Bengt Jansson

On what patients does the Tampa Scale for Kinesiophobia fit

The Tampa Scale of Kinesiophobia (TSK) has been used for a decade and is a valuable tool in researching pain-related fear. A variety of different factor models exist, however, and there are inconsistencies as to which model to use. The purpose of the study was twofold: 1) to thoroughly review existing factor models and 2) to empirically evaluate the previously proposed factor models in a large sample with persistent musculoskeletal pain. Subjects included 578 of 711 (81%) consecutive patients (aged 18-65 years) with persistent musculoskeletal pain from three different orthopedic outpatient clinics. We reviewed all existing factor models and performed confirmatory factor analyses on the existing models. Our review identified 11 factor models of the TSK. The identified models were tested on a large Swedish sample. All models were rejected because of unacceptable goodness-of-fit statistics in that specific sample. This study supports the fact that TSK is a multidimensional construct. Rather than searching for new factor solutions, future research should be devoted to forming a consensus for the conceptual and operational definitions of the construct kinesiophobia and the application of the Tampa Scale for Kinesiophobia. Physiotherapists are encouraged to take part in building new theories.

The impact on kinesiophobia (fear of movement) by clinical variables for patients with coronary artery disease.

BACKGROUND The impact on kinesiophobia (fear of movement) for patients with coronary artery disease (CAD) is not known. The aims were to describe the occurrence of kinesiophobia in patients with CAD, and to investigate the influence on kinesiophobia by clinical variables. MATERIALS AND METHODS In total, 332 patients, mean age, 65 ± 9.1 years diagnosed with CAD at a university hospital were included in the study. The Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) was used to assess kinesiophobia. Comparisons between high versus low levels of kinesiophobia were measured for each variable. Binary logistic regression analyses were performed with a high level of kinesiophobia (TSK-SV Heart>37) as dependent variable, and with the observed variables as independent. The study had an exploratory, cross-sectional design. RESULTS A high level of kinesiophobia was found in 20% of the patients. The following variables decreased the odds ratio (OR) for a high level of kinesiophobia: Attending cardiac rehabilitation (yes vs no: -56.7%), level of physical activity (medium vs high: -80.8%), Short-Form 36: general health (-4.3%), physical functioning (-1.8%). Two variables increased the OR for a high level of kinesiophobia: heart failure as complication at hospital (yes vs no: 418.7%), anxiety (19.2%). Previous heart failure (yes vs no) was unexpectedly found to reduce kinesiophobia (-88.3%) due to suppression. CONCLUSIONS Several important clinical findings with impact on rehabilitation and prognosis for patients with CAD were found to be associated with a high level of kinesiophobia. Therefore, kinesiophobia needs to be considered in secondary prevention for patients with CAD.

Subjective future as a mediating factor in the relation between pain, pain-related distress and depression

The coincidence of chronic pain, psychological distress and depression has been well documented in several studies. However, there is still debate about the type of causality linking these factors and whether psychological distress and depression precede or are a consequence of pain. This study contributes to this debate through an analysis of the latent structure behind these complex concepts. To test the hypothesis that subjective future (i.e. how the pain patient perceives the future) has an impact on pain, data were analysed from 660 chronic pain patients who were tested with The Multidimensional Pain Inventory (MPI), The Symptom Distress Checklist (SCL‐90) and a Future Scale, which was constructed from items of the Sense of coherence‐scale. By use of path analysis and structural equation modeling (S.E.M.) four latent constructs were tested: Pain, Interference, Distress and Subjective future. The results indicated that Subjective future has a strong impact on Distress, is a mediating variable, which contributes to conceptually explaining and practically nullifying the relationship between Pain and Distress, and finally that Pain is a concept, that changes with increasing duration.

Validation of a questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease.

OBJECTIVE To investigate the validity and reliability of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), a brief questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease. DESIGN Methodological research (cross-sectional study). SUBJECTS A total of 332 patients, mean age 65 years (standard deviation 9.1) diagnosed with coronary artery disease at a university hospital were included in the study. METHODS The psychometric properties of the TSK-SV Heart were tested. The tests of validity comprised face, content, and construct validity. The reliability tests included composite reliability, internal consistency and stability over time. RESULTS In terms of reliability, the TSK-SV Heart was found to be stable over time (intra-class correlation coefficient 0.83) and internally consistent (Cronbachs alpha 0.78). Confirmatory factor analysis provided acceptable fit for a hypothesized 4-factor model with inclusion of a method factor. CONCLUSION These results provide support for the reliability of the TSK-SV Heart. The questionnaire appears to be valid for use in patients with coronary artery disease. However, some items require further investigation due to low influence on some sub-dimensions of the test. The sub-dimensions of kinesiophobia require future research concerning their implications for the target group.

Psychological Distress and Adaptation to Chronic Pain: Symptomatology in Dysfunctional, Interpersonally Distressed, and Adaptive Copers

Objectives: To investigate psychological symptomatology and distress in sub groups of chronic pain patients with different adaptation styles. Methods: Subjects were 660 patients with chronic musculoskeletal pain who were tested by the combined use of the two large and much used psychological inventories-the Multidimensional Pain Inventory and the Symptom Check list-90-Revised. Results: The results showed significant differences between the three adaptation profiles, dysfunctional, inter personally distressed, and adaptive copers. Adaptive copers were equally and less distressed than a sample from a normal population. Conclusion: This study calls attention to the risk of blind faith of the ‘objective ness’ of psychometric scales and of the use of them as the sole basis for designing treatments. More attention seems to be needed to get more information about the ‘healthy’ group of adaptive copers by extended clinical judgment.

Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease

ABSTRACT Purpose: To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD). Patients: In total, 332 patients (75 women; mean age 65 ± 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden.Methods: The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made. Results: A current incidence of coronary bypass grafting (p < 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect. Conclusions: This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.

Cross-validation of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) for clinical use.

ObjectiveThe main objective of this study was to investigate different psychometric properties of the Swedish version of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) in patients with chronic musculoskeletal pain in an orthopedic setting. MethodsA total of 449 participants took part in the study, including 288 patients with chronic musculoskeletal pain and 161 participants in a reference group. Internal consistency, convergent validity, and measurement invariance of the constructs of DAPOS were investigated across sex and diagnostic groups. The Beck Depression Inventory and the Spielberger Anxiety Inventory were used for measures of convergent validity. Multigroup confirmatory factor analysis was performed to test measurement invariance of the theoretical constructs of DAPOS. ResultsInternal consistency was good for all 3 constructs, and correlations concerned with convergent validity were found to be acceptable to good. With regard to cross-validation, the 3 constructs of DAPOS were strictly measurement invariant with respect to sex. Across diagnostic groups, the constructs of anxiety and positive outlook were almost strictly measurement invariant, although there were some restrictions of measurement invariance for the construct of depression. DiscussionTo be able to rely on an instrument with as few items as DAPOS, the cross-validation of its constructs for sex and diagnostic groups is a valuable information, particularly when investigated in patients with musculoskeletal pain. Based on these results, we recommend that DAPOS could replace longer and more time-consuming screening tests in clinical settings.

790 MEASUREMENT INVARIANCE FOR GENDER AND PSYCHOMETRIC PROPERTIES OF THE DEPRESSION, ANXIETY AND POSITIVE OUTLOOK SCALE (DAPOS) IN CHRONIC MUSCULOSKELETAL PAIN

Background: On a 100mm VAS scale, 30–40mm is usually taken as the border between mild and moderate pain, based on evidence from classic postoperative pain trials that used both VAS and categorical scales. Methods: Paired categorical and VAS scale measurements were taken from individual-patient meta-analyses of randomised trials. One meta-analysis involved five trials (>900 patients) of epidural morphine, extended-release morphine, or placebo in major surgery, with pain assessed over 48 hours. Another meta-analysis involved four trials (2700 patients) of pregabalin in fibromyalgia with end of trial pain assessments. Results: In acute pain, almost 28,000 paired observations were available in postsurgical patients, both at rest and on activity. Median and IQR for no pain and mild pain were below 30mm VAS, while median and IQR for moderate and severe pain were above 30mm. In fibromyalgia, patient global impression of change of minimally improved, no change, minimally worse, much worse and very much worse were associated with average weekly pain VAS scores above 30mm. For very much improved almost all scores were below 30mm. For much improved there was no clear division. Conclusions: The assumption that 30mm marks the border between mild and moderate pain held true in large evaluations in pain conditions as disparate as postoperative pain after major surgery and fibromyalgia. It is reasonable to ask whether pain scores of less than 30mm might be a useful outcome in clinical trials, and a target for clinical practice.