The Tampa Scale of Kinesiophobia (TSK) is a commonly used measure for the assessment of kinesiophobia related to spinal diseases. The Italian version showed satisfactory psychometric properties, but its responsiveness has not yet been evaluated. This observational study is aimed at evaluating the responsiveness and minimal important changes (MICs) for the TSK in subjects with chronic low back pain.
At the beginning and end of an 8-week multidisciplinary rehabilitation programme, 205 patients completed the TSK. After the programme, patients also completed the global perceived effect (GPE) scale, which was divided to produce a dichotomous outcome. Responsiveness was calculated by distribution [effect size (ES); standardised response mean (SRM)] and anchor-based methods [receiver-operating characteristics (ROC) curves; correlations between change scores of the TSK and GPE]. ROC curves were also used to compute the best cut-off levels between subjects with a “good” or “poor” outcome (MICs).
The ES and the SRM were 1.49 and 1.36, respectively. The ROC analyses revealed a MIC value (AUC; sensitivity; specificity) of 5.5 (0.996; 95; 97). To avoid any dependence on the baseline scores, the MIC value [area under the curve (AUC); sensitivity; and specificity] was computed also based on the percentage of change from the baseline and a value of 18 % (0.998; 97; 98 %) was obtained. The correlation between change scores of the TSK and GPE was high (0.871).
The TSK was sensitive in detecting clinical changes in subjects with chronic low back pain. We recommend taking the MICs provided into account when assessing patients’ improvement or planning studies in this clinical context.
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Mokkink LB, Terwee CB, Patrick DL et al (2010) The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 63:737–745. doi:10.1016/j.jclinepi.2010.02.006
de Vet HC, Terwee CB, Ostelo RW et al (2006) Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes 4:54. doi:10.1186/1477-7525-4-54
Vlaeyen JW, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332
Kori S, Miller R, Todd D (1990) Kinesiophobia: a new view of chronic pain behavior. Pain Manag 3:35–43
French DJ, France CR, Vigneau F et al (2007) Fear of movement/(re)injury in chronic pain: a psychometric assessment of the original English version of the Tampa scale for kinesiophobia (TSK). Pain 127:42–51. doi:10.1016/j.pain.2006.07.016
Cleland JA, Childs JD, Whitman JM (2008) Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain. Arch Phys Med Rehabil 89:69–74. doi:10.1016/j.apmr.2007.08.126
Burwinkle T, Robinson JP, Turk DC (2005) Fear of movement: factor structure of the Tampa Scale of Kinesiophobia in patients with fibromyalgia syndrome. J Pain Off J Am Pain Soc 6:384–391. doi:10.1016/j.jpain.2005.01.355
de Souza FS, da Silva Marinho C, Siqueira FB et al (2008) Psychometric testing confirms that the Brazilian–Portuguese adaptations, the original versions of the Fear-Avoidance Beliefs Questionnaire, and the Tampa Scale of Kinesiophobia have similar measurement properties. Spine 33:1028–1033. doi:10.1097/BRS.0b013e31816c8329
Haugen AJ, Grøvle L, Keller A, Grotle M (2008) Cross-cultural adaptation and validation of the Norwegian version of the Tampa scale for kinesiophobia. Spine 33:E595–E601. doi:10.1097/BRS.0b013e31817c6c4b
Woby SR, Roach NK, Urmston M, Watson PJ (2005) Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain 117:137–144. doi:10.1016/j.pain.2005.05.029
Monticone M, Giorgi I, Baiardi P et al (2010) Development of the Italian version of the Tampa Scale of Kinesiophobia (TSK-I): cross-cultural adaptation, factor analysis, reliability, and validity. Spine 35:1241–1246. doi:10.1097/BRS.0b013e3181bfcbf6
Husted JA, Cook RJ, Farewell VT, Gladman DD (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53:459–468
Mokkink LB, Terwee CB, Knol DL et al (2010) The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 10:22. doi:10.1186/1471-2288-10-22
Airaksinen O, Brox JI, Cedraschi C et al (2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15 Suppl 2:S192–S300. doi:10.1007/s00586-006-1072-1
Monticone M, Ambrosini E, Rocca B et al (2014) A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study. Eur Spine J. doi:10.1007/s00586-014-3478-5
Kamper SJ, Ostelo RWJG, Knol DL et al (2010) Global Perceived Effect scales provided reliable assessments of health transition in people with musculoskeletal disorders, but ratings are strongly influenced by current status. J Clin Epidemiol 63(760–766):e1. doi:10.1016/j.jclinepi.2009.09.009
Revicki D, Hays RD, Cella D, Sloan J (2008) Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol 61:102–109. doi:10.1016/j.jclinepi.2007.03.012
Zweig MH, Campbell G (1993) Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39:561–577
de Vet HCW, Terwee CB, Mokkink LB, Knol DL (2011) Measurement in medicine: a practical guide. Cambridge University Press, Cambridge
Atkinson G, Nevill A (1997) Comment on the use of concordance correlation to assess the agreement between two variables. Biometrics 53:775–777
Schuller W, Ostelo RWJG, Janssen R, de Vet HCW (2014) The influence of study population and definition of improvement on the smallest detectable change and the minimal important change of the neck disability index. Health Qual Life Outcomes 12:53. doi:10.1186/1477-7525-12-53
Crosby RD, Kolotkin RL, Williams GR (2003) Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol 56:395–407
Monticone M, Ambrosini E, Vernon H et al (2015) Responsiveness and minimal important changes for the Neck Disability Index and the Neck Pain Disability Scale in Italian subjects with chronic neck pain. Eur Spine J. doi:10.1007/s00586-015-3785-5
Terwee CB, Bot SDM, de Boer MR et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42. doi:10.1016/j.jclinepi.2006.03.012
de Vet HCW, Terwee CB (2010) The minimal detectable change should not replace the minimal important difference. J Clin Epidemiol 63:804–805. doi:10.1016/j.jclinepi.2009.12.015 (author reply 806)
Beninato M, Fernandes A, Plummer LS (2014) Minimal clinically important difference of the functional gait assessment in older adults. Phys Ther 94:1594–1603. doi:10.2522/ptj.20130596
Slevin ML, Plant H, Lynch D et al (1988) Who should measure quality of life, the doctor or the patient? Br J Cancer 57:109–112
Wyrwich KW, Metz SM, Kroenke K et al (2007) Measuring patient and clinician perspectives to evaluate change in health-related quality of life among patients with chronic obstructive pulmonary disease. J Gen Intern Med 22:161–170. doi:10.1007/s11606-006-0063-6
Monticone M, Baiardi P, Bonetti F et al (2012) The Italian version of the Fear-Avoidance Beliefs Questionnaire (FABQ-I): cross-cultural adaptation, factor analysis, reliability, validity, and sensitivity to change. Spine 37:E374–E380. doi:10.1097/BRS.0b013e31822ff5a7
The authors would like to thank all of the health professionals and patients who took part in the study.
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Monticone, M., Ambrosini, E., Rocca, B. et al. Responsiveness of the Tampa Scale of Kinesiophobia in Italian subjects with chronic low back pain undergoing motor and cognitive rehabilitation. Eur Spine J 25, 2882–2888 (2016). https://doi.org/10.1007/s00586-016-4682-2
- Chronic low back pain
- Minimal important changes