The TSK, short for Tampa Scale for Kinesiophobia, measures fear of movement and of re-injury. Its original version has 17 items and scores from 17 to 68, a high score signalling high fear. The interpreter is right below.
A change of 9.2 points is needed to tell a real change from measurement noise, and the change patients judge important is around 10.5 points: the thresholds are detailed below.
Figures taken from the studies listed at the end of this page, every value carrying its source where it is written. No item of the scale is reproduced: its licence status is undetermined.
What the TSK measures
The TSK measures neither pain nor disability. It measures a belief: that moving will cause further damage. The distinction matters in rehabilitation, because that belief is treatable, and because it cannot be inferred from pain intensity.
The first published, citable evaluation of the scale covers 103 then 33 chronic low back pain patients. Its central result has held: fear of movement is related to catastrophising and to depressed mood, and much less to pain intensity. High scorers avoid more, including on a simple movement observed in the laboratory.
It is also this article that, in its own abstract, attributes the instrument to Kori et al., 1990: that is the only indexed trace of the authorship, the original publication not being referenced in PubMed.
Scoring the TSK, and which version
The original version has 17 items and its total score runs from 17 to 68. Each item is scored from 1 to 4, and four items are reversed before summing, which is the first source of scoring error.
There is not one TSK but five. The most TSK-specific systematic review, conducted to COSMIN methodology across 41 studies, catalogues the 17, 13, 11 and 4-item versions plus one dedicated to temporomandibular disorders. Their test-retest reliability runs from 0.77 to 0.99 and their internal consistency from 0.68 to 0.91 depending on the version.
The practical consequence: the version used goes in the notes alongside the score. Two numbers from two versions do not compare.
The four-point threshold, and why it does not hold
The number in circulation is four points. It comes from the 2005 article that created the 11-item version: a reduction of at least 4 points maximises correct identification of patients who improve.
The problem is that it does not survive the two other measurements. The smallest detectable change of the TSK, the gap below which two measurements cannot be told apart from noise, is 9.2 points on the 17 to 68 range. And the change patients themselves judge important, anchored on their global perception, is 10.5 points in chronic neck pain.
In other words, a 4-point improvement is smaller than the measurement error of the tool. It may well be real, but the scale cannot say so.
| What is measured | Value | Population and sample |
|---|---|---|
| Widely quoted threshold, identifying improvers | 4 points | chronic low back pain, TSK-11 article |
| Smallest detectable change | 9.2 points | acute low back pain, 95% CI 8.4 to 10.3 |
| Change judged important by patients | 10.5 points | 100 chronic neck pain, 4 weeks |
| Standard error of measurement, TSK-17 | 3.16 | chronic low back pain |
| Test-retest reliability, all versions | 0.77 to 0.99 | COSMIN review, 41 studies |
| Internal consistency, all versions | 0.68 to 0.91 | COSMIN review, 41 studies |
What the score does not tell you
It does not say whether the fear is high. None of the work retained here establishes a validated cut-off separating high from low kinesiophobia, and the figures seen in circulation for that were not verified against a source in this evidence base. The score therefore reads as a change, not as a level.
One reading caveat worth knowing: the reference study in acute low back pain, in 176 patients retested at 24 hours, gives its internal consistency of 0.70 to 0.83 and its reliability of 0.64 to 0.80 jointly for the TSK and the FABQ. The abstract gives no isolated value for the TSK alone, and quoting those bounds as its own would be a shortcut.
One reassuring point, however: no floor and no ceiling effect is reported on the total score, which is not the case for every scale in this field.
Why this page does not display the questionnaire
The licence status of the TSK is undetermined: the journal that published the scale in 1990 has disappeared and the chain of rights is not traceable. No open licence, no known royalty. Very widespread use is not authorisation, so no item is reproduced here. For the questionnaire itself, refer to the publisher of the article your version comes from.
Three administration pitfalls
Not recording the version
A score of 30 means nothing without knowing whether it comes from a 17, 13, 11 or 4-item version. The version goes next to the number, from the first administration.
Forgetting the reversed items
Four items of the original version are scored in reverse before summing. Adding them as they stand skews the total towards underestimated fear, and the error repeats identically at follow-up, so it does not show up in the change.
Concluding on four points
The 4-point threshold is well below the smallest detectable change. Announcing it to the patient as an established improvement means presenting measurement noise as a result.
Frequently asked questions
What does TSK stand for?
TSK stands for Tampa Scale for Kinesiophobia. It is attributed to Kori, Miller and Todd in 1990, in a journal that is not referenced in PubMed: its first citable evaluation is that of Vlaeyen et al. in 1995.
How is the TSK scored?
The original version has 17 items scored from 1 to 4, four of which are reversed before summing, for a total of 17 to 68. A high score signals high fear of movement.
How much change counts?
The smallest detectable change is 9.2 points (95% CI 8.4 to 10.3) and the change patients judge important is around 10.5 points. The widely quoted 4-point threshold is smaller than the measurement error of the scale.
Is there a cut-off for high kinesiophobia?
No validated cut-off appears in the sources retained here. The score is interpreted as a change between two administrations, not as a level at a given moment.
Is the TSK free to use?
Its status is undetermined. The original journal has disappeared and the chain of rights is not traceable: no open licence, no known royalty. Very widespread use is not authorisation, and this page therefore reproduces no item.
References
6 sources, PMIDs included
- Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995;62(3):363-72. PMID 8657437. The first published, citable evaluation of the scale, in 103 then 33 chronic low back pain patients. It is also the indexed source attributing the instrument to Kori et al., 1990.
- Swinkels-Meewisse EJ, Swinkels RA, Verbeek AL, Vlaeyen JW, Oostendorp RA. Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Man Ther 2003;8(1):29-36. PMID 12586559. 176 acute low back pain patients, retested at 24 hours: internal consistency 0.70 to 0.83 and reliability 0.64 to 0.80. A caveat worth knowing: the abstract gives these ranges jointly for the TSK and the FABQ, with no isolated value for the TSK alone.
- Woby SR, Roach NK, Urmston M, Watson PJ. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain 2005;117(1-2):137-44. PMID 16055269. Properties of the English 17-item version and creation of the TSK-11. TSK-17: alpha 0.76, ICC 0.82, standard error of measurement 3.16. This is the article the widely quoted 4-point threshold comes from.
- Ostelo RW, Swinkels-Meewisse IJ, Knol DL, Vlaeyen JW, de Vet HC. Assessing pain and pain-related fear in acute low back pain: what is the smallest detectable change? Int J Behav Med 2007;14(4):242-8. PMID 18001240. The smallest detectable change of the TSK is 9.2 points (95% CI 8.4 to 10.3) on a 17 to 68 range. No floor and no ceiling effect on the total score.
- Saadat M, Salamat S, Mostafaee N, Soleimani F, Rouintan Z, Amin M. To evaluate responsiveness and minimal important change for the Persian versions of FABQ, TSK and PCS in patients with chronic neck pain. PMID 37423940. 100 chronic neck pain patients followed for 4 weeks: the minimal important change, anchored on the patient perception, is 10.5 points, with areas under the curve of 0.84 to 0.94.
- Dupuis F, Cherif A, Batcho C, Masse-Alarie H, Roy JS. The Tampa Scale of Kinesiophobia: a systematic review of its psychometric properties in people with musculoskeletal pain. PMID 36917768. A COSMIN systematic review across 41 studies, the most TSK-specific one. Five versions catalogued, test-retest reliability from 0.77 to 0.99 and internal consistency from 0.68 to 0.91 depending on the version.
Page written by Anthony Baillon, physiotherapist, co-founder of Physio Learning. The scale itself is attributed to Kori, Miller and Todd, 1990: this page documents and interprets it, it does not claim authorship of it and reproduces none of its items.