Responsiveness and minimal clinically important changes for the Tampa Scale of Kinesiophobia after lumbar fusion during cognitive behavioral rehabilitation.
BACKGROUND
The Tampa Scale of Kinesiophobia (TSK) is a commonly-used measure for the assessment of fear of movement beliefs in chronic complaints, but its responsiveness in subjects after lumbar fusion has been never reported.


OBJECTIVE
Evaluating the responsiveness and minimal clinically important differences (MCIDs) for the TSK and its subscales after lumbar fusion.


METHODS
Population-based cohort study.


METHODS
Secondary care rehabilitation hospital.


METHODS
In-patients undergoing rehabilitation after lumbar fusion.


METHODS
At the beginning and end of a four-week motor and cognitive-behavioral rehabilitation program, 180 patients completed the TSK. After the intervention, the global perceived effect (GPE) was analyzed to produce a dichotomous outcome (improved vs. stable). Responsiveness for the TSK and its subscales were calculated by distribution (effect size [ES], standardized response mean [SRM]) and anchor-based methods (receiver operating characteristics (ROC) curves; correlations between change scores of the TSK and its subscales and GPE). ROC curves were also used to compute MCID values.


RESULTS
The ES ranged from 1.63 to 1.77 and the SRM from 1.25 to 1.39 for TSK and its subscales. The ROC analyses revealed a value of area under the curve (0.999 [95% CI: 0.978; 1.000], 0.998 [95% CI: 0.975; 1.000], 0.990 [95% CI: 0.962; 0.999] for the TSK, Harm and Activity Avoidance subscales, respectively). MCID values greater than 6 (95% CI: >5; >6), 4 (95% CI: >3; >5), and 2 (95% CI: >2; >2) were achieved for the TSK, Harm and Activity Avoidance subscales, respectively. Correlations between change scores of the TSK and its subscales and GPE were high (0.786-0.830).


CONCLUSIONS
The TSK and its subscales were sensitive in detecting clinical changes in subjects undergoing rehabilitation after lumbar fusion.


CONCLUSIONS
The obtained MCID values will help in the design of future randomized controlled trials and in the interpretation of the clinical impact of a rehabilitation program after lumbar fusion.
Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy - marco.monticone@unica.it.|Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation and Institute of Research and Care, Lissone, Italy - marco.monticone@unica.it.
Marco
M
Monticone
Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation and Institute of Research and Care, Lissone, Italy.|Laboratory of Neuroengineering and Medical Robotics, Department of Electronics, Information and Bioengineering, Polytechnic University of Milan, Milan, Italy.
Emilia
E
Ambrosini
Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation and Institute of Research and Care, Lissone, Italy.
Barbara
B
Rocca
Division of Physical Medicine and Rehabilitation, University of Rome Tor Vergata, Rome, Italy.
Calogero
C
Foti
Laboratory of Neuroengineering and Medical Robotics, Department of Electronics, Information and Bioengineering, Polytechnic University of Milan, Milan, Italy.
Simona
S
Ferrante
D000328:Adult; D000368:Aged; D001362:Avoidance Learning; D058443:Catastrophization / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy; D015331:Cohort Studies; D005239:Fear; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000534:rehabilitation / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010698:Phobic Disorders / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D011594:Psychometrics; D013123:Spinal Fusion