The Tampa Scale for Kinesiophobia, or TSK, is a patient-reported questionnaire used to assess fear of movement, fear of pain or concern about re-injury. Common versions include the original 17-item TSK and the shorter 11-item TSK-11. Higher scores indicate greater fear of movement-related pain or re-injury. The TSK can support education, graded exposure and progress tracking, but it does not diagnose a psychological condition or clear someone for activity, work, training or sport on its own.
Pain can influence how a person moves, trains, works and participates in daily life. Some clients may avoid movement because they are worried that activity will worsen pain, cause harm or lead to re-injury.
The Tampa Scale for Kinesiophobia, commonly called the TSK, is a patient-reported outcome measure used to assess fear of movement and re-injury.
It is commonly used for:
persistent musculoskeletal pain
low back pain
neck pain
shoulder pain
knee pain
post-injury confidence monitoring
return-to-activity planning
graded exposure planning
pain education support
biopsychosocial assessment
The original TSK is commonly described as a 17-item self-report questionnaire using a 4-point Likert scale. Shorter versions, including the TSK-11, are also widely used. Each version must be scored and interpreted according to its own rules.
Outcome measure: Tampa Scale for Kinesiophobia
Abbreviation: TSK
Common versions: TSK-17, TSK-13, TSK-11
Body region: Not region-specific
Common use: Musculoskeletal pain and persistent pain contexts
Type: Patient-reported fear-of-movement measure
Original version: 17 items
Response scale: 1–4 Likert scale
TSK-17 score range: commonly 17–68
TSK-11 score range: commonly 11–44
Higher score means: Greater fear of movement, pain or re-injury
Lower score means: Less reported fear of movement
Best used for: Baseline assessment, education planning, graded exposure and progress tracking
Key limitation: TSK does not diagnose a psychological condition, prove pain severity or determine readiness on its own
The TSK is a questionnaire used to assess fear of movement, fear of pain and concern about re-injury.
The original version includes:
17 items
a 4-point response scale
statements about pain, movement, injury and activity
a total score where higher values indicate greater fear of movement or re-injury
The TSK-11 is a shorter version with 11 items and a score range from 11 to 44. A 2018 clinimetric article describes the TSK-11 as using a 4-point Likert scale from 1 “strongly disagree” to 4 “strongly agree”, with higher scores indicating higher fear of movement-related pain.
The TSK is best understood as a movement-related fear measure, not a diagnostic test.
The TSK is used because fear of movement can influence activity, participation and progress.
A client may have improving strength, range of motion or physical capacity but still report:
fear of bending
fear of lifting
fear of re-injury
avoidance of movement
reduced confidence returning to sport
reduced confidence returning to work
worry that pain means harm
difficulty progressing load
hesitation with specific tasks
The TSK can help professionals:
identify movement-related fear
support pain education conversations
guide graded exposure planning
monitor confidence over time
understand barriers to activity progression
support return-to-work or return-to-sport reasoning
combine psychological, physical and functional findings
improve Measurz documentation
The TSK should support assessment reasoning and education. It should not be used to label the client or make clearance decisions on its own.
The TSK measures fear of movement and re-injury beliefs.
It may provide insight into:
concern that movement will cause pain
concern that movement will cause injury
reduced confidence with activity
fear of re-injury
belief that pain may indicate harm
avoidance of physical activity
perceived vulnerability during movement
barriers to graded activity or return-to-sport progress
It does not directly measure:
pain intensity
tissue damage
structural pathology
psychological diagnosis
motivation
effort
strength
range of motion
readiness to return to sport
readiness to return to work
The TSK may be useful for:
exercise professionals
rehabilitation practitioners
workplace health professionals
allied health support teams
strength and conditioning coaches working with injured clients
movement assessment professionals
students learning pain-related outcome measures
professionals using Measurz or MAT for structured progress tracking
It may be relevant for clients with:
persistent musculoskeletal pain
chronic low back pain
recurrent pain episodes
post-injury movement fear
fear of re-injury
reduced confidence returning to training
reduced confidence returning to work
difficulty progressing exercise
fear of bending, lifting, running, jumping or sport tasks
A 2023 systematic review examined different TSK versions and their psychometric evidence in people with musculoskeletal pain, supporting the need to record which version is used rather than treating all TSK forms as interchangeable.
Use the TSK when you want to understand whether fear of movement or re-injury may be affecting activity and participation.
It may be useful at:
initial assessment
onboarding
persistent pain review
post-injury confidence review
flare-up review
pain education planning
graded exposure planning
return-to-work planning
return-to-training planning
return-to-sport planning
reassessment or progress review
The TSK is most useful when repeated over time using the same version and scoring method.
Use caution when:
the client cannot complete the questionnaire independently
language or literacy affects responses
the wrong language version is used
the client interprets fear questions as judgement
the score is used to label the client
the score is interpreted without physical and functional context
the score is used as a pass/fail clearance decision
different TSK versions are compared directly
The TSK should not be used to:
diagnose anxiety or depression
diagnose a psychological disorder
diagnose pain severity
confirm tissue damage
determine whether pain is “real”
prove motivation or effort
clear someone for work, training or sport
replace a supportive conversation
replace professional judgement
TSK questionnaire
Version-specific scoring guide
Measurz recording workflow
Client-reported symptom and function notes
Baseline and retest dates
Optional related measures, such as:
Fear-Avoidance Beliefs Questionnaire
Pain Self-Efficacy Questionnaire
Örebro Musculoskeletal Pain Screening Questionnaire
Oswestry Disability Index
Roland-Morris Disability Questionnaire
Neck Disability Index
Lower Extremity Functional Scale
pain score
confidence notes
activity exposure notes
work or sport participation notes
Explain the purpose of the questionnaire before the client completes it.
Example wording:
“This questionnaire helps us understand whether movement or re-injury concerns are affecting activity confidence. It does not diagnose anything on its own, but it helps us plan education, graded activity and progress tracking.”
The TSK can be completed:
on paper
digitally
independently
verbally if assistance is needed
before a session
during reassessment
as part of a Measurz workflow
Ask the client to:
read each statement carefully
rate how much they agree with each statement
use the response scale provided
answer every item where possible
ask for clarification if they do not understand wording
complete the same version at each retest
Record whether the TSK was completed:
independently
digitally
on paper
verbally
with assistance
This supports repeatability and helps interpret change over time.
If assistance is needed:
explain instructions without leading the answer
avoid telling the client which score to choose
avoid challenging or correcting beliefs during completion
record that assistance was provided
use the same assistance approach at retest where possible
Do not guess missing responses.
For best practice:
record missing items
encourage completion of all items
avoid calculating a total score if required scoring items are missing unless the scoring guide allows it
interpret incomplete scores cautiously
use the same version and scoring rules at retest
The original 17-item TSK is commonly scored from 17 to 68.
Each item is scored from:
1: strongly disagree
2: disagree
3: agree
4: strongly agree
Some scoring guides reverse-score items 4, 8, 12 and 16, then sum all items. The Transport Accident Commission scoring document states that total score is calculated after inversion of items 4, 8, 12 and 16.
Score range:
17–68
Scoring direction:
Higher score: greater kinesiophobia / fear of movement
Lower score: less reported kinesiophobia / fear of movement
The TSK-11 has 11 items.
Each item is scored from 1 to 4.
Score range:
11–44
A clinimetric summary states that higher TSK-11 scores indicate higher fear of movement-related pain.
Retest at meaningful points, such as:
baseline
after pain education
after graded exposure progressions
after a flare-up
after increased training or work exposure
during return-to-sport monitoring
discharge or progress review
For consistency, record:
date
TSK version used
current pain behaviour
current activity exposure
recent flare-ups
current work or training exposure
education or graded exposure stage
current goals
any major life, work or training changes
The TSK is a self-report questionnaire, so it does not create physical testing risk.
However, high or worsening scores may suggest the need to:
explore concerns respectfully
review education
adjust graded exposure
support confidence building
consider additional support where appropriate
collaborate with other professionals when distress or participation restriction is significant
The TSK produces a total score that reflects fear of movement or re-injury beliefs.
Higher scores indicate greater fear of movement.
Lower scores indicate less fear of movement.
Score range: 17–68
Higher score: greater fear of movement or re-injury
Lower score: less fear of movement or re-injury
Score range: 11–44
Higher score: greater fear of movement-related pain
Lower score: less fear of movement-related pain
A higher TSK score may suggest:
greater concern that movement will worsen pain
greater concern about re-injury
lower confidence with activity
more avoidance of movement
more need for education and graded exposure support
possible barrier to return-to-work, training or sport progression
A lower TSK score may suggest:
fewer movement-related fear beliefs
greater confidence with activity
lower perceived threat from movement
fewer fear-related barriers to progression
A TSK score does not prove:
diagnosis
pain severity
tissue damage
psychological disorder
motivation
effort level
readiness to return to work
readiness to return to sport
whether one intervention caused change
Example wording:
“Your TSK score suggests that some movements may still feel threatening or risky. This does not mean anything is wrong with you psychologically. It gives us useful information for education, graded exposure and tracking confidence over time.”
For general fitness clients, the TSK may help identify whether movement fear is affecting:
gym participation
walking
lifting
bending
running
confidence after flare-ups
Interpretation cautions:
recent flare-ups may increase scores
fear may be task-specific and not fully captured by the total score
physical capacity should still be assessed
For athletes, TSK may help identify broad fear of movement or re-injury, but it may not capture sport-specific readiness fully.
Interpretation should also include:
sport-specific confidence
return-to-training exposure
workload history
pain response to sport tasks
psychological readiness measures where relevant
sport-specific functional testing
A low TSK score should not be treated as return-to-sport clearance on its own.
For workplace contexts, TSK may help identify fear of movement related to work tasks such as:
lifting
carrying
bending
prolonged standing
driving
repetitive tasks
Interpretation should also include:
job demands
work status
modified duties
work expectations
functional capacity
return-to-work planning
For older adults, TSK may help identify whether fear of movement is affecting participation.
Interpretation should consider:
general health
falls concern
balance confidence
comorbidities
social support
walking tolerance
independent living goals
The TSK is more commonly used in adults.
For youth clients, consider:
comprehension
school and sport context
parent or guardian influence
whether a youth-specific measure is more suitable
For persistent pain, TSK can help monitor whether fear of movement is changing alongside activity and participation.
Interpretation should also consider:
pain self-efficacy
fear-avoidance beliefs
disability scores
mood and stress
sleep
work demands
flare-up history
participation goals
The TSK measures general fear of movement, but it may not fully capture task-specific fear.
A 2023 study reported that TSK-11 can underestimate task-specific fear of movement in people with and without low back pain, suggesting that specific feared activities should also be discussed and recorded.
Meaningful change helps determine whether a score change is likely to matter.
Key terms:
MCID / MIC: the smallest change that may be meaningful to clients or professionals, depending on method used
MDC: the amount of change likely needed to exceed measurement error
SEM: estimated measurement error around a score
Responsiveness: ability of the questionnaire to detect change over time
Meaningful change values vary by TSK version, population and method.
A 2023 low back pain study using TSK-11 referenced a meaningful clinical change score of 4 points. This value should be interpreted in context and should not be automatically applied to every TSK version or population.
A 2023 systematic review summary reported that minimal detectable change differed across TSK versions, with lower values for TSK-17 and TSK-13 compared with TSK-11 when expressed as a percentage of total score.
When interpreting TSK change:
compare the same version to baseline
avoid comparing TSK-17 directly with TSK-11 raw scores
check whether movement confidence has changed
check whether activity exposure has increased
compare with pain, disability and function measures
look for changes in task-specific fear
avoid over-interpreting very small changes
Reported meaningful change values may vary by:
TSK version
low back pain versus other musculoskeletal pain
acute versus persistent symptoms
baseline fear level
education approach
graded exposure approach
follow-up timeframe
language version
When no matching MCID, MDC or SEM exists, interpretation should rely more heavily on:
baseline comparison
repeated measurement
client conversation
activity exposure
work or sport participation
disability scores
professional judgement
Published comparative values exist, but they should be applied carefully.
A Dutch norming study used data from 2,236 people and reported that pain diagnosis predicted TSK scores. Chronic low back pain showed the highest TSK scores, followed by upper extremity disorder, fibromyalgia and osteoarthritis.
Practical guidance:
Lower scores generally suggest less fear of movement.
Higher scores suggest greater fear of movement or re-injury.
A high score should prompt supportive discussion, not judgement.
Norms should be matched to diagnosis, language, setting and TSK version.
Baseline comparison is often more useful than one isolated score.
Do not use one cut-off as a universal clearance or risk threshold.
Comparison should consider:
pain duration
pain condition
activity exposure
work status
sport demands
recent flare-ups
previous pain education
language version
cultural context
disability level
support systems
The TSK has substantial post-2000 psychometric evidence across musculoskeletal pain populations, but measurement properties vary by version.
A 2023 systematic review examined different TSK versions and psychometric evidence in people with musculoskeletal pain. A summary of the review reported that most versions showed good to excellent test-retest reliability, with ICC values from 0.77 to 0.99, and internal consistency from 0.68 to 0.91, although evidence varied by version.
A 2018 clinimetric article describes the TSK as a self-report measure developed to assess fear of movement-related pain in people with musculoskeletal pain, especially low back pain.
Cross-cultural TSK-11 evidence has also been reviewed using COSMIN-informed methods, showing that many adaptations exist and that language/version selection matters.
Reliability and validity are stronger when:
the correct version is used
the correct language version is used
all items are completed
reverse scoring is done correctly where required
the same scoring method is repeated
results are interpreted in context
TSK is paired with disability, function and pain measures
Interpret cautiously when:
multiple items are missing
the client has difficulty understanding statements
the score is used to label the client
the score is used as a stand-alone return-to-activity decision
different versions are compared directly
task-specific fear is the main concern
Common errors include:
treating TSK as a diagnosis
using the score to label the client
interpreting high fear as poor motivation
using TSK as return-to-work clearance
using TSK as return-to-sport clearance
comparing TSK-17 and TSK-11 raw scores directly
forgetting reverse scoring on TSK-17
not recording the version used
not recording missing items
over-interpreting one score
failing to discuss results respectfully
Limitations include:
self-report may be influenced by recent pain, stress or flare-ups
high scores do not prove readiness problems
low scores do not guarantee readiness
TSK may not capture task-specific fear fully
meaningful change evidence varies by version and population
universal cut-offs are limited
it does not capture sport-specific readiness
it should be paired with physical, functional and psychosocial assessment
The TSK may help professionals:
document baseline fear of movement
identify movement or re-injury concerns
guide pain education
support graded exposure planning
support pacing discussions
monitor fear-related change over time
support return-to-work or return-to-training conversations
improve client-centred communication
strengthen Measurz reports
For fitness clients, it can help show whether fear of movement is affecting training progression.
For workplace clients, it can help identify whether concerns about movement are affecting work tasks.
For persistent pain clients, it can help monitor whether fear of movement changes alongside pain, disability and exposure.
For sport clients, it can support broader return-to-sport reasoning, but should be paired with sport-specific confidence and performance testing.
For Measurz users, TSK is most useful when combined with:
Pain Self-Efficacy Questionnaire
Fear-Avoidance Beliefs Questionnaire
Örebro Musculoskeletal Pain Screening Questionnaire
Oswestry Disability Index
Roland-Morris Disability Questionnaire
Neck Disability Index
Lower Extremity Functional Scale
pain score
activity exposure notes
work or sport participation notes
Record:
outcome measure name: Tampa Scale for Kinesiophobia / TSK
version used: TSK-17, TSK-13, TSK-11 or other
date completed
completion method: paper, digital, interview or assisted
language/version used
condition or presentation being tracked
total score
score range:
TSK-17: commonly 17–68
TSK-11: commonly 11–44
direction of scoring: higher score indicates greater fear of movement
reverse-scored items checked, if using TSK-17
missing items, if any
assistance provided, if any
current pain score, if relevant
current disability score, if relevant
current activity exposure
current work, training or sport exposure
key feared movements or tasks
confidence or participation goals
education or graded exposure notes
baseline comparison
MCID/MIC/MDC comparison where supported
related physical assessment findings
interpretation notes
retest date
referral or collaboration notes where appropriate
Record whether the main concern appears to be:
general fear of movement
fear of re-injury
lifting-related fear
running or jumping fear
work-task fear
sport-specific fear
flare-up-related fear
mixed fear pattern
unclear due to incomplete responses
This improves:
repeatability
communication
client education
assessment reasoning
monitoring over time
team consistency
reporting quality
The TSK measures fear of movement, fear of pain and concern about re-injury.
The original TSK has 17 items. Shorter versions, including TSK-11 and TSK-13, are also used.
The TSK-17 is commonly scored from 17 to 68. Items are rated from 1 to 4, and some scoring guides reverse-score items 4, 8, 12 and 16 before summing.
The TSK-11 is scored from 11 to 44, with higher scores indicating greater fear of movement-related pain.
Yes. Higher scores indicate greater reported fear of movement or re-injury.
No. The TSK does not diagnose anxiety, depression or any psychological disorder. It measures movement-related fear beliefs.
Yes, it can support broader return-to-sport reasoning, but it may not capture sport-specific fear fully. It should be paired with sport-specific confidence, exposure and physical testing.
No. TSK can support assessment reasoning, but it should not be used as the only clearance measure.
The TSK measures fear of movement and re-injury.
The original TSK has 17 items and is commonly scored from 17 to 68.
TSK-11 is commonly scored from 11 to 44.
Higher scores indicate greater fear of movement.
TSK does not diagnose a psychological condition or clear a client for activity.
Version choice matters because different TSK forms are not directly interchangeable.
TSK may not fully capture task-specific or sport-specific fear.
Measurz should record version, total score, reverse scoring, missing items, key feared tasks, activity exposure, baseline comparison and related physical findings.
Dupuis, F., Cherif, A., Batcho, C., Massé-Alarie, H., & Roy, J.-S. (2023). The Tampa Scale of Kinesiophobia: A systematic review of its psychometric properties in people with musculoskeletal pain. The Clinical Journal of Pain, 39(5), 236–247. https://doi.org/10.1097/AJP.0000000000001104
French, D. J., France, C. R., Vigneau, F., French, J. A., & Evans, R. T. (2007). Fear of movement/(re)injury in chronic pain: A psychometric assessment of the original English version of the Tampa Scale for Kinesiophobia. Pain, 127(1–2), 42–51. https://doi.org/10.1016/j.pain.2006.07.016
Goubert, L., Crombez, G., Van Damme, S., Vlaeyen, J. W. S., Bijttebier, P., & Roelofs, J. (2004). Confirmatory factor analysis of the Tampa Scale for Kinesiophobia: Invariant two-factor model across low back pain patients and fibromyalgia patients. The Clinical Journal of Pain, 20(2), 103–110.
Lundberg, M., Styf, J., & Carlsson, S. G. (2004). A psychometric evaluation of the Tampa Scale for Kinesiophobia: From a physiotherapeutic perspective. Physiotherapy Theory and Practice, 20(2), 121–133. https://doi.org/10.1080/09593980490453002
Roelofs, J., Goubert, L., Peters, M. L., Vlaeyen, J. W. S., & Crombez, G. (2004). The Tampa Scale for Kinesiophobia: Further examination of psychometric properties in patients with chronic low back pain and fibromyalgia. European Journal of Pain, 8(5), 495–502. https://doi.org/10.1016/j.ejpain.2003.11.016
Tissot, L.-P. M., Evans, D. W., Kirby, E., & Liew, B. X. W. (2023). Tampa Scale of Kinesiophobia may underestimate task-specific fear of movement in people with and without low back pain. PAIN Reports, 8(3), e1081. https://doi.org/10.1097/PR9.0000000000001081
Weermeijer, J. D., & Meulders, A. (2018). Clinimetrics: Tampa Scale for Kinesiophobia. Journal of Physiotherapy, 64(2), 126. https://doi.org/10.1016/j.jphys.2018.01.001
