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.

Introduction

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.  

Quick Summary

• 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

What Is the Tampa Scale for Kinesiophobia?

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.

Why It Is Used

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.

What It Measures

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

Who It Is Useful For

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.  

When to Use This Outcome Measure

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.

When Not to Use or When to Be Cautious

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

Equipment or Resources Required

• 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

Administration Protocol / Practice

Setup

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.”

Format

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

Client Instructions

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

Completion Method

Record whether the TSK was completed:

• independently
• digitally
• on paper
• verbally
• with assistance

This supports repeatability and helps interpret change over time.

Assistance Rules

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

Missing Item Handling

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

Scoring the TSK-17

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

Scoring the TSK-11

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.  

Retesting Considerations

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

Safety Notes

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

Scoring and Interpretation

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.

TSK-17

• Score range: 17–68
• Higher score: greater fear of movement or re-injury
• Lower score: less fear of movement or re-injury

TSK-11

• Score range: 11–44
• Higher score: greater fear of movement-related pain
• Lower score: less fear of movement-related pain

What a High Score May Suggest

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

What a Low Score May Suggest

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

What the Score Does Not Prove

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

How to Explain the Result Safely

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.”

What the Score May Mean in Different Client Populations

General Fitness Clients

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

Sport and Performance Clients

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.

Workplace Clients

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

Older Adults

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

Youth Clients

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

Persistent Pain Clients

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

Task-Specific Fear Considerations

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, MCID, MDC and Responsiveness

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

TSK Meaningful Change Evidence

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.  

Practical Interpretation

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

When Values Are Uncertain

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

Normative Data, Reference Values or Comparative Data

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

Reliability and Validity

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 and Limitations

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

Practical Applications

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

How to Record This in Measurz

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

Related Outcome Measures / Internal Links

• Pain Self-Efficacy Questionnaire / PSEQ
• Fear-Avoidance Beliefs Questionnaire / FABQ
• Örebro Musculoskeletal Pain Screening Questionnaire
• Oswestry Disability Questionnaire
• Quebec Back Pain Disability Scale
• Roland-Morris Lower Back Pain Disability Questionnaire
• Spine Function Index-10
• Neck Disability Index
• Lower Extremity Functional Scale / LEFS

FAQs

What does the Tampa Scale for Kinesiophobia measure?

The TSK measures fear of movement, fear of pain and concern about re-injury.

How many items are in the TSK?

The original TSK has 17 items. Shorter versions, including TSK-11 and TSK-13, are also used.

How is the TSK-17 scored?

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.  

How is the TSK-11 scored?

The TSK-11 is scored from 11 to 44, with higher scores indicating greater fear of movement-related pain.  

Does a higher TSK score mean more kinesiophobia?

Yes. Higher scores indicate greater reported fear of movement or re-injury.

Does the TSK diagnose anxiety or a psychological condition?

No. The TSK does not diagnose anxiety, depression or any psychological disorder. It measures movement-related fear beliefs.

Can TSK be used for athletes?

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.

Can the TSK clear someone for sport or work?

No. TSK can support assessment reasoning, but it should not be used as the only clearance measure.

Key Takeaways

• 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.

References

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