Background & Aims

Fear and avoidance responses to pain can provide valuable insights into the development and maintenance of chronic pain1. People with chronic pain may experience intense fear of movement, driven by the belief that it might cause or aggravate an injury and worsen their pain. Kinesiophobia, an extreme form of fear of movement, has been associated with heightened pain, increased disability, and reduced quality of life2. Moreover, reducing levels of kinesiophobia has been targeted as a relevant treatment outcome to improve the quality of life of people living with pain3. The Tampa Scale for Kinesiophobia4 is the predominant instrument used to assess kinesiophobia. This study aims to culturally adapt the 11-item Spanish version of the test (TSK-11)5 to the Chilean population with chronic pain and to provide evidence of its psychometric properties in this population.

Methods

For the cultural adaptation, Chilean patients with non-cancer chronic pain (N = 11) were interviewed. They were encouraged to comment on items and report any wording considered unclear or inappropriate in the Chilean context. Subsequently, participants with chronic pain (N = 401, mean age = 49 years (SD= 14.6), 82% women) completed the resulting slightly modified TSK-11, along with a battery of questionnaires assessing pain catastrophizing, pain intensity, pain interference, anxiety, and depression on two separate occasions, with a 3-month interval between them. We conducted a confirmatory factor analysis to test the two-factor structure supported by previous studies, including the factors of Activity Avoidance and Harm. We assessed the TSK-11 internal consistency using McDonald’s omega coefficient and its test-retest reliability using the intraclass correlation coefficient. Convergent validity was also examined.

Results

Following patient feedback, two minor wording changes were implemented in the instructions and item 11. Confirmatory factor analysis supported the two-factor structure of the TSK-11 (?2(43)= 126.660, p<.001; CFI=0.99; TLI=0.99; RMSEA= 0.07; SRMR=0.05). All items exhibited significant loadings on their respective factors. Internal consistency was acceptable for both factors (Activity Avoidance: ?=.85, Harm: ?=.76) as well as for the overall scale (?=.89). Test-retest reliability yielded a moderate intraclass correlation coefficient (ICC = 0.71). Furthermore, the TSK-11 showed a moderate positive correlation with pain catastrophizing (r=.53, p<.001), indicating convergent validity. It also showed small positive correlations with pain intensity (r=.25, p<.001), pain interference (r=.26, p<.001), anxiety (r=.22, p<.001), and depression (r=.17, p=.001), providing evidence of its discriminant validity.

Conclusions

Our study provides valuable evidence regarding structural validity, internal consistency, temporal stability, and convergent and discriminant validity of the Chilean adapted TSK-11. Our findings support the usefulness of this test as a valid and reliable tool for assessing kinesiophobia in the Chilean chronic pain population. Its satisfactory psychometric properties make it a reliable choice for clinicians and researchers aiming to assess kinesiophobia in this context.

References

1.Vlaeyen, J., & Linton, S. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317-332.
2.Luque-Suarez, A., Martinez-Calderon, J., & Falla, D. (2018). Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. British Journal of Sports Medicine, bjsports-2017.
3.Huang, J., Xu, Y., Xuan, R., Baker, J., & Gu, Y. (2022). A Mixed Comparison of Interventions for kinesiophobia in individuals with musculoskeletal pain: Systematic review and network meta-analysis. Frontiers in Psychology, 13, 886015.
4.Miller, R., Kori, S. & Todd, D. (1991). The Tampa Scale: a measure of kinesiophobia. The Clinical Journal of Pain, 7, 51-52.
5.Gómez-Pérez, L., López-Martínez, A., & Ruiz-Párraga, G. (2011). Psychometric properties of the Spanish version of the Tampa Scale for Kinesiophobia (TSK). The Journal of Pain, 12(4), 425-435.

Presenting Author

María Labbé

Poster Authors

Camila Román MSc

MSc

Pontificia Universidad Católica de Chile

Lead Author

Jorge Flores PhD.

Pontificia Universidad Católica de Chile

Lead Author

Patricio Cumsille PhD.

Pontificia Universidad Católica de Chile

Lead Author

Fernando Altermatt MSc

Lead Author

Lydia Gómez-Pérez PhD.

Universidad de Málaga

Lead Author

Topics

  • Assessment and Diagnosis