2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Validation of Tampa Scale for Kinesiophobia in Patients With Shoulder Instability

Marcello Motta, MD, Brescia ITALY
Mac Donald Tedah Djemetio, MD, Brescia ITALY
Andrea Pratobevera, MD, Carate Brianza, Lombardia ITALY
Emanuele Maggini, MD, Brescia ITALY
Giulia Roversi, MD, Brescia ITALY
Giuseppe Milano, Prof., Brescia, BS ITALY

Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Brescia, ITALY

FDA Status Not Applicable

Summary

Tampa scale, questionnaire, kinesiophobia, shoulder instability, validity, reliability.

Abstract

Purpose

The Tampa Scale for Kinesiophobia (TSK) has been used to evaluate psychological
outcomes in patients with low back pain, anterior cruciate ligament injuries, and other
orthopaedic conditions, but no previous study verified the validity of TSK for patients with
shoulder instability. The purpose of this study was to evaluate the measurement properties of the
TSK-13 in patients with shoulder instability.

Methods

The present study was designed as an observational study. The study population
included individuals with a diagnosis of glenohumeral instability, regardless of the cause,
direction, and frequency. All patients underwent a structured interview to collect information on
personal socio-demographic and contextual characteristics at the time of enrollment.
Kinesiophobia was assessed using the 13-item version of the Tampa Scale of Kinesiophobia
(TSK-13). The questionnaire is divided into two domains (subscales): activity avoidance (AA),
and health anxiety (HA). Additionally, enrolled patients were administered the American
Shoulder and Elbow Society (ASES) score and the Western Ontario Shoulder Instability Index
(WOSI) questionnaire. The validation of the TSK questionnaire was conducted according to the
analysis plan outlined in the IQOLA project and current guidelines.

Results

The study population consisted of 100 patients. The TSK-13 questionnaire showed no
floor and ceiling effects; all the correlations between each question in a given domain and the
score of the same domain showed a very significant correlation (p < 0.0001) with Pearson’s
correlation coefficient greater than 0.90. Regarding discriminant validity, for each domain, 100%
of questions showed a higher correlation with the domain of belonging than with the other
domains. Correlation analysis between the TSK and the other questionnaires showed a
significant correlation between each domain (and the overall score of TSK-13 and ASES and
WOSI questionnaires. The internal consistency was good for each domain and for the overall
score (Cronbach’s α = 0.874, 0.787, and 0.851 for AA and HA and the overall score,
respectively). Test-retest reliability was excellent for both domains (ICCs = 0.927 and 0.878 for
AA and HA domains, respectively), and the overall score (ICC = 0.915).

Conclusion

Measurement properties of the TSK-13 in patients with shoulder instability were
good to excellent in terms of validity and reliability. The TSK-13 is a valid and useful instrument
to assess kinesiophobia in patients affected by shoulder instability.