Association of high kinesiophobia and pain catastrophizing with quality of life in severe hip osteoarthritis: a cross-sectional study.

BACKGROUND: While fear of movement is an important predictor of pain and disability in osteoarthritis (OA), its impact on patients with hip OA remains uncertain. This study aimed to determine whether fear of movement, evaluated by the Tampa Scale for Kinesiophobia (TSK)-11, and pain catastrophizing, evaluated by the Pain Catastrophizing Scale (PCS), were associated with quality of life (QOL) in patients with hip OA. METHODS: This cross-sectional study was conducted between November 2017 and December 2018. Ninety-one consecutively enrolled patients with severe hip OA were scheduled for primary unilateral total hip arthroplasty. The EuroQOL-5 Dimensions questionnaire was used to measure general QOL. The Japanese Orthopedic Association Hip Disease Evaluation Questionnaire was used to assess disease-specific QOL. The covariates included age, sex, body mass index (BMI), pain intensity, high pain catastrophizing (PCS ≥ 30), and high kinesiophobia (TSK-11 ≥ 25). Variables were subjected to multivariate analysis using each QOL scale. RESULTS: In multiple regression analysis, pain intensity, high pain catastrophizing, and BMI were independently correlated with the disease-specific QOL scale. High pain catastrophizing, pain intensity, and high kinesiophobia were independently correlated with the general QOL scale. CONCLUSIONS: High pain catastrophizing (PCS ≥ 30) was independently associated with disease and general QOL scales. High kinesiophobia (TSK-11 ≥ 25) was independently associated with the general QOL scale in preoperative patients with severe hip OA.

Psychosocial interventions seem redact kinesiophobia after anterior cruciate ligament reconstruction but higher level of evidence is needed: a systematic review and meta-analysis.

PURPOSE: Psychosocial interventions have shown potential in reducing the fear of re-injury after anterior cruciate ligament reconstruction (ACLR), but this has not been systematically reviewed. The aim of this study was to assess the available evidence on the effect of psychosocial interventions on kinesiophobia after ACLR. METHODS: Two independent researchers conducted a systematic search in the electronic databases including Scopus, PubMed, Web of Science (WOS), SPORTDiscus, PsycINFO, and CINAHL from their inception until May 2022. They included studies that utilised a randomised controlled study design with a control group, and measured kinesiophobia using the Tampa Scale for kinesiophobia in patients who underwent primary ACLR. The outcome of interest was the mean and standard deviation of kinesiophobia. Extracted data were analysed using Comprehensive Meta-Analysis software, version 3.0 (CMA.V2), employing a random-effects model to calculate the overall effect estimates of psychosocial interventions on Kinesiophobia. The standardised mean difference with 95% confidence intervals (CIs) was computed based on the mean and standard deviation in each group. RESULTS: This systematic review and meta-analysis included 5 randomised controlled trials with a total of 213 patients who underwent ACLR. The results of the meta-analysis showed that psychosocial intervention was more effective than non-psychosocial comparators in reducing kinesiophobia among patients who underwent a primary ACLR (5 trials, MD 0.56, 95% CI 0.28-0.83, p < 0.001). The heterogeneity score was zero (I2 = 0%; n.s. for Cochran's Q test), indicating no significant variation among the studies. CONCLUSIONS: Psychosocial interventions can alleviate kinesiophobia in patients with primary ACLR. Although the limited number of reviewed studies and their methodological limitations precludes drawing a definitive conclusion regarding the effectiveness of psychosocial interventions on kinesiophobia, these promising findings can serve as a basis for developing psychological strategies to manage kinesiophobia in patients with primary ACLR and can also guide future research this issue. LEVEL OF EVIDENCE: II. TRIAL REGISTRATION: This trial is registered in PROSPERO on December 2021 (CRD42021282413).

[Kinesiophobia in shoulder disorders : Validation of the German version of the Tampa scale for kinesiophobia (TSK-GV)]. / Kinesiophobie bei Schulterbeschwerden : Validierung der deutschen Version der Tampa Scale for Kinesiophobia (TSK-GV).

BACKGROUND: With a prevalence of 7-30%, shoulder disorders form the third largest group of musculoskeletal complaints. Their formation and development is influenced by, e.g. psychological factors. The Tampa scale for kinesiophobia (TSK) is the most common measure for quantifying fear of movement. OBJECTIVES: To investigate the reliability and validity of the German version of the TSK (TSK-GV) in a shoulder pain population. MATERIALS AND METHODS: Subjects with shoulder pain were included in a multicenter cross-sectional study. In addition to kinesiophobia, pain intensity, subjective impairment in daily life and fear-avoidance beliefs were recorded. RESULTS: A total of 49 subjects (24 women and 25 men) with a mean age of 41.8 (SD = 12.8) were included. The descriptive evaluation at item level showed good internal consistency (Cronbach's α = 0.81). The homogeneity of the scale is poor (Loevinger's H = 0.35). The correlations did not show any clear convergence of the TSK-GV with the fear-avoidance beliefs questionnaire (FABQ) (r = 0.3501; p = 0.0137). The divergent validity was confirmed for both the numerical rating scale (NRS) (r = 0.1216; p = 0.4052) and the shoulder pain and disability index (SPADI) (r = 0.2571; p = 0.0745). The hypothesis testing resulted in 28.57% accepted hypotheses. There was a significant influence of the TSK-GV and the FABQ on the duration of complaints (R2 = 0.3652; p ≤ 0.0001), as well as an explained variance of the duration of complaints on the TSK-GV of R2 = 0.1834 (p = 0.0021). The subgroup analysis showed a significantly higher degree of kinesiophobia in male subjects (t = 3.8084/df = 47; p = 0.0002). CONCLUSION: The TSK-GV is a reliable measurement tool. The construct validity should be further investigated in future studies. This study shows comparable values to previous studies in other populations. The TSK-GV is to date the only validated German language measure for recording fear of movement in shoulder disorders and shows an acceptable fit for this population.

Dynamic Panel Data Modeling and Surveillance of COVID-19 in Metropolitan Areas in the United States: Longitudinal Trend Analysis.

BACKGROUND: The COVID-19 pandemic has had profound and differential impacts on metropolitan areas across the United States and around the world. Within the United States, metropolitan areas that were hit earliest with the pandemic and reacted with scientifically based health policy were able to contain the virus by late spring. For other areas that kept businesses open, the first wave in the United States hit in mid-summer. As the weather turns colder, universities resume classes, and people tire of lockdowns, a second wave is ascending in both metropolitan and rural areas. It becomes more obvious that additional SARS-CoV-2 surveillance is needed at the local level to track recent shifts in the pandemic, rates of increase, and persistence. OBJECTIVE: The goal of this study is to provide advanced surveillance metrics for COVID-19 transmission that account for speed, acceleration, jerk and persistence, and weekly shifts, to better understand and manage risk in metropolitan areas. Existing surveillance measures coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until, and after, an effective vaccine is developed. Here, we provide values for novel indicators to measure COVID-19 transmission at the metropolitan area level. METHODS: Using a longitudinal trend analysis study design, we extracted 260 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in the 25 largest US metropolitan areas as a function of the prior number of cases and weekly shift variables based on a dynamic panel data model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: Minneapolis and Chicago have the greatest average number of daily new positive results per standardized 100,000 population (which we refer to as speed). Extreme behavior in Minneapolis showed an increase in speed from 17 to 30 (67%) in 1 week. The jerk and acceleration calculated for these areas also showed extreme behavior. The dynamic panel data model shows that Minneapolis, Chicago, and Detroit have the largest persistence effects, meaning that new cases pertaining to a specific week are statistically attributable to new cases from the prior week. CONCLUSIONS: Three of the metropolitan areas with historically early and harsh winters have the highest persistence effects out of the top 25 most populous metropolitan areas in the United States at the beginning of their cold weather season. With these persistence effects, and with indoor activities becoming more popular as the weather gets colder, stringent COVID-19 regulations will be more important than ever to flatten the second wave of the pandemic. As colder weather grips more of the nation, southern metropolitan areas may also see large spikes in the number of cases.

Escaped bait: Bull shark Carcharhinus leucas with an intentionally attached harness rig.

A 193 cm total length female bull shark Carcharhinus leucas was captured in Florida bearing intentionally attached materials which resembled a harness. Harness-type live bait rigs are commonly used for small baitfish; some anglers use such devices with small sharks when targeting large sharks and bony fish. Biofouling on the apparatus and the extent of the injuries indicated the material had likely been on the shark for several years. This case highlights the dangers of using these types of devices on juveniles of long-lived species that attain a large body size.

Is There a Relationship Between Kinesiophobia and Physical Activity Level in Patients with Knee Osteoarthritis?

OBJECTIVE: To investigate the levels of kinesiophobia, physical activity, depression, disability, and quality of life in patients with knee osteoarthritis. DESIGN: A cross-sectional study. SETTING: A tertiary health care center. SUBJECTS: Ninety-six patients with knee osteoarthritis. METHODS: Pain intensity was evaluated by the Visual Analog Scale, kinesiophobia by the Tampa Scale of Kinesiophobia and Brief Fear of Movement Scale, depression by the Beck Depression Inventory, disability by the Western Ontario and McMaster Universities Arthritis Index, physical activity level by the International Physical Activity Questionnaire short form, and quality of life by the Short Form 12 Health Survey Questionnaire. RESULTS: Of the patients, 85.7% had high-level kinesiophobia, 70.6% had depression, and 64.4% had low, 27.8% moderate, and 7.8% high physical activity levels. Age, activity-related pain score of the Visual Analog Scale, Tampa Scale of Kinesiophobia and Brief Fear of Movement Scale scores, and Western Ontario and McMaster Universities Arthritis Index and Beck Depression Inventory scores were higher in the group with high-level kinesiophobia, whereas the mental, physical, and total scores obtained from the Short Form 12 Health Survey Questionnaire were higher in the group with low-level kinesiophobia (P < 0.05). CONCLUSIONS: As the treatment of pain alone in patients with knee osteoarthritis is not sufficient to reduce fear of movement, we suggest that approaches to increase awareness of fear of movement and physical activity and cognitive behavioral therapy related to fear of movement should be included in the treatment program.

Timing of anterior cruciate ligament reconstruction and preoperative pain are important predictors for postoperative kinesiophobia.

PURPOSE: Fear of movement (kinesiophobia) is a major limiting factor in the return to pre-injury sport level after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to gain insight into the prevalence of kinesiophobia pre-ACLR, 3 months post-ACLR and 12 months post-ACLR. Furthermore, the preoperative predictability of kinesiophobia at 3 months post-ACLR was addressed. METHODS: A retrospective study with data, which were prospectively collected as part of standard care, was conducted to evaluate patients who underwent ACLR between January 2017 and December 2018 in an orthopaedic outpatient clinic. Patient characteristics (age, sex, body mass index), injury-to-surgery time, preoperative pain level (KOOS pain subscale) and preoperative knee function (IKDC-2000) were used as potential predictor variables for kinesiophobia (TSK-17) at 3 months post-ACLR in linear regression analysis. RESULTS: The number of patients with a high level of kinesiophobia (TSK > 37) reduced from 92 patients (69.2%) preoperatively to 44 patients (43.1%) 3 months postoperatively and 36 patients (30.8%) 12 months postoperatively. The prediction model, based on a multivariable regression analysis, showed a positive correlation between four predictor variables (prolonged injury-to-surgery time, high preoperative pain level, male sex and low body mass index) and a high level of kinesiophobia at 3 months postoperatively (R2 = 0.384, p = 0.02). CONCLUSION: The prevalence of kinesiophobia decreases during postoperative rehabilitation, but high kinesiophobia is still present in a large portion of the patients after ACLR. Timing of reconstruction seems to be the strongest predictor for high kinesiophobia 3 months post-ACLR. This study is the first step in the development of a screening tool to detect patients with kinesiophobia after ACLR. Identifying patients preoperatively opens the possibility to treat patients and thereby potentially increase the return to pre-injury sport level rate after ACLR. LEVEL OF EVIDENCE: III.

The Tampa Scale of Kinesiophobia: Structural Validation among Adolescents with Idiopathic Scoliosis Undergoing Spinal Fusion Surgery.

AIMS: Spinal fusion surgery is one of the most invasive orthopedic surgeries. Pain while moving or a fear of experiencing pain after surgery may delay return to function and cause prolonged disability. The purpose of the study was to examine the psychometric properties of the Tampa Scale of Kinesiophobia (TSK) in pediatric patients undergoing scoliosis surgery. METHODS: Fifty-five adolescents (10-18 years old) scheduled for spinal fusion surgery were enrolled. Participants completed the TSK questionnaire before surgery and six weeks after surgery. Reliability, exploratory and confirmatory factor analyses were performed on the two-factors TSK including activity avoidance (TSK-AA) and somatic focus (TSK-SF). RESULTS: Before and after surgery, all TSK-AA items conformed into the same factor component and revealed good internal reliability with Cronbach's alpha of .76 and .70 respectively. TSK-SF items were separated into different factor components and revealed poor reliability (.11 and .56). The TSK-AA also produced an adequate fit to the data, as reflected with several fit indices at both timepoints, respectively: χ2/df = 1.19 and 1.22; CFI=.96 and .94; and RMSEA=.06 and .06. CONCLUSIONS: The TSK-AA demonstrated good psychometric properties in patients undergoing scoliosis surgery, which provides empirical evidence for pediatrics. Its validation in distinct populations and settings is recommended prior to its use.

Reproducibility, responsiveness and validation of the Tampa Scale for Kinesiophobia in patients with ACL injuries.

BACKGROUND AND PURPOSE: Psychological factors including fear of pain, re-injury during movement (kinesiophbia) affect return-to-sport rates after anterior cruciate ligament (ACL) reconstructive surgery. Clinicians often encounter in the daily practice that athletes explain lack of self-confidence or psychological readiness during the sports activity. The Tampa Scale for Kinesiophobia (TSK) has been used to evaluate psychological outcomes in patients with ACL injuries in many countries and translated into Japanese version in 2013. However, no researchers validated its reliability, validity, and responsiveness of TSK for patients with ACL injury up to now. The purpose of this study was to evaluate the measurement properties of the Japanese version of the TSK (TSK-J) in patients with ACL injuries. STUDY DESIGN: Cohort study (Diagnostic); Level of evidence, 2. METHODS: This prospective study was performed in the department of orthopaedic surgery at the university hospital of Juntendo from Sep 2016 and Apr 2017. Patients who diagnosed with ACL injury with or without reconstruction surgery completed several patient-reported outcome measures (PROMs) were included in this study. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines were used to evaluate reliability, validity, responsiveness, and interpretability of the TSK-J. RESULTS: 222 patients were included in this study. The TSK-J for ACL injured patients showed good internal consistency (Cronbach's alpha = 0.79) and excellent test-retest reliability (intra-class correlation coefficient, ICC2,1 = 0.90, 95% CI = 0.81 to 0.95). In addtion, the TSK-J was significantly but moderately correlated with the IKDC-SKF (r = - 0.49, P <0.001), VAS-Sports (r = - 0.48, P <0.001), and JACL-25 (r = 0.48, P <0.001). The effect size (ES) was small with the Cohen's d = - 0.2. The minimal important difference (MID) was - 1.3 points. No significant TSK-J score change was observed over 1-year after ACL reconstruction (r = - 0.12, P <0.001). There were no floor or ceiling effects. CONCLUSIONS: Our study demonstrated that the Japanese version of TSK has good reliability. However, its low validity and responsiveness indicate that it may not the best way to assess psychological factors for patients with ACL injury.

Cross-Cultural Adaptation, Reliability, and Validity of the Chinese Version of the Tampa Scale for Kinesiophobia-11 Among Patients Who Have Undergone Total Knee Arthroplasty.

BACKGROUND: The shortened version of the Tampa Scale for Kinesiophobia (TSK-11) has been well characterized in the literature. However, to the best of our knowledge, no previous studies have evaluated the reliability and validity of the TSK-11 for Chinese-speaking patients who have undergone total knee arthroplasty (TKA). Thus, the objectives of this study were to translate and adapt the TSK-11 cross-culturally into Chinese and to evaluate its reliability and validity in a sample of Chinese TKA patients. METHODS: The TSK-11 was translated and cross-culturally adapted into Chinese according to the international guidelines for the cross-cultural adaptation of self-report measures. The Chinese version of TSK-11 was administered to 254 patients following their TKA, along with the Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, Numerical Rating Scale, and 12-Item Short Form Health Survey. Psychometric testing included internal consistency, test-retest reliability, floor and ceiling effects, construct validity, and convergent validity. RESULTS: A high completion rate of 95.8% with no floor or ceiling effects was noted in the Chinese version of the TSK-11. The questionnaire also showed good internal consistency (Cronbach's α = 0.883) and test-retest reliability (intraclass correlation coefficient = 0.798). Construct validity was assessed by exploratory factor analysis, and 3 factors were extracted that accounted for 65.2% of the variance. Convergent validity was confirmed by significant Pearson correlations between the Chinese version of the TSK-11 and the Pain Catastrophizing Scale (r = 0.751), Fear-Avoidance Beliefs Questionnaire (r = 0.719) and VAS (r = 0.450), as well as the 12-Item Short Form Health Survey subdomains Bodily Pain (r = -0.391), Mental Health (r = -0.356), Physical Functioning (r = -0.339), Role-Emotional (r = -0.317), and Role-Physical (r = -0.277). CONCLUSION: The Chinese version of the TSK-11 demonstrated satisfactory acceptability, reliability, and validity; therefore, it can be used in clinical practice and research for assessing kinesiophobia in Chinese patients after TKA.

Evaluation of person-centred care after hip replacement-a controlled before and after study on the effects of fear of movement and self-efficacy compared to standard care.

BACKGROUND: The goal of total hip arthroplasty (THA) is optimal pain relief and a normalized health-related quality of life. Anxious patients describe more pain and more difficulties than non-anxious patients during rehabilitation after THA. The aims of the present study were twofold: (1) to identify vulnerable patients using the general self-efficacy scale (GSES) and the Tampa scale for Kinesiophobia (TSK), and (2) to evaluate if person-centred care including the responses of the instruments made rehabilitation more effective in terms of shortening hospital length of stay. METHODS: The design of the study was quasi-experimental. Patients scheduled for THA, a control group (n = 138) and an intervention group (n = 128) were consecutively recruited. The intervention was the provision of person-centred care which was designed to reduce the negative effects of low self-efficacy and high levels of pain-related fear of movement. RESULTS: Patients with low GSES in the intervention group had shorter length of stay (LoS) by 1.6 days (95 % CI 0.16-3.15) p-value 0.03. Patients with high TSK in the intervention group had shorter LoS by 2.43 days (95 % CI 0.76-4.12) p-value 0.005. For patients who had both, the reduction of LoS was 2.15 days (95 % CI 0.24-4.04) p-value 0.028. CONCLUSIONS: The GSES and the TSK instrument were found useful as tools to provide information to support patients which reduced the LoS by 1.67 days in the whole intervention group (95 % CI 0.72-2.62) p-value 0.001. More importantly, vulnerable patients such as ASA group 3 probably gained the most from the extra support, they had a reduction with 6.78 days (95 % CI 2.94-10.62) p-value 0.001.

Exploring the clinical course of neck pain in physical therapy: a longitudinal study.

OBJECTIVE: To investigate the short-term trajectory of recovery from mechanical neck pain, and predictors of trajectory. DESIGN: Prospective, longitudinal cohort study with 5 repeated measurements over 4 weeks. SETTING: Community-based physical therapy clinics. PARTICIPANTS: Convenience sample of community-dwelling adults (N=50) with uncomplicated mechanical neck disorders of any duration. INTERVENTIONS: Usual physical therapy care. MAIN OUTCOME MEASURES: Neck Disability Index (NDI), numeric rating scale (NRS) of pain intensity. RESULTS: A total of 50 consecutive subjects provided 5 data points over 4 weeks. Exploratory modeling using latent class growth analysis revealed a linear trend in improvement, at a mean of 1.5 NDI points and 0.5 NRS points per week. Within the NDI trajectory, 3 latent classes were identified, each with a unique trend: worsening (14.5%), rapid improvement (19.6%), and slow improvement (65.8%). Within the NRS trajectory, 2 unique trends were identified: stable (48.0%) and improving (52.0%). Predictors of trajectory class suggest that it may be possible to predict the trajectory. Results are described in view of the sample size. CONCLUSIONS: The mean trajectory of improvement in neck pain adequately fits a linear model and suggests slow but stable improvement over the short term. However, up to 3 different trajectories have been identified that suggest neck pain, and recovery thereof, is not homogenous. This may hold value for the design of clinical trials.

Translation and examination of construct validity of the Danish version of the Tampa Scale for Kinesiophobia.

OBJECTIVES: This study investigates the construct validity of the Danish Tampa Scale for Kinesiophobia (TSK). METHODS: The English 17-item scale was translated into Danish adhering to WHO's guidelines. The construct validity of the TSK was examined in a random general population sample of 4,884 18- to 72-year olds with pain within the past 4 weeks. Examination of construct validity adhered to the COSMIN checklist. Structural validity was examined by splitting the sample and conducting exploratory factor analysis on one half and confirmatory factor analysis on the other half. Convergent validity was examined through associations with self-report measures and objective physical performance tests. Reference scores for the TSK were calculated. RESULTS: After translation, all respondents felt confident that they understood the meaning of the items. All but one found the questionnaire acceptable. The exploratory factor analysis suggested that a 1-factor 13-item version without 4 reversed items resulted in the most consistent fit across subgroups of gender, age, and severe pain report. Five different models of the TSK were tested in the confirmatory factor analysis. While none were excellent fits, both one- and two-factor models of the TSK-13 and TSK-11 were acceptable. Two-factor models marginally outperformed one-factor models on goodness of fit. There was no association between TSK scores and muscular fitness or self-reported physical activity. Cardiorespiratory fitness, self-perceived physical fitness, and self-efficacy had weak correlations with TSK scores. Scores showed modest associations with self-report measures of anxiety, illness worry, pain interference, and daily limitations. CONCLUSIONS: Based on an overall consideration of results, we recommend using the TSK-13 as a one-dimensional construct for both research and clinical purposes pending further examinations of the TSK in clinical samples. TSK scores from the present study can serve as a standard of reference for levels of Kinesiophobia in the general population.

Kinesiophobia in Injured Athletes: A Systematic Review.

Athletes have a high risk of injury. Kinesiophobia is a condition in which an individual experiences a fear of physical movement and activity after an injury occurs. Our purpose was to systematically review the literature about Kinesiophobia in athletes. A systematic review was conducted in February 2023 using PubMed, CINAHL, SPORTDiscus, Web of Science, Cochrane Library, and Medline. Studies were included if they were peer-reviewed, in English, within the last 20 years and included athletes who had been injured and tracked Kinesiophobia. Articles were checked for quality via the modified Downs and Black checklist. Fourteen studies were included in the review and had an average "fair" quality score. Authors examined Kinesiophobia in injured athletes with mostly lower-extremity injuries. Kinesiophobia was associated with lower physical and mental outcomes. Kinesiophobia exists in athletes and can affect both physical and mental factors. The Tampa Scale of Kinesiophobia (TSK) was the most common tool used to examine Kinesiophobia. Common mental factors associated with Kinesiophobia include anxiety, low confidence, and fear avoidance.

Tampa Difficulty Score: a novel scoring system for difficulty of robotic hepatectomy.

BACKGROUND: Difficulty scoring system (DSS) has been established for laparoscopic hepatectomy and serves as useful tools to predict difficulty and guide preoperative planning. Despite increased adoption of robotics and its unique technical characteristics compared with laparoscopy, no DSS currently exists for robotic hepatectomy. We aimed to introduce a new DSS for robotic hepatectomy. METHODS: A total of 328 patients undergoing a robotic hepatectomy were identified. After removing the first 24 major and 30 minor hepatectomies using cumulative-sum analysis, 274 patients were included in this study. Relevant clinical variables underwent linear regression using operative time and/or estimated blood loss (EBL) as markers for operative difficulty. Score distribution was analyzed to develop a difficulty-level grouping system. RESULTS: Of the 274 patients, neoadjuvant chemotherapy; tumor location, size, and type; the extent of parenchymal resection; the need for portal lymphadenectomy; and the need for biliary resection with hepaticojejunostomy were significantly associated with operative time and/or EBL. They were used to develop the difficulty scores from 1 to 49. Grouping system results were group 1 (less demanding/beginner), 1 to 8 (n = 39); group 2 (intermediate), 9 to 24 (n = 208); group 3 (more demanding/advanced), 25 to 32 (n = 17); and group 4 (most demanding/expert), 33 to 49 (n = 10). When stratified by group, age, previous abdominal operation, Child-Pugh score, operative duration, EBL, major resection, 30-day mortality, 90-day mortality, and length of stay were significantly different among the groups. CONCLUSION: In addition to established variables in laparoscopic systems, new factors such as the need for portal lymphadenectomy and biliary resection specific to the robotic approach have been identified in this new robotic DSS. Internal and external validations are the next steps in maturing this robotic DSS.

A tracer model nowcast/forecast study of the Tampa Bay, Piney Point effluent plume: Rapid response to an environmental hazard.

An emergency discharge of nutrient-rich effluent from the defunct Piney Point fertilizer stack into Tampa Bay at Port Manatee occurred from 30 March-8 April 2021. This resulted in a pollutant plume that evolved over time and space across the entire bay, including its environmentally sensitive marine preserves, and out onto the adjacent continental shelf. As a rapid response to environmental concerns, the plume evolution was simulated using the high resolution, unstructured grid, Tampa Bay Coastal Ocean Model (TBCOM) nowcast/forecast system, with an embedded tracer module that included realistic point discharge rates. Normalized tracer distributions were automatically updated each day, providing 1-day hindcasts and 3.5-day forecasts. Due to mixing and advection, tracer concentration was quickly reduced by two or more orders of magnitude as the plume spread out. Highest tracer concentrations hugged the southeastern Tampa Bay shoreline during the first week. Lower tracer concentrations were gradually advected to the western side of Tampa Bay, and the tracer was slowly flushed out of the bay to be transported primarily northward along the coast. The modeled plume evolution served as principal guidance for coordinating environmental monitoring by state, local and academic personnel. The model results also provide a basis for future multidisciplinary studies.

The relationship of kinesiophobia in patients with lymphedema: a case-control investigation.

Introduction: Kinesiophobia and lymphedema appear to be related conditions, and it is important to understand this relationship, as many of the symptoms and comorbidities presented by individuals with lower limb lymphedema are prevented and treated through movement, thus constituting kinesiophobia as a barrier to intervention. The objective of this study is, therefore, to evaluate and analyze the kinesiophobic beliefs reported by individuals with and without lower limb lymphedema, regarding the agreement, severity and differences found, and to establish levels of kinesiophobia. Methods: A case-control study with a total sample of 80 participants (40 with lower limb lymphedema and 40 without) was performed. Both groups (with and without lymphedema) were characterized anthropologically, sociodemographically, and clinically. In the case group, lymphedema was evaluated. Participants in both groups completed the Tampa Scale for Kinesiophobia - 13 items (TSK-13). Results: Individuals with lower limb lymphedema had higher TSK-13 scores than their matched group without lymphedema. The items belonging to the activity avoidance subscale had the highest agreement and score in both groups. Differences between groups were mainly established for items belonging to the somatic focus subscale, showing that individuals with lower limb lymphedema have kinesiophobic beliefs related to the perceived severity of their lymphedema. The prevalence of kinesiophobia was increased in both groups, but the severity was mild. Conclusions: Considering the apparent tendency of people with lower limb lymphedema to present kinesiophobia and movement-limiting beliefs regarding the condition, greater attention should be paid to its assessment, prevention and treatment from a multidisciplinary and multimodal perspective, which takes into account the multiplicity of factors inherent to kinesiophobia and lymphedema and thus reduce their impact on the management of lymphedema.

Less is more: reliability and measurement error for three versions of the Tampa Scale of Kinesiophobia (TSK-11, TSK-13, and TSK-17) in patients with high-impact chronic pain.

OBJECTIVES: The Tampa Scale of Kinesiophobia (TSK) is a valid and reliable tool to assess somatic focus and activity avoidance in patients. Currently, the test-retest reliability and measurement error for the Danish version is unknown. The aim of the study was to determine standard error of measurement (SEM) and smallest detectable change (SDC) for three Danish lengths of the TSK in patients with chronic pain. METHODS: Waiting-list patients (n = 77) completed the TSK-17 twice from home with a test interval between 7 and 14 days. Based on COSMIN recommendations, the test-retest reliability was estimated using intraclass correlation coefficient (ICC2,1), and measurement error in terms of standard error of measurement (SEMagreement) and SDC95% were calculated. RESULTS: All three versions showed good test-retest reliability with ICC2,1-values (CI95%) of 0.86(0.79-0.91), 0.88(0.82-0.92) and 0.87(0.81-0.92) for the TSK-17, TSK-13, and TSK-11. The SEM-values were 3.08, 2.42 and 2.10 respectively and SDC95%-values were 8.53, 6.71 and 5.82. CONCLUSIONS: The Danish versions of TSK-11, TSK-13 and TSK-17 showed good to excellent test-retest reliability. SEM and SDC95% values in patients with chronic pain are reported. The TSK-11 did not show systematic bias between test and retest and may be preferred to minimize responder burden.

Validity and reliability of the Tampa Kinesiophobia-Fatigue Scale in patients with multiple sclerosis.

BACKGROUND: Kinesiophobia can be a barrier for physical activity in patients with multiple sclerosis (PwMS) and it can develop as a result of fear and avoidance reactions due to fatigue. However, there is no valid and reliable scale available to assess kinesiophobia due to fatigue in PwMS. AIMS: To investigate the test-retest reliability and construct validity of the Tampa Scale of Kinesiophobia-Fatigue (TSK-F) in PwMS. METHODS: Eighty-seven PwMS were included in the study. In addition to TSK-F, the following measurements were used for construct validity: Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Fatigue Impact Scale (FIS), 6-Minute Walking Test (6MWT), International Physical Activity Questionnaire (IPAQ), Beck Depression Inventory (BDI), Multiple Sclerosis Quality of Life Scale-54 (MSQoL-54). TSK-F was administered twice (3-7 days apart) to measure test-retest reliability. RESULTS: The intraclass correlation coefficient of the TSK-F was 0.867. It had a weak correlation with the IPAQ and EDSS, moderate correlation with the MSQoL-54 and 6MWT, and strong correlation with the BDI, FSS, and FIS (respectively, rho - 0.345, rho 0.365, rho 0.544, rho - 0.449, rho 0.690, rho 0.602, rho 0.650). The scale had good performance to discriminate the disease severity with the area under the curve (AUC) value 0.730. CONCLUSIONS: TSK-F has excellent reliability and moderate-to-good validity in evaluating kinesiophobia and the scale may be a useful outcome measurement for assessment of kinesiophobia due to fatigue in PwMS.

Development and Validation of Short Forms of the Pain Catastrophizing Scale (F-PCS-5) and Tampa Scale for Kinesiophobia (F-TSK-6) in Musculoskeletal Chronic Pain Patients.

Purpose: Chronic pain is a complex phenomenon. Understanding its multiple dimensions requires the use of a combination of several patient-reported outcome measures (PROMs). However, completing multiple PROMs is time-consuming and can be a burden for patients. The objective of our study was to simultaneously reduce the French versions of the Pain Catastrophizing Scale (PCS) and Tampa Scale for Kinesiophobia (TSK) questionnaires to enable their use in an ambulatory and clinical settings. Patients and Methods: We conducted a clinical study between May 2014 and August 2020 in our rehabilitation center. 1428 chronic musculoskeletal pain patients (CMSP) were included. The originality of our approach is that the reduction method included qualitative as well as quantitative analyses. The study was divided into two parts: 1) reduction of the questionnaires (n=1363) based on internal consistency (item-to-total correlation), principal component analysis (item loadings), Rasch analysis (infit/outfit), floor and ceiling effect (quantitative analyses) and expert judgment of items (qualitative analysis), and 2) validation of the reduced questionnaires (n=65), including test-retest reliability (intraclass correlation coefficient [ICC]), homogeneity (Cronbach α), criterion validity (Pearson correlation [r] with the long-version score), determination of the pathological cutoff and Minimal Clinically Important Difference (MCID). The two full-length questionnaires include 30 items in total. Results: The reduction resulted in a 5-item PCS (score 0-20) and 6-item TSK (score 0-24). Psychometric properties of the reduced questionnaires were all acceptable as compared with other version (α=0.89 and 0.71, ICC=0.75 and 0.60, r=0.86 and 0.70, MCID=2 and 2 for PCS and TSK, respectively) while keeping the structure and coherence of the long versions. Conclusion: The two reduced versions of the PCS and TSK can be used in CMSP patient. As their administration only requires a few minutes, they can be implemented in outpatient consultation as well as in clinical settings.