Fear of movement: the Tampa Scale, the TSK-11 and what a total can tell you

Each of the 17 statements describes a belief about pain and movement — for example that pain means the body has been injured, or that exercise is unsafe with a condition like the patient’s. The patient says how far they agree on a four-point scale, strongly disagree 1 to strongly agree 4, and the item scores are added.

It was designed to capture fear of movement and (re)injury, the belief at the centre of the fear-avoidance model of persistent pain, in which fear of pain leads to avoidance of activity, which leads to disability and more pain.

Four statements — items 4, 8, 12 and 16 — are worded in the opposite direction, so agreeing with them signals less fear. They are reverse scored: for those four, strongly disagree scores 4 and strongly agree scores 1. Forgetting to reverse them is an easy error when scoring the scale by hand, and the calculator applies the reversal for you.

Those four items have also performed poorly in later analyses, which is one reason a short form was created.

The TSK-11 drops the four reverse-scored items and two others, items 9 and 14, leaving items 1, 2, 3, 5, 6, 7, 10, 11, 13, 15 and 17. Because every remaining item is worded in the same direction, nothing needs reversing, and the total runs from 11 to 44.

The two forms are not interchangeable. A 17-item total and an 11-item total sit on different ranges, so they cannot be compared directly or pooled in one analysis.

Studies of the 17-item scale commonly treat a total above 37 as high kinesiophobia. That is a convention in the literature, not a validated diagnostic threshold: it flags a patient for a closer look at fear and avoidance and does not diagnose anything.

We could not verify a published cut-off for the TSK-11, so the TSK-11 page reports the total without a severity band. Applying 37 to an 11 to 44 total would be wrong.

The scale is most useful in persistent pain, where fear of movement can hold back a graded activity or exposure-based rehabilitation programme, and for following change in that fear across a course of treatment. It is less meaningful in acute pain, where caution after a fresh injury can be a proportionate response rather than a maladaptive belief.

It pairs naturally with a measure of confidence, such as the Pain Self-Efficacy Questionnaire, and with a screening tool for risk of a poor outcome in back pain, such as the STarT Back tool: fear, confidence and risk answer different questions.