Content » Vol 52, Issue 2

Original report

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
Faculty of Health, ACHIEVE Centre for Applied Research, Amsterdam, The Netherlands. E-mail:
DOI: 10.2340/16501977-2653


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.

Lay Abstract

Fear of movement (kinesiophobia) in common is patients with cardiac diseases. As a consequence, these patients have lower levels of adherence to cardiac rehabilitation. It would be useful to gain more insight into kinesiophobia in cardiac patients. In order to effectively screen for kinesiophobia and to evaluate treatment for these patients, an objective measurement tool would be useful. Secondly, in order to effectively treat patients, it would be useful to determine which subgroups of cardiac patients experience kinesiophobia. The aim of this study was to determine the reliability and validity of a questionnaire to measure kinesiophobia, and to determine the level of kinesiophobia in subgroups of patients.

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