Tampa scale of kinesiophobia may underestimate task-specific fear of movement

Key points

1. 01Viewing images and videos of lifting produced greater fear of movement than the written TSK-11 in all groups (people with current low back pain, recovered, and pain-free controls).
2. 02Image-based and video-based fear was not associated with disability, whereas TSK-11 fear was, so the questionnaire still tracks the impact of fear on daily life.
3. 03Images and videos gave similar fear ratings, with no significant difference between the two formats.
4. 04Watching a person lift a heavier load evoked more fear than a lighter load.
5. 05The gap between the TSK-11 and image or video scores was larger in pain-free controls than in people with current pain, hinting the TSK-11 underestimates lifting fear most in pain-free people.

How it was conducted

Design

Cross-sectional online survey (Qualtrics) of 51 adults recruited Nov 2021 to Jul 2022

Groups

Current low back pain (n=14), recovered low back pain (n=13), and asymptomatic controls (n=24)

Methods compared

TSK-11 questionnaire, images of lifting, and videos of lifting, all rescaled to a 0 to 100 fear scale

Disability measure

Oswestry Disability Index, completed only by the current and recovered low back pain groups

Analysis

Linear mixed models for method, group, and load effects; linear regression for association of each method with the ODI, adjusting for group

What they found

• Significant main effect of method on fear (F(2,91), P=0.030); images elicited greater fear than the TSK-11 (mean difference 11.51, 95% CI [2.96, 20.05], P=0.009) and videos elicited greater fear than the TSK-11 (mean difference 8.95, 95% CI [0.50, 17.39], P=0.038).
• No significant group by method interaction (F(4,95), P=0.498) and no significant main effect of group (F(2,44), P=0.367).
• TSK-11 regression on disability was significant (R2=0.61, F(2,24), P=0.001) and TSK-11 fear was significantly associated with the ODI.
• Image-based and video-based regressions were overall significant (each R2=0.26, P=0.026 and P=0.028) but the fear term itself was not associated with disability (P=0.725 for images, P=0.933 for videos).
• Significant main effect of load on fear (F(1,137), P=0.001); higher loads evoked greater fear than lighter loads (mean difference 13.23, 95% CI [8.97, 17.50]); no significant method by load interaction (P=0.294).
• TSK-11 underestimated fear relative to an image by 19.8% in controls, 11.7% in recovered low back pain, and 3.0% in current low back pain (a nonstatistically significant trend).
• Group fear levels (Table 1, scaled): TSK-11 mean 18.83 (SD 4.00) in controls, 26.29 (SD 7.19) in current LBP, 22.31 (SD 5.50) in recovered LBP; ODI 13.71 (SD 11.28) in current LBP and 4.15 (SD 3.21) in recovered LBP.

Limitations

• Small cross-sectional sample of 51 participants, below the planned 57, with only 14 in the current low back pain group, limiting statistical power and the ability to detect group differences.
• The 9% to 11.5% difference between the TSK-11 and image or video scores was below the 21% threshold considered a clinically meaningful TSK-11 change.
• Image and video fear was measured on a single lifting task, while the TSK-11 and ODI are task-generic, which may explain why only the questionnaire tracked disability.
• Convenience sampling via social media and a relatively young sample may not represent the broader low back pain population, and a cross-sectional design cannot establish causation.

Why it matters

For patients

If you fear specific movements such as lifting, a written fear questionnaire alone may not fully capture that fear, and seeing the movement may reveal more.

For clinicians

Do not rely on the TSK-11 in isolation to gauge fear of lifting, especially in pain-free people, but keep using it because it best reflects the link between fear and disability.

For readers

Task-specific image-based or video-based tools may better measure fear of a particular movement, while task-generic questionnaires better track overall disability.