Research Article

Assessment and treatment of patients with kinesiophobia: A Delphi consensus

Mattias Santi*, Ina Diener and Rob Oostendorp

Published: 26 October, 2022 | Volume 6 - Issue 2 | Pages: 023-028

Kinesiophobia is described as pain-related fear of movement and plays a role in the development of chronic musculoskeletal pain. Several approaches have been described in the literature, but there does not seem to be a consensus on the most appropriate way to evaluate and treat patients with kinesiophobia. The aim of this study was to identify clinically relevant assessments and treatments recommended by a consensus of experts. Fourteen experts were identified to participate in a three-round internet-based Delphi study. Participants were asked to propose assessments and treatments (round 1), to grade each proposal on a Likert scale of 9 (round 2), and to reassess their level of agreement (round 3). The consensus was defined with 75% agreement. Five methods of assessment and six treatment approaches reached a consensus. The TAMPA scale reached the top position as an assessment of kinesiophobia. Graded exposure to movement, cognitive and behavioral therapy, and pain neuroscience education were the highest-rated interventions. These results provide the first expert consensus on preferred assessments and treatments for patients with kinesiophobia and correspond with the evidence base in the literature.

Read Full Article HTML DOI: 10.29328/journal.jnpr.1001047 Cite this Article Read Full Article PDF


Assessment; Treatment; Kinesiophobia; Delphi


  1. Kori SH. Kinisophobia : A new view of chronic pain behavior . Pain Manage Jan:/Feb:35‑43,1990.
  2. Vlaeyen JWS, Crombez G, Linton SJ. The fear-avoidance model of pain. Pain. 2016 Aug;157(8):1588-1589. doi: 10.1097/j.pain.0000000000000574. PMID: 27428892.
  3. Perrot S, Trouvin AP, Rondeau V, Chartier I, Arnaud R, Milon JY, Pouchain D. Kinesiophobia and physical therapy-related pain in musculoskeletal pain: A national multicenter cohort study on patients and their general physicians. Joint Bone Spine. 2018 Jan;85(1):101-107. doi: 10.1016/j.jbspin.2016.12.014. Epub 2017 Jan 3. PMID: 28062380.
  4. Brown OS, Hu L, Demetriou C, Smith TO, Hing CB. The effects of kinesiophobia on outcome following total knee replacement: a systematic review. Arch Orthop Trauma Surg. 2020 Dec;140(12):2057-2070. doi: 10.1007/s00402-020-03582-5. Epub 2020 Aug 24. PMID: 32839826.
  5. Filardo G, Roffi A, Merli G, Marcacci T, Ceroni FB, Raboni D, Bortolotti B, De Pasqual L, Marcacci M. Patient kinesiophobia affects both recovery time and final outcome after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016 Oct;24(10):3322-3328. doi: 10.1007/s00167-015-3898-8. Epub 2015 Dec 19. PMID: 26685685.
  6. Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med. 2019 May;53(9):554-559. doi: 10.1136/bjsports-2017-098673. Epub 2018 Apr 17. PMID: 29666064.
  7. Ng W, Slater H, Starcevich C, Wright A, Mitchell T, Beales D. Barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain: a systematic review and qualitative evidence synthesis. Pain. 2021 Aug 1;162(8):2154-2185. doi: 10.1097/j.pain.0000000000002217. PMID: 33534357.
  8. Weermeijer JD, Meulders A. Clinimetrics: Tampa Scale for Kinesiophobia. J Physiother. 2018 Apr;64(2):126. doi: 10.1016/j.jphys.2018.01.001. Epub 2018 Mar 19. PMID: 29567379.
  9. Williamson E. Fear Avoidance Beliefs Questionnaire (FABQ). Aust J Physiother. 2006;52(2):149. doi: 10.1016/s0004-9514(06)70052-6. PMID: 16805041.
  10. McCracken LM, Zayfert C, Gross RT. The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain. 1992 Jul;50(1):67-73. doi: 10.1016/0304-3959(92)90113-P. PMID: 1513605.
  11. Oliveira CB, Pinto RZ. Clinimetrics: Photograph Series of Daily Activities - Short Electronic Version (PHODA-SeV). J Physiother. 2021 Jul;67(3):222. doi: 10.1016/j.jphys.2020.09.006. Epub 2020 Oct 20. PMID: 33097439.
  12. Monticone M, Ferrante S, Rocca B, Salvaderi S, Fiorentini R, Restelli M, Foti C. Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil. 2013 Feb;94(2):231-9. doi: 10.1016/j.apmr.2012.10.003. Epub 2012 Oct 12. PMID: 23063624.
  13. Mannion AF, Müntener M, Taimela S, Dvorak J. A randomized clinical trial of three active therapies for chronic low back pain. Spine (Phila Pa 1976). 1999 Dec 1;24(23):2435-48. doi: 10.1097/00007632-199912010-00004. PMID: 10626305.
  14. Domingues de Freitas C, Costa DA, Junior NC, Civile VT. Effects of the pilates method on kinesiophobia associated with chronic non-specific low back pain: Systematic review and meta-analysis. J Bodyw Mov Ther. 2020 Jul;24(3):300-306. doi: 10.1016/j.jbmt.2020.05.005. Epub 2020 May 12. PMID: 32826004.
  15. de Jong JR, Vlaeyen JW, Onghena P, Goossens ME, Geilen M, Mulder H. Fear of movement/(re)injury in chronic low back pain: education or exposure in vivo as mediator to fear reduction? Clin J Pain. 2005 Jan-Feb;21(1):9-17; discussion 69-72. doi: 10.1097/00002508-200501000-00002. PMID: 15599127.
  16. Cai L, Gao H, Xu H, Wang Y, Lyu P, Liu Y. Does a Program Based on Cognitive Behavioral Therapy Affect Kinesiophobia in Patients Following Total Knee Arthroplasty? A Randomized, Controlled Trial With a 6-Month Follow-Up. J Arthroplasty. 2018 Mar;33(3):704-710. doi: 10.1016/j.arth.2017.10.035. Epub 2017 Oct 28. PMID: 29239772.
  17. Nambi G, Abdelbasset WK, Alrawaili SM, Alsubaie SF, Abodonya AM, Saleh AK. Virtual reality or isokinetic training; its effect on pain, kinesiophobia and serum stress hormones in chronic low back pain: A randomized controlled trial. Technol Health Care. 2021;29(1):155-166. doi: 10.3233/THC-202301. PMID: 32831210.
  18. MKE Lundberg, Jorma S, Sven G. Carlsson. A Psychometric Evaluation of the Tampa Scale for Kinesiophobia — from a Physiotherapeutic Perspective. Physiotherapy Theory and Practice 20(2):121‑ doi: 10.1080/09593980490453002.
  19. Black N, Murphy M, Lamping D, McKee M, Sanderson C, Askham J, Marteau T. Consensus development methods: a review of best practice in creating clinical guidelines. J Health Serv Res Policy. 1999 Oct;4(4):236-48. doi: 10.1177/135581969900400410. PMID: 10623041.
  20. Michael Quinn P. Qualitative Research & Evaluation Methods. 2002.
  21. Jünger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review. Palliat Med. 2017 Sep;31(8):684-706. doi: 10.1177/0269216317690685. Epub 2017 Feb 13. PMID: 28190381.
  22. Diamond IR, Grant RC, Feldman BM, Pencharz PB, Ling SC, Moore AM, Wales PW. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol. 2014 Apr;67(4):401-9. doi: 10.1016/j.jclinepi.2013.12.002. PMID: 24581294.
  23. Gregg CD, McIntosh G, Hall H, Watson H, Williams D, Hoffman CW. The relationship between the Tampa Scale of Kinesiophobia and low back pain rehabilitation outcomes. Spine J. 2015 Dec 1;15(12):2466-71. doi: 10.1016/j.spinee.2015.08.018. Epub 2015 Aug 14. PMID: 26282104.
  24. Liu H, Huang L, Yang Z, Li H, Wang Z, Peng L. Fear of Movement/(Re)Injury: An Update to Descriptive Review of the Related Measures. Front Psychol. 2021 Jul 7;12:696762. doi: 10.3389/fpsyg.2021.696762. PMID: 34305755; PMCID: PMC8292789.
  25. Mintken PE, Cleland JA, Whitman JM, George SZ. Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with shoulder pain. Arch Phys Med Rehabil. 2010 Jul;91(7):1128-36. doi: 10.1016/j.apmr.2010.04.009. PMID: 20599053.
  26. Swinkels-Meewisse EJ, Swinkels RA, Verbeek AL, Vlaeyen JW, Oostendorp RA. Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Man Ther. 2003 Feb;8(1):29-36. doi: 10.1054/math.2002.0484. PMID: 12586559.
  27. George SZ, Zeppieri G. Physical therapy utilization of graded exposure for patients with low back pain. J Orthop Sports Phys Ther. 2009 Jul;39(7):496-505. doi: 10.2519/jospt.2009.2983. PMID: 19574658.
  28. Chand SP, DP Kuckel, Martin R. Huecker. Cognitive Behavior Therapy . in StatPearls. Treasure Island (FL): StatPearls Publishing. 2021.
  29. Monticone M, Cedraschi C, Ambrosini E, Rocca B, Fiorentini R, Restelli M, Gianola S, Ferrante S, Zanoli G, Moja L. Cognitive-behavioural treatment for subacute and chronic neck pain. Cochrane Database Syst Rev. 2015 May 26;2015(5):CD010664. doi: 10.1002/14651858.CD010664.pub2. PMID: 26006174; PMCID: PMC8922276.
  30. Stefanie T, Thomas H, Ehrenbrusthoff K. Effectiveness of additional cognitive behavioural interventions on pain, catastrophising, kinesiophobia and anxiety in people with whiplash-associated disorders compared to physiotherapy alone: A systematic review . Pain and Rehabilitation - the Journal of Physiotherapy Pain Association 2022(52):53‑
  31. Vlaeyen JW, de Jong J, Geilen M, Heuts PH, van Breukelen G. Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain. Behav Res Ther. 2001 Feb;39(2):151-66. doi: 10.1016/s0005-7967(99)00174-6. PMID: 11153970.
  32. Woods MP, Asmundson GJG. Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: a randomized controlled clinical trial. Pain. 2008 Jun;136(3):271-280. doi: 10.1016/j.pain.2007.06.037. Epub 2007 Aug 22. PMID: 17716819.
  33. Araya-Quintanilla F, Gutiérrez-Espinoza H, Jesús Muñoz-Yanez M, Rubio-Oyarzún D, Cavero-Redondo I, Martínez-Vizcaino V, Álvarez-Bueno C. The Short-term Effect of Graded Motor Imagery on the Affective Components of Pain in Subjects with Chronic Shoulder Pain Syndrome: Open-Label Single-Arm Prospective Study. Pain Med. 2020 Oct 1;21(10):2496-2501. doi: 10.1093/pm/pnz364. PMID: 32003812.
  34. Bilterys T, Kregel J, Nijs J, Meeus M, Danneels L, Cagnie B, Van Looveren E, Malfliet A. Influence of education level on the effectiveness of pain neuroscience education: A secondary analysis of a randomized controlled trial. Musculoskelet Sci Pract. 2022 Feb;57:102494. doi: 10.1016/j.msksp.2021.102494. Epub 2021 Dec 15. PMID: 34953290.
  35. Burton AK, Waddell G, Tillotson KM, Summerton N. Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine (Phila Pa 1976). 1999 Dec 1;24(23):2484-91. doi: 10.1097/00007632-199912010-00010. PMID: 10626311.
  36. Lorimer MG.Reconceptualising Pain According to Modern Pain Science. Physical Therapy Reviews 12(3):169‑ 2007; doi: 10.1179/108331907X223010.
  37. Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial. Arch Phys Med Rehabil. 2010 Aug;91(8):1153-9. doi: 10.1016/j.apmr.2010.04.020. PMID: 20684894.
  38. Gül H, Erel S, Toraman NF. Physiotherapy combined with therapeutic neuroscience education versus physiotherapy alone for patients with chronic low back pain: A pilot, randomized-controlled trial. Turk J Phys Med Rehabil. 2021 Sep 1;67(3):283-290. doi: 10.5606/tftrd.2021.5556. PMID: 34870114; PMCID: PMC8606998.
  39. Huang J, Xu Y, Xuan R, Baker JS, Gu Y. A Mixed Comparison of Interventions for Kinesiophobia in Individuals with Musculoskeletal Pain: Systematic Review and Network Meta-Analysis. Front Psychol. 2022 Jun 29; 13:886015. doi: 10.3389/fpsyg.2022.886015. PMID: 35846681; PMCID: PMC9277051.
  40. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13; 312(7023):71-2. doi: 10.1136/bmj.312.7023.71. PMID: 8555924; PMCID: PMC2349778.
  41. Pincus T, Smeets RJ, Simmonds MJ, Sullivan MJ. The fear avoidance model disentangled: improving the clinical utility of the fear avoidance model. Clin J Pain. 2010 Nov-Dec; 26(9):739-46. doi: 10.1097/AJP.0b013e3181f15d45. PMID: 20842017.


Figure 1

Figure 1

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?