Journal of Rehabilitation Medicine (2020-02-01)

Fear of movement in patients attending cardiac rehabilitation: A validation study

  • Paul Keessen,
  • Iris den Uijl,
  • Bart Visser,
  • Hendrika van den Berg-Emons,
  • Corine H.M. Latour,
  • Madoka Sunamura,
  • Harald T. Jorstad,
  • Gerben ter Riet,
  • Wilma J.M. Scholte op Reimer,
  • Roderik A. Kraaijgenhagen,
  • Nienke ter Hoeve

Journal volume & issue
Vol. 52, no. 2
p. jrm00021


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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). A strong negative correlation was found between the TSK-NL Heart and the HADS (Anxiety) (rs –0.51). 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.