Objectives: To determine the psychometric properties of a questionnaire to assess fear of movement (kinesiophobia): the Tampa Scale for Kinesiophobia (TSK-NL Heart), and to investigate the prevalence of kinesiophobia in patients attending cardiac rehabilitation.Methods: A total of 152 patients were evaluated with the TSK-NL Heart during intake and 7 days later. Internal consistency, test-retest reliability and construct validity were assessed. For construct validity, the Cardiac Anxiety Questionnaire (CAQ) and the Hospital Anxiety and Depression Scale (HADS) were used. The factor structure of the TSK-NL Heart was determined by a principal component analysis (PCA).Results: After removal of 4 items due to low internal consistency, the TSK-NL Heart showed substantial reliability (intraclass correlation coefficient; ICC: 0.80). A strong positive correlation was found between the TSK-NL Heart and the CAQ (rs: 0.61). Strong positive correlations were found between the TSK-NL Heart and de HADS (Anxiety) (rs: 0.60) and between the TSK-NL Heart and the CAQ (rs: 0.61). The PCA revealed a 3-factor structure as most suitable (fear of injury, avoidance of physical activity, perception of risk). High levels of kinesiophobia were found in 45.4% of patients.Conclusion: The 13-item TSK-NL Heart has good psychometric properties, and we recommend using this version to assess kinesiophobia, which is present in a substantial proportion of patients referred for cardiac rehabilitation.Keywords: Tampa Scale for Kinesiophobia; cardiac rehabilitation; exercise; fear of movement; physical activity; cardiovascular disease
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Objectives: The primary objective was to determine the responsiveness of the Dutch version of the 13-item Tampa Scale for Kinesiophobia for cardiac patients (TSK-NL Heart). The secondary objective was to assess changes in kinesiophobia during cardiac rehabilitation.Methods: Kinesiophobia was measured pre- and post-cardiac rehabilitation using the TSK-NL Heart questionnaire in 109 cardiac patients (61 years; 76% men). The effect size of kinesiophobia score changes was calculated for the full population. A measure that is responsive to change should produce higher effects sizes in patients in whom kinesiophobia improves. Therefore, effect sizes were also calculated for patients who did or did not improve on selected external measures. For this step, the Cardiac Anxiety Questionnaire (CAQ) and the Hospital Anxiety and Depression Scale (HADS) were completed as external measures in a subsample of 58 patients.Results: The effect size of the TSK-NL Heart for the full study population was small (0.29). In line with the study hypothesis the effect size was higher (moderate) for patients with improved CAQ (0.52) and HADS scores (0.54). Prevalence of high kinesiophobia levels decreased from 40% pre-cardiac rehabilitation to 26% post-cardiac rehabilitation (p = 0.004).Conclusion: The TSK-NL Heart has moderate responsiveness and can be used to measure changes in kinesiophobia. Improvements in kinesiophobia were observed during cardiac rehabilitation. Nevertheless, high levels of kinesiophobia were still highly prevalent post-cardiac rehabilitation.
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Objectives To identify factors associated with kinesiophobia (fear of movement) after cardiac hospitalisation and to assess the impact of kinesiophobia on cardiac rehabilitation (CR) initiation.Design Prospective cohort study.Setting Academic Medical Centre, Department of Cardiology.Participants We performed a prospective cohort study in cardiac patients recruited at hospital discharge. In total, 149 patients (78.5% male) with a median age of 65 years were included, of which 82 (59%) were referred for CR.Primary and secondary outcome measures We assessed kinesiophobia with the Tampa Scale for Kinesiophobia (TSK). For this study, the total score was used (range 13–52). We assessed baseline factors (demographics, cardiac disease history, questionnaire data on anxiety, biopsychosocial complexity and self-efficacy) associated with kinesiophobia using linear regression with backward elimination. For linear regression, the standardised beta (β) was reported. Prospectively, the impact of kinesiophobia on probability of CR initiation, in the first 3 months after hospital discharge (subsample referred for CR), was assessed with logistic regression. For logistic regression, the OR was reported.Results Moderate and severe levels of kinesiophobia were found in 22.8%. In the total sample, kinesiophobia was associated with cardiac anxiety (β=0.33, 95% CI: 0.19 to 0.48), social complexity (β=0.23, 95% CI: 0.06 to 0.39) and higher education (β=−0.18, 95% CI: −0.34 to −0.02). In those referred for CR, kinesiophobia was negatively associated with self-efficacy (β=−0.29, 95% CI: −0.47 to −0.12) and positively with cardiac anxiety (β=0.43, 95% CI: 0.24 to 0.62). Kinesiophobia decreased the probability of CR initiation (ORRange13–52 points=0.92, 95% CI: 0.85 to 0.99).Conclusion In patients hospitalised for cardiovascular disease, kinesiophobia is associated with cardiac anxiety, social complexity, educational level and self-efficacy. Kinesiophobia decreased the likelihood of CR initiation with 8% per point on the TSK.
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Aim and method: To examine in obese people the potential effectiveness of a six-week, two times weekly aquajogging program on body composition, fitness, health-related quality of life and exercise beliefs. Fifteen otherwise healthy obese persons participated in a pilot study. Results: Total fat mass and waist circumference decreased 1.4 kg (p = .03) and 3.1 cm (p = .005) respectively. The distance in the Six-Minute Walk Test increased 41 meters (p = .001). Three scales of the Impact of Weight on Quality of Life-Lite questionnaire improved: physical function (p = .008), self-esteem (p = .004), and public distress (p = .04). Increased perceived exercise benefits (p = .02) and decreased embarrassment (p = .03) were observed. Conclusions: Aquajogging was associated with reduced body fat and waist circumference, and improved aerobic fitness and quality of life. These findings suggest the usefulness of conducting a randomized controlled trial with long-term outcome assessments.
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Purpose: The etiology of pain in osteoarthritis (OA) is complex andmultifactorial. A growing number of studies suggest that modificationof pain-transmission in the peripheral and central nervous system,leading to sensitization, plays a role in OA pain. Sensitization seems tobe associated with neuropathic pain-like symptoms and assessment ofthese symptoms can help to identify patients who could benefit fromadditional treatment options. Several questionnaires are available todistinguish neuropathic from nociceptive pain symptoms. The modifiedpainDETECT questionnaire (mPDQ) is a self-reported questionnairedeveloped to discriminate between nociceptive- and possible/likelyneuropathic pain in knee OA patients. Recently the mPDQ was translatedinto Dutch and adjusted to also fit hip OA patients. The aim of thisstudy was to assess the validity of the mPDQ-NL in patients with hip orknee OA.Methods: Primary hip and knee OA patients were recruited from threeDutch hospitals. Based on previous research, confirmatory factor analysisfor two principal components was performed to assess structuralvalidity. Construct validity (both convergent and divergent) wasassessed using hypothesis testing. Predefined hypotheses were formulatedconcerning the correlation between the mPDQ-NL and theSelf-reported Leeds Assessment of Neuropathic Symptoms and Signs (SLANSS),subscales of the Knee injury and Osteoarthritis Outcome score/Hip disability and Osteoarthritis Outcome Score (KOOS/HOOS), VisualAnalogue Scale for pain (VAS pain), and subscales of the RAND-36health survey (RAND-36). According to the COSMIN criteria, constructvalidity of a questionnaire is sufficient if 75% of predefined hypothesesare met. Additionally, convergent validity was assessed with blunt PainPressure Thresholds (PPTs) in a subsample of participants. A reducedPPT is a somatosensory abnormality that is considered an indication ofsensitization in OA. Therefore it was expected that reduction of PPTswas associated with higher mPDQ scores.Results: 168 participants were included. PPT measurements wereperformed in a sample of 46 participants. Factor analysis confirmed twoprincipal components. The items that loaded on the first componentcould be described as “evoked neuropathic sensations”, the items thatloaded on the second component as “spontaneous neuropathic sensations”.However there were two items that substantially loaded on bothcomponents. The item regarding pain pattern did not load on anycomponent. Considering construct analysis, 80% of the predefinedhypotheses concerning the correlation between mPDQ and self-reportedquestionnaires were met. Considering the correlation with PPTmeasurements, 50% of the predefined hypotheses were met.Conclusions: The mPDQ-NL seems to adequately reflect neuropathicpain-like symptoms experienced by hip and knee OA patients. Concerningstructural validity, two determinative components seem to bepresent, in line with previous research. However, one particular itemregarding pain pattern might not reflect the construct of neuropathicpain-like symptoms in hip or knee OA. Therefore, when using the mPDQin hip or knee OA patients, it might be considered to skip this particularitem. Construct validity can be considered sufficient, with over 75% ofthe predefined hypotheses regarding correlation between the mPDQNLand other questionnaires were met. However, only 50% of the hypotheses concerning PPT measurements were met, probably due toheterogeneity and limited sample size of this subgroup. To ourknowledge, this study is the first to assess the structural validity of themPDQ knee and hip by using factor analysis and to assess constructvalidity using elaborate hypothesis testing as proposed by the COSMINguidelines.
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BackgroundLittle is known about the association between fear of movement (kinesiophobia) and objectively measured physical activity (PA), the first 12 weeks after cardiac hospitalization.PurposeTo assess the longitudinal association between kinesiophobia and objectively measured PA and to assess the factor structure of kinesiophobia.MethodsWe performed a longitudinal observational study. PA was continuously measured from hospital discharge to 12 weeks using the Personal Activity Monitor. The PAM measures time spent per day in PA-intensity categories: light, moderate and heavy. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK) at four time points (hospital discharge, 3, 6 and 12 weeks). The longitudinal association between PA-intensity and kinesiophobia was studied with a random intercept cross lagged panel model (RI-CLPM). A RI-CLPM estimates effects from kinesiophobia on objectively measured PA and vice versa (cross-over effects), and autoregressive effects (e.g. kinesiophobia from one occasion to the next).ResultsIn total, 116 patients (83.6% male) with a median age of 65.5 were included in this study. On no occasion did we find an effect of kinesiophobia on PA and vice versa. Model fit for the original model was poor (X2: = 44.646 P<0.001). Best model fit was found for a model were kinesiophobia was modelled as a stable between factor (latent variable) and PA as autoregressive component (dynamic process) (X2 = 27.541 P<0.12).ConclusionKinesiophobia and objectively measured PA are not associated in the first 12 weeks after hospital discharge. This study shows that kinesiophobia remained relatively stable, 12 weeks after hospital discharge, despite fluctuations in light to moderate PA-intensity.
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Background: Fear of movement (kinesiophobia) after an acute cardiac hospitalization (ACH) is associated with reduced physical activity (PA) and non-adherence to cardiac rehabilitation (CR). Purpose: To investigate which factors are related to kinesiophobia after an ACH, and to investigate the support needs of patients in relation to PA and the uptake of CR. Methods: Patients were included 2-3 weeks after hospital discharge for ACH. The level of kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK-NL Heart). A score of > 28 points is defined as 'high levels of kinesiophobia' (HighKin) and ≤ 28 as 'low levels of kinesiophobia' (LowKin). Patients were invited to participate in a semi-structured interview with the fear avoidance model (FAM) as theoretical framework. Interviews continued until data-saturation was reached. All interviews were analyzed with an inductive content analysis. Results: Data-saturation was reached after 16 participants (median age 65) were included in this study after an ACH. HighKin were diagnosed in seven patients. HighKin were related to: (1) disrupted healthcare process, (2) negative beliefs and attitudes concerning PA. LowKin were related to: (1) understanding the necessity of PA, (2) experiencing social support. Patients formulated 'tailored information and support from a health care provider' as most important need after hospital discharge. Conclusion: This study adds to the knowledge of factors related to kinesiophobia and its influence on PA and the uptake of CR. These findings should be further validated in future studies and can be used to develop early interventions to prevent or treat kinesiophobia and stimulate the uptake of CR. Keywords: Acute cardiac hospitalization; Cardiac rehabilitation; Cardiovascular disease; Exercise; Fear of movement; Physical activity.
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Funding Acknowledgements Type of funding sources: None. Background An important factor related to low physical activity in cardiac patients is fear of movement (kinesiophobia). The setting of cardiac rehabilitation (CR) seems suitable for targeting kinesiophobia. Nevertheless, the impact of CR on kinesiophobia is currently unknown, partly due to the absence of information on the responsiveness of instruments to measure kinesiophobia. Purpose To determine the responsiveness of the Dutch version of the Tampa Scale for Kinesiophobia questionnaire (TSK-NL Heart), to asses changes in kinesiophobia during participation in CR and to assess predictors of high levels of kinesiophobia at completion of CR. Methods This study was performed among 109 patients (mean age: 61 years; 76% men) who participated in a 6- till 12-week CR program. Kinesiophobia was measured using the TSK-NL Heart questionnaire. To determine the responsiveness of the TSK-NL Heart, the Cardiac Anxiety Questionnaire (CAQ) and the general anxiety scale of the Hospital Anxiety and Depression Scale (HADS-A) were used as external measures. All questionnaires were completed pre- and post-CR. Internal responsiveness was estimated by calculating the effect size (ES) and standardized response mean (SRM). External responsiveness was determined by calculating the correlation between change scores on the TSK-NL heart and on the external measures. Furthermore, univariate logistic regression analysis was performed with the dichotomized TSK-NL Heart score post-CR as dependent variable (high vs low scores) and baseline characteristics (age, sex, reason for referral and pre-CR scores on the TSK-NL Heart, CAQ and HADS) as predictor variables. Results Prevalence of a high levels of kinesiophobia improved from 40.4% pre-CR to 25.7% at completion of CR (p = 0.05). Both the ES and the SRM of the TSK change score were moderate for patients with an improved CAQ and HADS-A score (respectively ES = 0.52; SRM = 0.57 and ES = 0.54; SRM = 0.60) and small for patients with a stable score (ES = 0; SRM = 0 and ES = 0.26; SRM = 0.36). There was a moderate correlation between the TSK-NL Heart change score and the CAQ (Rs = 0.30, p = 0.023) and a small correlation between the TSK-NL Heart change score and the HADS-A (Rs =0.21, p = 0.107). The odds of having high kinesiophobia levels post-CR were increased by having a high level of kinesiophobia pre-CR (OR= 9.83, 95%CI: 3.52-27.46), a higher baseline score on the CAQ (OR = 1.12, 95%CI: 1.06-1.19), and a higher baseline score on the HADS-A (OR = 1.26, 95% CI: 1.11-1.42). Conclusion The TSK-NL Heart has moderate responsiveness. In addition, this study shows that there are reductions in kinesiophobia during the course of CR. Nevertheless, a large number of patients (26%) still had high levels of kinesiophobia at completion of CR. Interventions targeting kinesiophobia should focus on patients that enter CR with high levels of kinesiophobia, cardiac anxiety and generic anxiety.
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Introduction: Patients with kinesiophobia (fear of movement) avoid physical activity. Avoidance of physical activity is linked to adverse cardiac events and thus needs to be targeted. However, there is no contemporary measurement tool to assess kinesiophobia in cardiac patients. Therefore data on prevalence of kinesiophobia are lacking in patients attending Cardiac Rehabilitation (CR). The Tampa Scale for Kinesiophobia (TSK-NL Heart) is a 17 item questionnaire using a 4 point Likert scale (score range 17 to 68 points) to measurekinesiophobia).Purpose: To study the test-retest reliability and construct validity of the TSK-NL Heart and to assess the distribution of kinesiophobia in patients.Methods: Patients referred for CR were asked to fill in the TSK-NL Heart and the Cardiac Anxiety Questionnaire (CAQ). After five days patients filled in the TSK-NL Heart for the second time. Test-retest reliability of the TSK-NL Heart was assessed with the Interclass Correlation Coefficient (ICC) and construct validity with the Spearman Rank Correlation Coefficient (r) by correlating the TSK-NL Heart with the CAQ. The distribution of kinesiophobia in cardiac patients was assessed by determining the median score with range and quartiles (Q1-4) since there is no well validated cut off point of the TSK-NL Heart. Nevertheless, recent studies have used a score >37 as an indication for Kinesiophobia.Results: We included 116 patients in this study with a median age of 64, 5 years old who were mainly referred for CR after a PCI procedure for STEMI. Substantial agreement was found for the overall ICC of the TSK (ICC = 0.67; p = < 0.001). With regard to construct validity, a moderate strong correlation was found between the TSK and CAQ (r= 0.57; p = < 0.001). Scores of the TSK-NL Heart ranged from 26 to 56 points with a median patient score of 39.Q1 = 26-33, Q2 = 33-39, Q3 = 39-44, Q4 = 4456.Conclusion: The TSK-NL Heart has substantial test-retest reliability and a moderate to strong correlation with the CAQ suggesting construct validity. The scores on CAQ and the TSK indicate that cardiac anxiety and fear of movement is present in a large proportion of cardiac patients. Further research is necessary to investigate the impact of kinesiophobia on objectively measured physical activity and to develop treatment strategies for kinesiophobia in cardiac patients
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Background Physical activity after bariatric surgery is associated with sustained weight loss and improved quality of life. Some bariatric patients engage insufficiently in physical activity. The aim of this study was to examine whether and to what extent both physical activity and exercise cognitions have changed at one and two years post-surgery, and whether exercise cognitions predict physical activity. Methods Forty-two bariatric patients (38 women, 4 men; mean age 38 ± 8 years, mean body mass index prior to surgery 47 ± 6 kg/m²), filled out self-report instruments to examine physical activity and exercise cognitions pre- and post surgery. Results Moderate to large healthy changes in physical activity and exercise cognitions were observed after surgery. Perceiving less exercise benefits and having less confidence in exercising before surgery predicted less physical activity two years after surgery. High fear of injury one year after surgery predicted less physical activity two years after surgery. Conclusion After bariatric surgery, favorable changes in physical activity and exercise cognitions are observed. Our results suggest that targeting exercise cognitions before and after surgery might be relevant to improve physical activity.
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