Assessing Changes in Fear of Movement in Patients attending Cardiac Rehabilitation: Responsiveness of the TSK-NL Heart Questionnaire

Abstract

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.

Measurement properties of assessment tools of Kinesophobia in patients with cardiovascular disease: A systematic review

“…Six instruments, specifically developed or translated for assessing fear of exercise in patients with CVD, were identified [ 14 , 15 , [23] , [24] , [25] , [26] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ]. Table 1 presents the basic characteristics of these studies, published between 1993 and 2023, with study sites in countries including the United Kingdom, Poland, Sweden, Turkey, and China.…”

“…Table 1 presents the basic characteristics of these studies, published between 1993 and 2023, with study sites in countries including the United Kingdom, Poland, Sweden, Turkey, and China. Three PROMs (The Tampa Scale for Kinesiophobia Heart [TSK Heart], Exercise Sensitivity Questionnaire [ESQ], Fear of Activity in Patients with Coronary Artery Disease [FACT-CAD]) were available in multiple languages [ [14] , [23] , [24] , [26] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ]. Lei et al.…”

“…[ 24 ] and Ter Hoeve et al. [ 38 ] independently translated the TSK Heart into Dutch version (TSK-DV Heart) and conducted tests of its validity and reliability.…”

“…Table 2 displays the methodological and measurement attribute quality ratings. Regarding PROMs development, six studies did not adequately report the development process of the scale in terms of relevance, comprehensiveness, and understanding, leading to a “doubtful” assessment of their methodological quality [ 15 , 25 , 31 , 33 , 35 , 38 ].…”

“… Adequate/+ Very good/+ NA/NA Doubtful/? NA/NA NA/NA NA/NA NA/NA TSK-DV Heart [ 38 ] Doubtful Doubtful/? NA/NA NA/NA NA/NA NA/NA NA/NA NA/NA NA/NA Doubtful/?…”