Fear of movement in patients referred to cardiac rehabilitation

<b>Introduction:</b> Patients with kinesiophobia (fear of movement) avoid physical activity. Avoidance of physical activity is linked to adverse cardiac events and thus needs to be targeted. However, there is no contemporary measurement tool to assess kinesiophobia in cardiac patients. Therefore data on prevalence of kinesiophobia are lacking in patients attending Cardiac Rehabilitation (CR). The Tampa Scale for Kinesiophobia (TSK-NL Heart) is a 17 item questionnaire using a 4 point Likert scale (score range 17 to 68 points) to measurekinesiophobia).<b>Purpose:</b> To study the test-retest reliability and construct validity of the TSK-NL Heart and to assess the distribution of kinesiophobia in patients.<b>Methods:</b> Patients referred for CR were asked to fill in the TSK-NL Heart and the Cardiac Anxiety Questionnaire (CAQ). After five days patients filled in the TSK-NL Heart for the second time. Test-retest reliability of the TSK-NL Heart was assessed with the Interclass Correlation Coefficient (ICC) and construct validity with the Spearman Rank Correlation Coefficient (r) by correlating the TSK-NL Heart with the CAQ. The distribution of kinesiophobia in cardiac patients was assessed by determining the median score with range and quartiles (Q1-4) since there is no well validated cut off point of the TSK-NL Heart. Nevertheless, recent studies have used a score >37 as an indication for Kinesiophobia.<b>Results:</b> We included 116 patients in this study with a median age of 64, 5 years old who were mainly referred for CR after a PCI procedure for STEMI. Substantial agreement was found for the overall ICC of the TSK (ICC = 0.67; p = < 0.001). With regard to construct validity, a moderate strong correlation was found between the TSK and CAQ (r= 0.57; p = < 0.001). Scores of the TSK-NL Heart ranged from 26 to 56 points with a median patient score of 39.Q1 = 26-33, Q2 = 33-39, Q3 = 39-44, Q4 = 4456.<b>Conclusion:</b> The TSK-NL Heart has substantial test-retest reliability and a moderate to strong correlation with the CAQ suggesting construct validity. The scores on CAQ and the TSK indicate that cardiac anxiety and fear of movement is present in a large proportion of cardiac patients. Further research is necessary to investigate the impact of kinesiophobia on objectively measured physical activity and to develop treatment strategies for kinesiophobia in cardiac patients