Original articleFear of movement in pre-operative patients with a lumbar stenosis and or herniated disc: Factor structure of the Tampa scale for kinesiophobia
Introduction
The term fear of movement was introduced by Kori et al. (1990) as an excessive, irrational, and debilitating fear of physical movement and activities resulting from painful injury or re-injury (Kori et al., 1990). The importance of fear of movement has been stressed in the fear avoidance model of chronic pain (Lethem et al., 1983). The presence of fear of movement is significantly related to higher disability rates in several patient groups such as acute low back pain (Swinkels-Meewisse et al., 2003b), chronic low back pain (Vlaeyen et al., 1995a, Vlaeyen et al., 1995b, Geisser et al., 2000, Roelofs et al., 2004), fibromyalgia (Turk et al., 1996, Burwinkle et al., 2005), chronic fatigue syndrome (Nijs et al., 2004) an anterior cruciate ligament reconstruction (Kvist et al., 2005) and ostechondritis (Heuts et al., 2004).
In patients with acute low back pain fear of movement has been recognized as important predictor for the development of chronic low back pain (Klenerman et al., 1995). Although Pincus et al. (2006) found no evidence for the role of fear of movement in the chronification of low back pain. The presence of fear of movement in patients with radiculopathy measured pre-operatively was related to more disability and pain 6 weeks post-operatively and with more severe pain 6 months post-operatively (Boer den et al., 2006). Patients with a poor functional status pre-operatively are associated with a poor functional status after surgery (Ostelo et al., 2003). Early identification of fear of movement in this patient group might therefore be of importance to reduce disability and to facilitate rehabilitation post-operatively.
The Tampa Scale for Kinesiophobia (TSK) is a widely used questionnaire to assess fear of movement. Several studies found support for the construct and predictive validity and reliability i.e. internal consistency (Vlaeyen et al., 1995b) and test–retest reliability (Swinkels-Meewisse et al., 2003a). The TSK-17 (17 items) is a powerful predictor of disability in patients with chronic non-specific low back pain (Crombez et al., 2001, Goubert et al., 2004). On the other hand the use of the TSK-17 has been discussed in literature and previous findings with the TSK showed different factor structures in several patient groups (Table 1). A two-factor structure with 13 items originally presented by Clark et al. (1996) dominates especially in patients with chronic pain, although Burwinkle et al. (2005) presented a one-factor structure (4 items) in patients with fibromyalgia. In pre-operative patients with a lumbar stenosis and or herniated disc a factor analysis of the TSK has not been performed before. The analysis of this group is interesting because these patients are aware of having a somatic spinal anatomical defect on which they will be operated upon. This group differs from the group with chronic pain that is often investigated in studies describing the TSK. This might have consequences for the factor structure of the TSK.
The purpose of this study was first to analyze if fear of movement in pre-operative patients was present and related to pain and disability. Secondly to analyze the factor structure of the TSK in this patient group.
Section snippets
Participants
Patients were aged between 18 and 85 years and where hospitalized for lumbar surgery in the Neurosurgery Department of the University Medical Centre of Groningen in the period of March–September 2005. Inclusion criteria for the study were low back pain with radiculopathy, due to lumbar stenosis and or a herniated disc for which surgery was indicated. Excluded were patients with: other neurological diseases, cancer, respiratory insufficiency, rheumatoid arthritis and severe osteoporosis. The
Results
In total 128 of 140 eligible patients were suitable for analyses, 12 patients were excluded due to: early discharge (n = 2), unwillingness to cooperate (n = 3), or missing data (n = 7). Descriptive statistics are presented in Table 2. The total scores on the TSK ranged from 24 to 58, the median equals the mean and was 41 (SD 7.0).
Discussion
The present study aims at analyzing fear of movement in pre-operative patients with low back pain and radiculopathy as a consequence of lumbar stenosis and or a herniated disc. Fear of movement is significantly related with leg-pain and disability. According to analyses a three-factor model of the TSK with nine items had the best fit.
The total score on the TSK in this patient group before surgery is 41 (SD 7.0); pre-operative patients are aware of having an anatomical deficit for which surgery
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