eg, football injury, bad posture, stress); pain intensity was measured as last-week average pain (0 to 10 rating, with 0 indicating no pain and 10 indicating greatest pain). The number of attributions categorized by masked coders as reflecting mind or brain processes were summed to yield mind-brain attribution scores (range, 0-3). An automated scoring algorithm was developed and benchmarked against human coder–derived scores. A data-driven natural language processing (NLP) algorithm identified the dimensional structure of pain attributions. Results We enrolled 151 adults (81 female [54%], 134 White [89%], mean [SD] age, 41.1 [15.6] years) reporting moderate severity CBP (mean [SD] intensity, 4.10 [1.26]; mean [SD] duration, 10.0 [8.9] years). At pretreatment, 41 attributions (10%) were categorized as mind- or brain-related across intervention conditions. PRT led to significant increases in mind- or brain-related attributions, with 71 posttreatment attributions (51%) in the PRT condition categorized as mind- or brain-related, as compared with 22 (8%) in control conditions (mind-brain attribution scores: PRT vs placebo, g = 1.95 [95% CI, 1.45-2.47]; PRT vs usual care, g = 2.06 [95% CI, 1.57-2.60]). Consistent with hypothesized PRT mechanisms, increases in mind-brain attribution score were associated with reductions in pain intensity at posttreatment (standardized β = −0.25; t 127 = −2.06; P = .04) and mediated the effects of PRT vs control on 1-year follow-up pain intensity (β = −0.35 [95% CI, −0.07 to −0.63]; P = .05). The automated word-counting algorithm and human coder-derived scores achieved moderate and substantial agreement at pretreatment and posttreatment (Cohen κ = 0.42 and 0.68, respectively). The data-driven NLP algorithm identified a principal dimension of mind and brain vs biomechanical attributions, converging with hypothesis-driven analyses. Conclusions and Relevance In this secondary analysis of a randomized trial, PRT increased attribution of primary CBP to mind- or brain-related causes. Increased mind-brain attribution was associated with reductions in pain intensity.

Ischemic compression associated with joint mobilization does not promote additional clinical effects in individuals with rotator cuff related shoulder pain: A randomized clinical trial

Article

Aug 2023

Understanding Discrepancies in a Person's Fear of Movement and Avoidance Behavior: A Guide for Musculoskeletal Rehabilitation Clinicians Who Support People With Chronic Musculoskeletal Pain

Article

Feb 2023
J ORTHOP SPORT PHYS

Background: Generic self-report measures do not reflect the complexity of a person’s pain-related behaviour. Since variations in a person’s fear of movement and avoidance behaviour may arise from contextual and motivational factors, a person-centred evaluation is required—addressing the cognitions, emotions, motivation and actual behaviour of the person. Clinical Question: Most musculoskeletal rehabilitation clinicians will recognise that different people with chronic pain have very different patterns of fear and avoidance behaviour. However, an important remaining question for clinicians is “how can I identify and reconcile discrepancies in fear of movement and avoidance behaviour observed in the same person, and adapt my management accordingly?”. Key Results: We frame a clinical case of a patient with persistent low back pain to illustrate the key pieces of information that clinicians may consider in a person-centred evaluation (i.e., patient interview, self-report measures and behavioural assessment) when working with patients to manage fear of movement and avoidance behaviour. Clinical Application: Understanding the discrepancies in a person’s fear of movement and avoidance behaviour is essential for musculoskeletal rehabilitation clinicians, as they work in partnership with patients to guide tailored approaches to changing behaviours.

Development and Validation of Short Forms of the Pain Catastrophizing Scale (F-PCS-5) and Tampa Scale for Kinesiophobia (F-TSK-6) in Musculoskeletal Chronic Pain Patients

Article

Full-text available

Jan 2023

Purpose: Chronic pain is a complex phenomenon. Understanding its multiple dimensions requires the use of a combination of several patient-reported outcome measures (PROMs). However, completing multiple PROMs is time-consuming and can be a burden for patients. The objective of our study was to simultaneously reduce the French versions of the Pain Catastrophizing Scale (PCS) and Tampa Scale for Kinesiophobia (TSK) questionnaires to enable their use in an ambulatory and clinical settings. Patients and methods: We conducted a clinical study between May 2014 and August 2020 in our rehabilitation center. 1428 chronic musculoskeletal pain patients (CMSP) were included. The originality of our approach is that the reduction method included qualitative as well as quantitative analyses. The study was divided into two parts: 1) reduction of the questionnaires (n=1363) based on internal consistency (item-to-total correlation), principal component analysis (item loadings), Rasch analysis (infit/outfit), floor and ceiling effect (quantitative analyses) and expert judgment of items (qualitative analysis), and 2) validation of the reduced questionnaires (n=65), including test-retest reliability (intraclass correlation coefficient [ICC]), homogeneity (Cronbach α), criterion validity (Pearson correlation [r] with the long-version score), determination of the pathological cutoff and Minimal Clinically Important Difference (MCID). The two full-length questionnaires include 30 items in total. Results: The reduction resulted in a 5-item PCS (score 0-20) and 6-item TSK (score 0-24). Psychometric properties of the reduced questionnaires were all acceptable as compared with other version (α=0.89 and 0.71, ICC=0.75 and 0.60, r=0.86 and 0.70, MCID=2 and 2 for PCS and TSK, respectively) while keeping the structure and coherence of the long versions. Conclusion: The two reduced versions of the PCS and TSK can be used in CMSP patient. As their administration only requires a few minutes, they can be implemented in outpatient consultation as well as in clinical settings.

Sensibility and measurement properties of the Tampa Scale of Kinesiophobia to measure fear of movement in children and adults in surgical settings

Article

Jun 2022

Purpose: Fear of movement, or kinesiophobia, is a risk factor for developing chronic post-surgical pain (CPSP) and may impede recovery. Identifying people with kinesiophobia peri-operatively is potentially valuable to intervene to optimize rehabilitation and prevent CPSP. This narrative review aims to describe and critically appraise the sensibility and measurement properties of the Tampa Scale of Kinesiophobia (TSK) in the surgical setting in both pediatric and adult populations.Material and methods: PubMed was searched for relevant articles using search terms related to the TSK and measurement properties; the search was restricted to articles published in English. COSMIN guidelines were used to rate measurement property sufficiency and study quality.Results: Four articles examined the measurement properties of the TSK-17 in the surgical setting. Included studies demonstrated sufficient internal consistency, structural validity, construct validity, but insufficient predictive validity. Study quality was variable. Although the TSK was not originally intended for the surgical setting, with minor modification, it appears sensible to use in this population.Conclusions: The TSK is a sensible tool to measure fear of movement in children and adults undergoing, or who underwent, surgery. Future studies are needed to test content validity, test-retest reliability, measurement error, and responsiveness in the surgical setting.IMPLICATIONS FOR REHABILITATIONFear of movement is a predictor of developing chronic post-surgical pain in children and adults.Rehabilitation interventions can address fear of movement in hopes to optimize surgical outcomes and prevent chronic post-surgical pain.The Tampa Scale of Kinesiophobia (TSK), with minor modification, is a sensible tool to measure fear of movement in surgical settings.There is some evidence that the TSK is reliable and valid to use with older children, adolescents, and adults who are undergoing or underwent surgery.

Less is more: Reliability and measurement error for three versions of the Tampa Scale of Kinesiophobia (TSK-11, TSK-13, and TSK-17) in patients with high-impact chronic pain

Article

Feb 2022

Objectives The Tampa Scale of Kinesiophobia (TSK) is a valid and reliable tool to assess somatic focus and activity avoidance in patients. Currently, the test-retest reliability and measurement error for the Danish version is unknown. The aim of the study was to determine standard error of measurement (SEM) and smallest detectable change (SDC) for three Danish lengths of the TSK in patients with chronic pain. Methods Waiting-list patients (n = 77) completed the TSK-17 twice from home with a test interval between 7 and 14 days. Based on COSMIN recommendations, the test-retest reliability was estimated using intraclass correlation coefficient (ICC 2,1 ), and measurement error in terms of standard error of measurement (SEM agreement ) and SDC95% were calculated. Results All three versions showed good test-retest reliability with ICC 2,1 -values (CI95%) of 0.86(0.79–0.91), 0.88(0.82–0.92) and 0.87(0.81–0.92) for the TSK-17, TSK-13, and TSK-11. The SEM-values were 3.08, 2.42 and 2.10 respectively and SDC95%-values were 8.53, 6.71 and 5.82. Conclusions The Danish versions of TSK-11, TSK-13 and TSK-17 showed good to excellent test-retest reliability. SEM and SDC95% values in patients with chronic pain are reported. The TSK-11 did not show systematic bias between test and retest and may be preferred to minimize responder burden.

Measurement properties of the Brazilian versions of Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in individuals with shoulder pain

Article

Full-text available

Dec 2021
PLOS ONE

Purpose To verify the measurement properties of the Brazilian versions of Fear-avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK) in individuals with shoulder pain. Methods Individuals with shoulder pain (>18 years) were included in this study. Structural validity was verified by exploratory factor analysis, which was used to identify dimensionality of the FABQ and TSK. Test-retest reliability was assessed with intraclass correlation coefficient (3,1) and internal consistency with Cronbach’s alpha. Floor or ceiling effects were also investigated. Responsiveness was verified by effect sizes and area under the receiver operating characteristic curve (AUC). Results Exploratory factor analysis identified two and one factor in the FABQ and TSK, respectively. FABQ and TSK presented moderate to good reliability and adequate internal consistency (Cronbach’s alpha > 0.70). The floor effect was present in one factor of the FABQ. The FABQ and TSK showed small to moderate effect sizes and did not show adequate AUC. Conclusion FABQ and TSK are multidimensional and unidimensional instruments, respectively. Those instruments presented moderate to good reliability and the responsiveness was considered to be suboptimal in individuals with shoulder pain.

Do fear and catastrophizing about mental activities relate to fear-avoidance behavior in a community sample? An experimental study

Article

Full-text available

Feb 2021
J CLIN EXP NEUROPSYC

Introduction: Healthy people often experience headache, cognitive failures, or mental fatigue. Some people even experience these symptoms on a level comparable to patients with mild spectrum brain injuries. In these individuals, the fear-avoidance model explains symptoms as a consequence of catastrophizing and fear-avoidance toward mental activities. This experimental study investigated in healthy adults whether fear-avoidance and catastrophizing about mental activities are related to fear-avoidance behavior (i.e., behavioral avoidance of mental activities) according to the fear-avoidance model. Method: A randomized crossover within-subject design was used with two measurements and 80 participants. Participants were exposed to three demanding cognitive tasks and their simplified counterparts. Post-concussion symptoms, catastrophizing, fear-avoidance, behavioral avoidance (time spent working on cognitive tasks), exposure to mental activity, depression, heart rate, and state-trait anxiety were assessed. Results: Significant correlations between the variables of the fear-avoidance model were found. Furthermore, catastrophizers spent less time on difficult tasks compared to easy tasks. Both catastrophizing and female sex predicted time spent on difficult tasks, whereas only female sex predicted time spent on easy tasks. Conclusions: This study found that, according to the fear-avoidance model, catastrophizing is related to behavioral avoidance of cognitively challenging tasks in a community sample.

PROGNOSTIC FACTORS AND UNDERLYING MECHANISMS IN CHRONIC LOW BACK PAIN

Thesis

Full-text available

Nov 2009

Marije Vos-van der Hulst

Is the fear-avoidance model also relevant for chronic disability after traumatic brain injury?

Article

Aug 2020

Previous studies convincingly suggests that the biopsychosocial fear-avoidance model (FAM) may be of added value to understand chronic disability after traumatic brain injury (TBI). Within this model, persistent symptoms occur as a result of catastrophizing and fear-avoidance regarding initial symptoms, leading to depression, reduced mental activity, and greater disability in daily functioning. This study examined the FAM in a large English-speaking TBI sample. A cross-sectional study was conducted in 117 individuals with complicated mild, moderate, or severe TBI at 1-5 years post-injury. Participants completed questionnaires assessing personal, injury-related, and psychological characteristics. Reliability, correlational, and regression analyses were performed. Main outcomes measures of chronic disability were depression, disuse (e.g. less mental activities), and functional disability. The results revealed that all correlations suggested by the FAM were significant. Catastrophizing thoughts were positively associated with TBI-related symptoms and fear-avoidance thoughts. Main outcome measures were positively associated with fear-avoidance thoughts and TBI-related symptoms. Furthermore, variables in the FAM were of additive value to personal, injury-related, and psychological variables in understanding unfavorable chronic disability after TBI. The separate regression analyses for depression, less mental activities, and disability revealed 'fear-avoidance thoughts' as the only consistent variable. In conclusion, this study shows the associations of the FAM with chronic disability after TBI, which has implications for assessment and future management of the FAM in TBI in English-speaking countries. Longitudinal studies are warranted to further investigate and refine the model.

Activity Avoidance and Function in Persons with Chronic Back Pain

Article

Full-text available

Sep 2000

This study examined the relative contribution of two aspects of pain-related fear to functional disability among 133 persons with chronic pain, predominantly chronic back pain: 1) beliefs that pain represents damage or significant harm to the body and 2) beliefs that activities that cause pain should be avoided. Pain-related fear was assessed using the Tampa Scale for Kinesiophobia, Version 2 (TSK-2). Factor analysis in the present study replicated the two-factor solution found in a previous investigation, representing the two dimensions of pain-related fear noted above. Activity avoidance was significantly associated with the percent of maximum expected weight lifted from floor to waist and waist to shoulder during Progressive Isoinertial Lifting Evaluation (PILE). Fear of damage or harm to the body was only significantly related to the floor to waist lift. When controlling for demographic, physiologic, and other psychological variables, only activity avoidance continued to significantly predict performance on both lifts of the PILE. Although it has been proposed that deconditioning may mediate the relationship between activity avoidance and disability, this was not supported in the present investigation. The results highlight the importance of pain-related fear, particularly activity avoidance, in the assessment of functional activity among persons with chronic pain.

The role of fear of movement/(re)injury in pain disability

Article

Full-text available

Dec 1995
J OCCUP REHABIL

It is now well established that in chronic low back pain, there is no direct relationship between impairments, pain, and disability. From a cognitive-behavioral perspective, pain disability is not only influenced by the organic pathology, but also by cognitive-perceptual, psychophysiological, and motoric-environmental factors. This paper focuses on the role of specific beliefs that are associated with avoidance of activities. These beliefs are related to fear of movement and physical activity, which is (wrongfully) assumed to cause (re)injury. Two studies are presented, of which the first examines the factor structure of the Tampa Scale for Kinesiophobia (TSK), a recently developed questionnaire that is aimed at quantifying fear of movement/(re)injury. In the second study, the value of fear of movement/(re)injury in predicting disability levels is analyzed, when the biomedical status of the patient and current pain intensity levels are controlled for. In addition, the determinants of fear of movement/(re)injury are examined. The discussion focuses on the clinical relevance of the fear-avoidance model in relation to risk assessment, assessment of functional capacity, and secondary prevention.

Factor Analytic Evidence for the Construct Validity of Scores: A Historical Overview and Some Guidelines

Article

Full-text available

Apr 1996
EDUC PSYCHOL MEAS

Expectations for reporting factor analysis results as part of construct validation are explored in the context of emerging views of measurement validity. Desired practices are discussed regarding both exploratory factor analysis (e.g., principal components analysis) and confirmatory factor analysis (e.g., LISREL and EQS factor analyses). A short computer program for conducting parallel analysis is appended.

Goodness-of-Fit Indexes in Confirmatory Factor Analysis: The Effect of Sample Size. [Miscellaneous Article]

Article

Full-text available

May 1988

In confirmatory factor analysis, hypothesized models reflect approximations to reality so that any model can be rejected if the sample size is large enough. The appropriate question is whether the fit is adequate to support the model, and a large number of fit indexes have been proposed for this purpose. In the present article, we examine the influence of sample size on different fit indexes for both real and simulated data. Contrary to claims by Bentler and Bonett (1980), their incremental fit index was substantially affected by sample size. Contrary to claims by Joreskog and Sorbom (1981), their goodness-of-fit indexes provided by LISREL were substantially affected by sample size. Contrary to claims by Bollen (1986), his new incremental fit index was substantially affected by sample size. Hoelter's (1983) critical N index was also substantially affected by sample size. Of the more than 30 indexes considered, the Tucker-Lewis (1973) index was the only widely used index that was relatively independent of sample size. However, four new indexes based on the same form as the Tucker-Lewis index were also relatively independent of sample size., (C) 1988 by the American Psychological Association <2>

The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee

Article

Full-text available

Mar 1990

To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.

Comparative Fit Indexes in Structural Models

Article

Full-text available

Mar 1990

P. M. Bentler

Normed and nonnormed fit indexes are frequently used as adjuncts to chi-square statistics for evaluating the fit of a structural model. A drawback of existing indexes is that they estimate no known population parameters. A new coefficient is proposed to summarize the relative reduction in the noncentrality parameters of two nested models. Two estimators of the coefficient yield new normed (CFI) and nonnormed (FI) fit indexes. CFI avoids the underestimation of fit often noted in small samples for Bentler and Bonett's (1980) normed fit index (NFI). FI is a linear function of Bentler and Bonett's non-normed fit index (NNFI) that avoids the extreme underestimation and overestimation often found in NNFI. Asymptotically, CFI, FI, NFI, and a new index developed by Bollen are equivalent measures of comparative fit, whereas NNFI measures relative fit by comparing noncentrality per degree of freedom. All of the indexes are generalized to permit use of Wald and Lagrange multiplier statistics. An example illustrates the behavior of these indexes under conditions of correct specification and misspecification. The new fit indexes perform very well at all sample sizes.

Formulating Clinical Research Hypotheses as Structural Equation Models: A Conceptual Overview

Article

Full-text available

Jun 1994

Structural equation modeling is a comprehensive, flexible approach to research design and data analysis. Although in recent years there has been phenomenal growth in the literature on technical aspects of structural equation modeling, relatively little attention has been devoted to conceiving research hypotheses as structural equation models. The aim of this article is to provide a conceptual overview of clinical research hypotheses that invite evaluation as structural equation models. Particular attention is devoted to hypotheses that are not adequately evaluated using traditional statistical models.

Pain demands attention: A cognitive-affective model of the interruptive function of pain

Article

Full-text available

Jun 1999

Pain interrupts and demands attention. The authors review evidence for how and why this interruption of attention is achieved. The interruptive function of pain depends on the relationship between pain-related characteristics (e.g., the threat value of pain) and the characteristics of the environmental demands (e.g., emotional arousal). A model of the interruptive function of pain is developed that holds that pain is selected for action from within complex affective and motivational environments to urge escape. The implications of this model for research and therapy are outlined with an emphasis on the redefinition of chronic pain as chronic interruption.

Comparative fit indices in structural models

Article

Jan 1990

P.M. Bentler

Kinisophobia: A new view of chronic pain behavior

Article

Jan 1990

Fit Indexes, Lagrange Multipliers, Constraint Changes and Incomplete Data in Structural Models

Article

Apr 1990

Peter M. Bentler

Certain aspects of model modification and evaluation are discussed, with an emphasis on some points of view that expand upon or may differ from Kaplan (1990). The usefulness of BentlerBonett indexes is reiterated. When degree of misspecification can be measured by the size of the noncentrality parameter of a x[SUP2] distribution, the comparative fit index provides a useful general index of model adequacy that does not require knowledge of sourees of misspecification. The dependence of the Lagrange Multiplier X[SUP2] statistic on both the estimated multiplier parameter and estimated constraint or parameter change is discussed. A sensitivity theorem that shows the effects of unit change in constraints on model fit is developed for model modification in structural models. Recent incomplete data methods, such as those developed by Kaplan and his collaborators, are extended to be applicable in a wider range of situations.

Beyond pain

Article

Jan 1999
CLIN PSYCHOL REV

The purpose of the present article is to provide unification to a number of somewhat disparate themes in the chronic pain and phobia literature. First, we present a summary review of the early writings and current theoretical perspectives regarding the role of avoidance in the maintenance of chronic pain. Second, we present an integrative review of recent empirical investigations of fear and avoidance in patients with chronic musculoskeletal pain, relating the findings to existing cognitive-behavioral theoretical positions. We also discuss several new and emerging lines of investigation, specifically related to information processing and anxiety sensitivity, which appear to be closely linked to pain-related avoidance behavior. Finally, we discuss the implications of the recent empirical findings for the assessment and treatment of individuals who experience disabling chronic musculoskeletal pain and suggest possible avenues for future investigation.

Tests for Structural Equation Models: Introduction

Article

Nov 1992

Mannual for the State-Trait anxiety inventory STAI (Form)

Book

Wolfe F, Smythe HA, Yunus MB, Benett RM, Bombardier C, Goldenberg DL, Tugwell P, Campell SM, Abeles M, Clark P. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee

Article

Feb 1990
ARTHRIT RHEUM-ARTHR

To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in ⩾ 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.

Testing Structural Equation Model

Book

Jan 1993

Ambulatory accelerometry to quantify motor behaviour in patients after failed back surgery: A validation study

Article

Feb 1998

In the treatment of patients with pain, measures related to (pain) behaviour are of major importance. Ambulatory activity monitoring can be used to obtain insight into actual behaviour. This study was designed to validate the Activity Monitor (AM), an instrument based on long-term ambulatory monitoring of accelerometer signals, to assess several physical activities during normal daily life. Ten failed back surgery (FBS) patients performed a number of functional activities in and around their own houses. During the measurements, continuous ambulatory registrations of accelerometer signals were made, based on four body-mounted accelerometers (one on each upper leg, two on the trunk). Video recordings made simultaneously with the measurements were used as a reference. The continuous output of the AM (postures, transitions, dynamic activities) was compared with visual analysis of the videotapes. The overall results showed an agreement between AM output and video analysis of 87% (inter subject range: 83-88%). The maximal error in the determination of the duration of activities was 0.3%. The overall number of dynamic periods was determined well (AM: 359; video: 368), while the number of transitions was slightly overestimated (AM: 228; video: 205). The results when using the three-sensor version of the AM were somewhat less accurate (overall agreement from 87% to 82%). The AM appeared to be a valid instrument to quantify aspects of behaviour of FPS patients, such as duration of activities and number of transitions. This new technique of ambulatory measurement of mobility activities seems to be a relevant and promising extension of the techniques currently used in the evaluation of pain treatment.

The Back Pain Revolution

Article

Jul 1999
J Can Chiropract Assoc

Rhonda Kirkwood

The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain

Article

Aug 1992

Fear of pain has been implicated in the development and maintenance of chronic pain behavior. Consistent with conceptualizations of anxiety as occurring within three response modes, this paper introduces an instrument to measure fear of pain across cognitive, overt behavioral, and physiological domains. The Pain Anxiety Symptoms Scale (PASS) was administered to 104 consecutive referrals to a multidisciplinary pain clinic. The alpha coefficients were 0.94 for the total scale and ranged from 0.81 to 0.89 for the subscales. Validity was supported by significant correlations with measures of anxiety and disability. Regression analyses controlling for measures of emotional distress and pain showed that the PASS made a significant and unique contribution to the prediction of disability and interference due to pain. Evidence presented here supports the potential utility of the PASS in the continued study of fear of pain and its contribution to the development and maintenance of pain behaviors. Factor analysis and behavioral validation studies are in progress.

The Pain Anxiety Symptoms Scale: Psychometric properties in a community sample

Article

Nov 1994

This study investigated the factor structure and psychometric properties of the Pain Anxiety Symptoms Scale (PASS). The PASS assesses four components of pain-related anxiety: cognitive, fear, escape/avoidance, and physiological. Confirmatory factor analyses provided support for both the one-factor and the four-factor structures reported for samples of clinic-referred pain patients. The alpha coefficients were high for the PASS subscales. Significant gender differences were obtained on the PASS total and subscale scores. Convergent and divergent validity estimates of the PASS were also assessed. Results may be used to evaluate the responses of clinic-referred pain patients.

Prediction of Pain in Patients with Chronic Low Back Pain: Effects of Inaccurate Prediction and Pain-Related Anxiety

Article

Oct 1993
BEHAV RES THER

This study investigated predictions of pain intensity, reports of pain and anxiety, frequency of pain-related anxiety symptoms, and range of motion, in 43 patients exposed to pain during a physical examination. All patients had primary complaints of low back pain. The pain stimuli used for this study included back and/or leg pain produced by repeatedly raising the extended leg of the patient to the point of pain tolerance. Generally, findings demonstrated that (a) predictions of pain were a function of discrepancies between previous predictions and experiences of pain, (b) patients reporting greater pain-related anxiety showed a tendency to overpredict new pain events, but corrected their predictions readily, (c) patients reporting less pain-related anxiety displayed a persistent tendency to underpredict pain, and (d) higher predictions of pain, independent of pain reports, related to less range of motion during a procedure that involved painful movement. Discussion focuses on differences between these results and those of previous studies and the implications of inaccurate prediction for continued pain and disability.

A Fear-Avoidance Beliefs Questionnaire (FABQ) and the Role of Fear-Avoidance Beliefs in Chronic Low Back Pain and Disability

Article

Mar 1993

Pilot studies and a literature review suggested that fear-avoidance beliefs about physical activity and work might form specific cognitions intervening between low back pain and disability. A Fear-Avoidance Beliefs Questionnaire (FABQ) was developed, based on theories of fear and avoidance behaviour and focussed specifically on patients' beliefs about how physical activity and work affected their low back pain. Test-retest reproducibility in 26 patients was high. Principal-components analysis of the questionnaire in 210 patients identified 2 factors: fear-avoidance beliefs about work and fear-avoidance beliefs about physical activity with internal consistency (alpha) of 0.88 and 0.77 and accounting for 43.7% and 16.5% of the total variance, respectively. Regression analysis in 184 patients showed that fear-avoidance beliefs about work accounted for 23% of the variance of disability in activities of daily living and 26% of the variance of work loss, even after allowing for severity of pain; fear-avoidance beliefs about physical activity explained an additional 9% of the variance of disability. These results confirm the importance of fear-avoidance beliefs and demonstrate that specific fear-avoidance beliefs about work are strongly related to work loss due to low back pain. These findings are incorporated into a biopsychosocial model of the cognitive, affective and behavioural influences in low back pain and disability. It is recommended that fear-avoidance beliefs should be considered in the medical management of low back pain and disability.

Fear Of Movement/(Re)Injury In Chronic Low Back Pain And Its Relation To Behavioral Performance

Article

Oct 1995

Two studies are presented that investigated 'fear of movement/(re)injury' in chronic musculoskeletal pain and its relation to behavioral performance. The 1st study examines the relation among fear of movement/(re)injury (as measured with the Dutch version of the Tampa Scale for Kinesiophobia (TSK-DV)) (Kori et al. 1990), biographical variables (age, pain duration, gender, use of supportive equipment, compensation status), pain-related variables (pain intensity, pain cognitions, pain coping) and affective distress (fear and depression) in a group of 103 chronic low back pain (CLBP) patients. In the 2nd study, motoric, psychophysiologic and self-report measures of fear are taken from 33 CLBP patients who are exposed to a single and relatively simple movement. Generally, findings demonstrated that the fear of movement/(re)injury is related to gender and compensation status, and more closely to measures of catastrophizing and depression, but in a much lesser degree to pain coping and pain intensity. Furthermore, subjects who report a high degree of fear of movement/(re)injury show more fear and escape/avoidance when exposed to a simple movement. The discussion focuses on the clinical relevance of the construct of fear of movement/(re)injury and research questions that remain to be answered.

The assessment of anxiety and fear in persons with chronic pain: A comparison of instruments

Article

Nov 1996
BEHAV RES THER

Instruments used to study anxiety and fear responses related to chronic pain vary along two dimensions. They differ in terms of the stimuli or situations that evoke anxiety responses and the types of anxiety responses included (i.e. cognitive, motoric, and physiological). This study examined relations of variables from the Pain Anxiety Symptoms Scale (PASS), the Fear-Avoidance Beliefs Questionnaire (FABQ), the Fear of Pain Questionnaire (FPQ), and the trait version of the Spielberger State-Trait Anxiety Inventory (STAI) with variables related to pain severity, perceived disability, and pain behavior. Subjects were 45 consecutive referrals to a university pain clinic who completed these measures during their evaluation. Results suggested that anxiety responses directly related to the patient's particular pain sensations are more relevant to the understanding of chronic pain than are more general tendencies to respond anxiously or fear more varied pain stimuli. Regression analyses showed that empirically selected subsets of the anxiety variables predict from 16 to 54% of the variance in pain severity, disability and pain behavior. Also, assessment of multiple anxiety response types appears useful for understanding pain behavior and disability. Further study of fear and anxiety responses of persons with pain is likely to benefit from careful selection of measures dependent on the stimulus and response dimensions assessed.

Exploratory factor analysis of the Pain Anxiety Symptoms Scale in patients with chronic pain complaints

Article

Feb 1997

The Pain Anxiety Symptoms Scale (PASS) is a 40-item self-report measure that consists of four subscales measuring aspects of pain-related anxiety and avoidance. Despite its growing popularity, there have been few studies of its psychometric properties. The primary purpose of this study was to determine the factor structure of the PASS in a sample of 259 chronic pain patients. Principal component analysis with oblique (Oblimin) rotation provided partial support for the factorial validity of the PASS. Five factors were extracted: (1) catastrophic thoughts, (2) physiological anxiety symptoms, (3) escape/avoidance behaviours, (4) cognitive interference, and (5) coping strategies. The use of analgesic medication did not influence the factor solution. The factors were characterised by correlating them with pain-related measures, and with measures of mood state. Implications are considered for revising the PASS subscales to provide a more comprehensive and factorially valid assessment of pain-related fear and avoidance.

Avoidance and Confrontation of Painful, Back-Straining Movements in Chronic Back Pain Patients

Article

Feb 1998
BEHAV MODIF

Avoidance of painful activities has been proposed to be an important risk factor for the initiation and maintenance of chronic low back suffering, whereas exposure to these activities has been suggested to be beneficial for recovery. In a cross-sectional study, the differences between chronic patients with avoidant and confrontational styles were investigated using self-report measures and a behavioral test. Participants were first classified as avoiders or confronters. In comparison with confronters, avoiders reported greater frequency and duration of pain, higher fear of pain and injury, more disability in daily living, and more attention to back sensations. Finally, avoiders reported more fear of (re)injury during the behavioral test and had a worse performance than confronters. The results suggest a close link between the fear of pain/(re)injury on one hand and avoidance behavior and physical deconditioning on the other hand.

Can We Screen for Problematic Back Pain? A Screening Questionnaire for Predicting Outcome in Acute and Subacute Back Pain

Article

Oct 1998

Because musculoskeletal pain is the second most frequent reason for seeking health care, the aims of this study were to determine the value of psychosocial variables in evaluating risk for developing chronic back pain problems and to develop a screening methodology to identify patients likely to have a poor prognosis. A prospective study was conducted on consecutive patients with acute or subacute back pain, in which patients completed a screening questionnaire and were then followed up for 6 months to determine outcome. The primary outcome variable was accumulated sick leave. One hundred forty-two consecutive patients were asked to complete a questionnaire designed for this study. This questionnaire contained 24 items concerning psychosocial aspects of the problem. Six months later, patients were contacted to complete outcome questions about accumulated sick leave. A total of 97% of the patients completed both questionnaires. Although patients, on average, improved greatly, 18% had 1-30 days and 20% had fewer than 30 days of sick leave during the follow-up period. Five variables were found to be the strongest predictors of sick leave outcome (fear-avoidance work beliefs, perceived improvement, problems with work function, stress, and previous sick leave), correctly classifying 73% of the patients as opposed to a chance rate of 33%. A total score was evaluated as a means of judging risk and found to be strongly related to outcome. Potent psychosocial risk factors associated with future sick absenteeism were identified. Because the total score was related to outcome, the instrument may have use in screening patients with acute or subacute spinal pain in clinical situations.

Beyond pain: the role of fear and avoidance in chronicity

Article

Feb 1999
CLIN PSYCHOL REV

Article

Apr 1999

There is growing evidence for the idea that in back pain patients, pain-related fear (fear of pain/physical activity/(re)injury) may be more disabling than pain itself. A number of questionnaires have been developed to quantify pain-related fears, including the Fear-Avoidance Beliefs Questionnaire (FABQ), the Tampa Scale for Kinesiophobia (TSK), and the Pain Anxiety Symptoms Scale (PASS). A total of 104 patients, presenting to a rehabilitation center or a comprehensive pain clinic with chronic low back pain were studied in three independent studies aimed at (1) replicating that pain-related fear is more disabling than pain itself (2) investigating the association between pain-related fear and poor behavioral performance and (3) investigating whether pain-related fear measures are better predictors of disability and behavioral performance than measures of general negative affect or general negative pain beliefs (e.g. pain catastrophizing). All three studies showed similar results. Highest correlations were found among the pain-related fear measures and measures of self-reported disability and behavioral performance. Even when controlling for sociodemographics, multiple regression analyses revealed that the subscales of the FABQ and the TSK were superior in predicting self-reported disability and poor behavioral performance. The PASS appeared more strongly associated with pain catastrophizing and negative affect, and was less predictive of pain disability and behavioral performance. Implications for chronic back pain assessment, prevention and treatment are discussed.

Attention to chronic pain is dependent upon pain-related fear

Article

Dec 1999
J PSYCHOSOM RES

Pain interrupts, distracts, and is difficult to disengage from. In this study, the role of pain-related fear in moderating attentional interference produced by chronic pain was investigated. Forty chronic pain patients completed a list of questionnaires assessing pain severity, pain-related fear (Tampa Scale for Kinesiophobia), and negative affect (Negative Emotionality scale). Attentional interference was measured by a numerical interference test. Multiple regression analysis revealed that the attentional interference was best predicted by the interaction between pain severity and pain-related fear. These results are discussed in terms of how pain-related fear creates a hypervigilance to pain.

Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art

Article

May 2000

In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al. (Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401-408).ntroduced a so-called 'fear-avoidance' model. The central concept of their model is fear of pain. 'Confrontation' and 'avoidance' are postulated as the two extreme responses to this fear, of which the former leads to the reduction of fear over time. The latter, however, leads to the maintenance or exacerbation of fear, possibly generating a phobic state. In the last decade, an increasing number of investigations have corroborated and refined the fear-avoidance model. The aim of this paper is to review the existing evidence for the mediating role of pain-related fear, and its immediate and long-term consequences in the initiation and maintenance of chronic pain disability. We first highlight possible precursors of pain-related fear including the role negative appraisal of internal and external stimuli, negative affectivity and anxiety sensitivity may play. Subsequently, a number of fear-related processes will be discussed including escape and avoidance behaviors resulting in poor behavioral performance, hypervigilance to internal and external illness information, muscular reactivity, and physical disuse in terms of deconditioning and guarded movement. We also review the available assessment methods for the quantification of pain-related fear and avoidance. Finally, we discuss the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain. Although there are still a number of unresolved issues which merit future research attention, pain-related fear and avoidance appear to be an essential feature of the development of a chronic problem for a substantial number of patients with musculoskeletal pain.

Do fibromyalgia patients display hypervigilance for inocuous sensory stimuli? Application of a body scanning reaction time paradigm

Article

Jul 2000

This study tested the hypothesis that fibromyalgia patients display hypervigilance for somatosensory signals. Hypervigilance was operationalized as the detection of weak electrocutaneous stimuli. Innocuous electrical stimuli gradually increasing in strength were administered to one of four different body locations. A reaction time paradigm was used in which subjects had to respond as fast as possible to stimulus detection by pressing a button corresponding to the correct body location. The detection task was presented first under single task conditions and subsequently under dual task conditions, in combination with a second (visual) reaction time task. It was predicted that hypervigilance would be most prominent under dual task conditions, where subjects can choose to allocate attention selectively to one of the tasks. Questionnaires on general body vigilance, pain vigilance, pain related-fear and pain catastrophizing were also administered. Thirty female fibromyalgia patients were compared to 30 healthy controls matched on age, sex and educational level. No evidence for hypervigilance for innocuous signals was found: patients did not show superior detection of electrical stimuli either under single or dual task conditions. Also, no differences were found between patients and controls on the body vigilance questionnaire. Detection of electrical stimuli was, however, predicted by pain-related fear and pain vigilance.

Fear of pain in orofacial patients

Article

Feb 2001

In the present study, we examined whether fear of pain, dental fear, general indices of psychological distress, and self-reported stress levels differed between 40 orofacial pain patients and 40 gender and age matched control general dental patients. We also explored how fear of pain, as measured by the Fear of Pain Questionnaire-III (J Behav Med 21 (1998) 389), relates to established measures of psychological problems in our sample of patients. Finally, we examined whether fear of pain uniquely and significantly predicts dental fear and psychological distress relative to other theoretically-relevant psychological factors. Our results indicate that fear of severe pain and anxiety-related distress, broadly defined, are particularly elevated in orofacial pain patients relative to matched controls. Additionally, fear of pain shares a significant relation with dental fear but not other general psychological symptomology, and uniquely and significantly predicts dental fear relative to other theoretically-relevant variables. Taken together, these data, in conjunction with other recent studies, suggest greater attention be placed on understanding the fear of pain in orofacial pain patients and its relation to dental fear and anxiety.

De Tampa Schaal voor Ki-nesiofobie. Psychometrische karakteristieken en normeringThe Tampa Scale for Kinesiophobia. Psy-chometric characteristics and norms

54-62

L Goubert
G Crombez
Jws Vlaeyen

Goubert L, Crombez G, Vlaeyen JWS, et al. De Tampa Schaal voor Ki-nesiofobie. Psychometrische karakteristieken en normering. Gedrag en Gezondheid. 2000;28:54–62. (The Tampa Scale for Kinesiophobia. Psy-chometric characteristics and norms

Theroleoffearof movement/(re)injury in pain disability

235-251

Vlaeyenjws
Kole
Snijdersamj
Rotteveelam

VlaeyenJWS,Kole-SnijdersAMJ,RotteveelAM,etal.Theroleoffearof movement/(re)injury in pain disability. J Occup Rehabil. 1995;5:235– 251

Canwescreenforproblematicbackpain?Ascreen-ingquestionnaireforpredictingoutcomeinacuteandsubacutebackpain

209-215

Lintonsj

LintonSJ,HalldénK.Canwescreenforproblematicbackpain?Ascreen-ingquestionnaireforpredictingoutcomeinacuteandsubacutebackpain. Clin J Pain. 1998;14:209–215

Kinesiophobia and chronic pain: psycho-metric characteristics and factor analysis of the Tampa Scale

Me Clark
Sh Kori
J Brockel

Clark ME, Kori SH, Brockel J. Kinesiophobia and chronic pain: psycho-metric characteristics and factor analysis of the Tampa Scale. Amer Pain Soc Abstracts. 1996;15:77

Kinesiophobia:anewviewofchronicpain behavior

35-43

Korish
Millerrp

KoriSH,MillerRP,ToddDD.Kinesiophobia:anewviewofchronicpain behavior. Pain Manage. 1990;35–43

Ambulatory accel-erometrytoquantifymotorbehaviourinpatientsafterfailedbacksurgery: a validation study

153-161

Jbj Bussmann
De Laar Ym
Neeleman
Mp

Bussmann JBJ, van de Laar YM, Neeleman MP, et al. Ambulatory accel-erometrytoquantifymotorbehaviourinpatientsafterfailedbacksurgery: a validation study. Pain. 1998;74:153–161

The Pain Anxiety Symptoms Scale:developmentandvalidationofascaletomeasurefearofpain

67-73

Lm Mccracken
C Zayfert
Gross

McCracken LM, Zayfert C, Gross RT. The Pain Anxiety Symptoms Scale:developmentandvalidationofascaletomeasurefearofpain.Pain. 1992;50:67–73.

Alternative ways of assessing model fit Testing Structural Equation Models

136-162

Mw Browne
Cudeck

Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, eds. Testing Structural Equation Models. Newbury Park, CA: Sage; 1993;136–162

In: Bollen KA, Long JS, eds. Testing Structural Equation Models

Ka Bollen
Js Long
Introduction

Bollen KA, Long JS. Introduction. In: Bollen KA, Long JS, eds. Testing Structural Equation Models. Newbury Park, CA: Sage; 1993;1–9

The Tampa Scale. Unpublished Report

Jan 1991

Rp Miller
Sh Kori
Dd Todd

Miller RP, Kori SH, Todd DD. The Tampa Scale. Unpublished Report. 1991. Tampa, FL.

Jan 1999
356

Eccleston

Confirmatory Factor Analysis of the Tampa Scale for Kinesiophobia: Invariant Two-Factor Model Across Low Back Pain Patients and Fibromyalgia Patients

Abstract

No full-text available

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