Identifying Kinesiophobia as a Barrier to Physical Activity in People With Cancer: Psychometric Properties of the Tampa Scale for Kinesiophobia–Symptoms (TSK-Symptoms)
Anna Efverman, Sven Blomqvist, Angela G.E.M. de Boer, Katarina Wijk, Marina HeidenAim
To investigate the psychometric properties of the TSK-Symptoms—including content and face validity, internal consistency, structural validity, test-retest reliability, measurement error, and responsiveness—and to determine the prevalence of kinesiophobia (excessive fear of motion) relative to multiple symptoms in patients undergoing cancer therapy.
Methods
In this methodological study, 440 patients (90% response rate, mean age 66 years ± standard deviation 12 years) responded to TSK-Symptoms during cancer therapy for breast- (37%), prostate- (32%), or other cancer types (31%). The psychometric properties of the TSK-Symptoms were evaluated in relation to content and face validity, internal consistency, structural validity, test-retest reliability, measurement error, and responsiveness. Kinesiophobia was defined as a score >37 on the TSK-Symptoms instrument, ranged 17-68.
Results
The total score of TSK-Symptoms showed satisfactory internal consistency, Cronbach’s alpha 0.77, ranging from 0.40 to 0.64 for the four sub-scales. Structural validity was acceptable; confirmatory factor analysis showed acceptable fit for a hypothesized 4-factor model (Danger, Fear, Avoidance and Dysfunction). Test-retest reliability was good; intra-class correlation coefficient for average measures [ICC] was 0.87 and ranged 0.73 to 0.87 for the four sub-scales. The smallest detectable change was 9.4. TSK-Symptoms presented responsiveness to detect reduction in physical activity engagement; the area under the receiver operating characteristic curve, AUC, was 0.70, ranging from 0.53 to 0.70 for the sub-scales. The 32 patients who reported decreased engagement in physical activity at retest had worse TSK-scores at retest (m 31.0, SD 6.8) compared to the patients who remained their physical activity engagement (m 27.0, SD 6.0 p=0.016). Of 388 patients delivering complete data, TSK-Symptoms score was 29.6 (SD 7.1), and 57 (17%) reported kinesiophobia.
Conclusion
The TSK-Symptoms appears to be valid and reliable for use among patients undergoing cancer therapy. The instrument was able to discriminate between patients who are at risk of reducing their physical activity during cancer therapy and those who remain physically active. Kinesiophobia was present in 15 percent of patients undergoing cancer therapy. This suggests that cancer care professionals could use the TSK-Symptoms to quantify kinesiophobia and provide early intervention strategies.