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European Journal of Physical and Rehabilitation Medicine 2017 June;53(3):351-8

DOI: 10.23736/S1973-9087.16.04362-8

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Responsiveness and minimal clinically important changes for the Tampa Scale of Kinesiophobia after lumbar fusion during cognitive behavioral rehabilitation

Marco MONTICONE 1, 2 , Emilia AMBROSINI 2, 3, Barbara ROCCA 2, Calogero FOTI 4, Simona FERRANTE 3

1 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation and Institute of Research and Care, Lissone, Italy; 3 Laboratory of Neuroengineering and Medical Robotics, Department of Electronics, Information and Bioengineering, Polytechnic University of Milan, Milan, Italy; 4 Division of Physical Medicine and Rehabilitation, University of Rome Tor Vergata, Rome, Italy


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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.
AIM: Evaluating the responsiveness and minimal clinically important differences (MCIDs) for the TSK and its subscales after lumbar fusion.
DESIGN: Population-based cohort study.
SETTING: Secondary care rehabilitation hospital.
POPULATION: 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.
CLINICAL REHABILITATION IMPACT: 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.


KEY WORDS: Phobic disorders - Diagnostic techniques and procedures - ROC curve - Minimal clinically important difference

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