title: The NeckPix(©): development of an evaluation tool for assessing kinesiophobia in subjects with chronic neck pain.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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 purposes.
authors.affiliation: Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone (Milan), Institute of Care and Research, Salvatore Maugeri Foundation, IRCCS, Via Monsignor Bernasconi 16, 20035, Lissone, MI, Italy, marco.monticone@fsm.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Monticone
authors.forename: Howard
authors.initials: H
authors.lastname: Vernon
authors.forename: Roberto
authors.initials: R
authors.lastname: Brunati
authors.forename: Barbara
authors.initials: B
authors.lastname: Rocca
authors.forename: Simona
authors.initials: S
authors.lastname: Ferrante
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D058443:Catastrophization; D059350:Chronic Pain / Q000523:psychology*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000523:psychology*; D010147:Pain Measurement; D010698:Phobic Disorders / Q000175:diagnosis* / Q000209:etiology; D011594:Psychometrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires