Kinesiophobia — TSK-11

Status: stable Category: fear_avoidance Added: 2026-04-20 Last reviewed: 2026-04-21

Summary

The Tampa Scale for Kinesiophobia — 11-item short form (TSK-11) is Trinity's general fear-of-movement instrument. Eleven items, each scored 1–4, summing to a 11–44 total. Higher scores indicate stronger kinesiophobia.

⚠ Item-scoring orientation

The TSK-11 as published contains several items whose wording is "reversed" relative to the construct (agreeing with the item reflects less kinesiophobia). Standard scoring reverses those items before summing.

Trinity performs a straight simple_sum over all eleven items as submitted — it does not internally reverse any items. To produce the standard TSK-11 interpretation, the caller must submit values that are already oriented so that higher = more kinesiophobia. In practice, this means:

For items whose wording aligns with kinesiophobia (stronger agreement = stronger fear), submit the response value directly.
For items whose wording is reversed (for example, "My pain would probably be relieved if I were to exercise"), submit the response value that would result from applying the TSK-11 reversal convention (5 - value on the published 1–4 scale).

If you administer the TSK-11 verbatim and forward raw responses, your scores will not match published norms — Trinity's sum will include reverse-worded item contributions without flipping them.

This gotcha is real and can yield misleading bands. Read the instrument wording on /questions carefully; decide whether your integration pre-reverses or re-implements the reverse-scoring rules before ingesting scores.

Resource identity

Field	Value
Category	`fear_avoidance`
Resource	`kinesiophobia`
Instrument ID	`kinesiophobia`
Rubric version	`1.0.0`
Path prefix	`/api/fear_avoidance/kinesiophobia`

Operations

Operation	Method	Path	Contract
Questions	`GET`	`/api/fear_avoidance/kinesiophobia/questions`	patterns-questions.md
Score	`POST`	`/api/fear_avoidance/kinesiophobia/score`	patterns-score.md

Items

Eleven items, each on a 1–4 scale.

ID	Prompt (paraphrased)
`item_1`	I am afraid that I might injure myself if I exercise.
`item_2`	If I were to try to overcome it, my pain would increase.
`item_3`	My body is telling me I have something dangerously wrong.
`item_4`	My pain would probably be relieved if I were to exercise.
`item_5`	People are not taking my medical condition seriously enough.
`item_6`	My accident has put my body at risk for the rest of my life.
`item_7`	Pain always means I have injured my body.
`item_8`	Just because something aggravates my pain does not mean it is dangerous.
`item_9`	I am afraid that I might injure myself accidentally.
`item_10`	Simply being careful that I do not make any unnecessary movements is the safest thing I can do to prevent my pain.
`item_11`	I would not have this much pain if there were not something potentially dangerous going on in my body.

Answer choices per item:

Value	Label
`1`	Strongly disagree
`2`	Disagree
`3`	Agree
`4`	Strongly agree

Items whose wording is commonly reverse-scored in published TSK-11 scoring rules: item_4 and item_8. See the orientation note above.

Scoring

Field	Value
Method	`simple_sum` over all eleven items, as submitted (no internal reversal).
Score range	`11` – `44`.

Bands

Band	Range (inclusive)	Clinical meaning
`low`	`11` – `21`	Low kinesiophobia.
`high`	`22` – `44`	Elevated kinesiophobia.

The 22 threshold sits near the widely-cited clinical cutoff (literature commonly cites 22–24 depending on population).

Required items

All eleven items are required for a strict /score call.

Worked example

Every item answered with 3 ("agree"), forwarded as-is without reversal. See quickstart.md for per-language scaffolding and patterns-score.md for the shared /score contract.

Send:

POST /api/fear_avoidance/kinesiophobia/score HTTP/1.1
Host: engine.tripod-health.com
apikey: $ENGINE_API_KEY
Content-Type: application/json
X-Request-ID: docs-kinesiophobia-score-basic

{
  "responses": {
    "item_1": 3, "item_2": 3, "item_3": 3, "item_4": 3, "item_5": 3,
    "item_6": 3, "item_7": 3, "item_8": 3, "item_9": 3, "item_10": 3,
    "item_11": 3
  }
}

Receive (200 OK):

{
  "instrument": "kinesiophobia",
  "category": "fear_avoidance",
  "finding": {
    "algorithm_id": "kinesiophobia",
    "algorithm_version": "1.0.0",
    "score": 33,
    "band": "high",
    "raw": {
      "rubric_version": "1.0.0",
      "responded_items": 11
    },
    "context": null,
    "imputed": false,
    "sd": null,
    "prior_source": null
  },
  "confidence": {
    "overall": 1,
    "tier": "high",
    "breakdown": {
      "input_completeness": 1,
      "imputation_variance": null,
      "model_certainty": null
    }
  },
  "recommendations": null,
  "depth": "basic",
  "catalog_version": "0.13.0",
  "request_id": "docs-kinesiophobia-score-basic",
  "timestamp": "2026-04-21T23:15:00.922789+00:00"
}

Computation: 11 × 3 = 33 → high band (22–44). Same subject with items 4 and 8 pre-reversed (client sends 5 - 3 = 2 instead of 3): 9 × 3 + 2 × 2 = 31 — still high but three points lower. The client-side reversal of items 4 and 8 makes a meaningful difference at the cutoff; see the note in the Scoring section.

Calling in your language

curl

curl -sS -X POST "https://engine.tripod-health.com/api/fear_avoidance/kinesiophobia/score" \
  -H "apikey: $ENGINE_API_KEY" \
  -H "Content-Type: application/json" \
  -d '{"responses":{"item_1":3,"item_2":3,"item_3":3,"item_4":3,"item_5":3,"item_6":3,"item_7":3,"item_8":3,"item_9":3,"item_10":3,"item_11":3}}'

Python (`requests`)

# Uses the call() helper from quickstart.md.
responses = {f"item_{i}": 3 for i in range(1, 12)}
result = call("POST", "/api/fear_avoidance/kinesiophobia/score",
              {"responses": responses})
print(result["finding"]["score"], result["finding"]["band"])

Node.js (native `fetch`)

// Uses the call() helper from quickstart.md.
const responses = Object.fromEntries(
  Array.from({ length: 11 }, (_, i) => [`item_${i + 1}`, 3]),
);
const result = await call("POST",
  "/api/fear_avoidance/kinesiophobia/score", { responses });
console.log(result.finding.score, result.finding.band);

TypeScript

// Uses the typed call<T>() helper from quickstart.md.
const responses = Object.fromEntries(
  Array.from({ length: 11 }, (_, i) => [`item_${i + 1}`, 3]),
);
const result = await call<ScoreResponse>(
  "POST",
  "/api/fear_avoidance/kinesiophobia/score",
  { responses },
);

Go

// Uses the call() helper from quickstart.md.
responses := make(map[string]int, 11)
for i := 1; i <= 11; i++ {
    responses[fmt.Sprintf("item_%d", i)] = 3
}
result, err := call("POST",
    "/api/fear_avoidance/kinesiophobia/score",
    map[string]any{"responses": responses}, 3)
if err != nil {
    panic(err)
}
finding := result["finding"].(map[string]any)
fmt.Printf("TSK-11: %v (%v)\n", finding["score"], finding["band"])

Java

// Uses the call() helper from quickstart.md.
StringBuilder body = new StringBuilder("{\"responses\":{");
for (int i = 1; i <= 11; i++) {
    if (i > 1) body.append(",");
    body.append("\"item_").append(i).append("\":3");
}
body.append("}}");
String result = call("POST",
    "/api/fear_avoidance/kinesiophobia/score",
    body.toString(), 3);
System.out.println(result);

C# (.NET `HttpClient`)

// Uses the Call() helper from quickstart.md.
var responses = Enumerable.Range(1, 11)
    .ToDictionary(i => $"item_{i}", _ => 3);
var result = await Call(HttpMethod.Post,
    "/api/fear_avoidance/kinesiophobia/score",
    new { responses });
var finding = result.GetProperty("finding");
Console.WriteLine($"TSK-11: {finding.GetProperty("score").GetDouble()} ({finding.GetProperty("band").GetString()})");

PowerShell

# Uses the Invoke-Engine helper from quickstart.md.
$responses = @{}
1..11 | ForEach-Object { $responses["item_$_"] = 3 }
$result = Invoke-Engine -Method Post -Path "/api/fear_avoidance/kinesiophobia/score" -Body @{ responses = $responses }
"TSK-11: $($result.finding.score) ($($result.finding.band))"

Clinical interpretation

What it measures. Fear of movement or re-injury — the belief that activity will worsen pain or cause harm.
Psychosocial flag. Elevated TSK-11 scores predict poorer physical-activity adherence and slower functional recovery in musculoskeletal pain populations.
Complementary to FABQ-W. TSK-11 measures general kinesiophobia; FABQ-W is specific to work-related beliefs. The two overlap but tap different constructs.

Intended use

Identifying candidates for graded-exposure or cognitive-functional therapy in musculoskeletal pain care.
Monitoring change in kinesiophobia across a rehabilitation course.
Feeding the CDRI composite as the general fear-of-movement signal.

Mistaken use

Do not submit raw values without considering reverse-scored items. Trinity's sum does not reverse items 4 or 8.
Do not use TSK-11 as a substitute for FABQ-W. They measure overlapping but distinct constructs.
Do not interpret high as "will not participate in physical therapy." It flags elevated fear of movement — a treatable target, not an outcome.
Do not compare raw TSK-11 scores across clients who handled reverse-scoring differently. Without a shared orientation convention, the numbers are not comparable.

Debugging

Capture request_id. Present in every response body.
Score seems inconsistent with published norms. Investigate whether items 4 and 8 need reversal on your side. See the orientation note above.
400 ValidationError with missing_items. Send all eleven items.
Score reads 11 for a subject you expected to be high. Every response was sent as 1. Confirm your UI is not inadvertently defaulting to "strongly disagree" for unanswered items.

patterns-questions.md, patterns-score.md — shared contracts.
instruments-fear_avoidance_beliefs.md — FABQ-W; fear-avoidance specific to work.
instruments-yellow_flag_screen.md — OSPRO-YF; breadth screen covering kinesiophobia as one flag.
instruments-orebro.md — multi-domain yellow-flag screen.
composite-cdri-compute.md — composite.

Change history

Date	Change
2026-04-20	Initial publication.

Summary​

⚠ Item-scoring orientation​

Resource identity​

Operations​

Items​

Scoring​

Bands​

Required items​

Worked example​

Calling in your language​

curl​

Python (requests)​

Node.js (native fetch)​

TypeScript​

Go​

Java​

C# (.NET HttpClient)​

PowerShell​

Clinical interpretation​

Intended use​

Mistaken use​

Debugging​

Related​

Change history​