The NeckPix©: development of an evaluation tool for assessing kinesiophobia in subjects with chronic neck pain

Abstract

Purpose: To develop and validate NeckPix©, a multi-image instrument for assessing daily activities in the context of pain-related fear, in order to allow its use in patients with chronic neck pain (NP). Methods: The measure was developed by means of item generation followed by reduction/selection. The psychometric testing included exploratory factor analysis; content validity by investigating clarity, specificity, appropriateness for the target population, relevance and completeness; reliability by internal consistency (Cronbach’s alpha) and test–retest stability (intra-class coefficient correlation, ICC); and construct validity by comparing NeckPix with the Tampa Scale of Kinesiophobia (TSK), the Pain Catastrophising Scale (PCS), the Neck Disability Index (NDI) and a Numerical Rating Scale of pain intensity (NRS) (Pearson’s correlation). Results: The measure, which includes ten images used to assess everyday activities in the context of pain-related fear, was administered to 118 subjects with chronic non-specific NP, and proved to be acceptable and feasible. Factor analysis revealed a one-factor solution (which explained 71.12 % of variance). The content of the images was considered adequate, appropriate for the target population, comprehensive, and relevant for evaluating activity-related kinesiophobia. The instrument’s internal consistency was good (α = 0.954), as was its test–retest stability (ICC 0.979). Construct validity demonstrated a close correlation with the TSK (r = 0.759), and moderate correlations with the PCS (r = 0.583), the NDI (r = 0.520), and a NRS (r = 0.455). Conclusion: NeckPix©, which was successfully developed following international recommendations, proved to have a good factorial structure and satisfactory psychometric properties. Its use is recommended for research purpose

Patient-reported outcome measures for non-specific neck pain validated in the Italian-language: a systematic review

“…This measure [ 84 ] was recently developed in Italian to assess activity-related kinesiophobia in outpatients with chronic NSNP (Table 6 ). It consists of ten images that represent everyday activities involving the neck.…”

“…An excellent methodological quality exploratory factor analysis revealed a one-factor structure [ 84 ]. The internal consistency and reliability were excellent, and good correlations were found with the Tampa Scale of Kinesiophobia and the Pain Catastrophizing Scale.…”

Cross-cultural adaptation and validation of the Dutch language version of the Pictorial Fear of Activity Scale – Cervical

“…Correlations between the PFActS-C-DLV and NDI ( r = 0.488) were higher than expected. Even higher correlations between fear and disability were found by Turk ( r = 0.56) and Monticone ( r = 0.52) [ 11 , 33 ]. It could be that disability and/or pain and fear of movement are closely related constructs or that the central question ‘how afraid or fearful would you be to perform the activity shown on this picture?’ was not clear enough.…”

“…When formulating these hypotheses it was taken into account that the TSK and FABQ are related, but not completely comparable with the PFActS-C-DLV, because of the differences in underlying constructs (i.e., kinesiophobia, fear avoidance beliefs and fear of movement) [ 6 ]. Although the PFActS-C correlated only moderately to poorly with other instruments that measure fear or anxiety (r ranging from 0.37 to 0.40 [ 11 ]), a recent study revealed that the NeckPix (which is another Pictionary scale to measure fear of activities in people with neck pain) had a higher correlation ( r = 0.76) with measures of kinesiophobia [ 33 ]. Therefore, correlations between the scales that measure fear were expected to be at least moderate (r > 0.5), and at least 0.1 higher than correlations with scales that measure different constructs such as pain and/or disability.…”

Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain

“…41,42 If psychological factors, including fear-avoidance behavior, catastrophizing, or other behaviors, appear to be present, evaluation by a psychologist may be appropriate, and consideration of a trial of cognitive behavioral therapy may be warranted. 43,44 Onset and Mechanism of Injury Record precipitating factors (particularly injury or non-injury onset) and the date of onset or duration of pain. Temporal factors associated with neck pain including onset of pain may provide clues about the nature of the condition.…”