The Spanish adaptation of the Tampa Scale for Kinesiophobia Heart: psychometric evidence in cardiac rehabilitation patients.

Background: The factor structure of the Tampa Scale of Kinesiophobia Heart version has rarely been adequately analyzed. We aimed to evaluate the psychometric properties of this scale through a variety of exploratory and confirmatory factorial approaches.

Aim: To perform a translation, cross-cultural adaptation, and psychometric evaluation of the Spanish version of the Tampa Scale of Kinesiophobia Heart in patients attending Cardiac Rehabilitation (TSK-SPA).

Design: Cross-sectional study.

Setting: A Cardiac Rehabilitation unit.

Population: Adults with the principal diagnosis of coronary artery disease (83%) who were referred to Cardiac Rehabilitation (N.=194; mean age, 64.28±9.2; 15% women).

Methods: We performed a translation and a cross-cultural adaptation of the TSK-SPA. The psychometric properties of validity comprising the face, content, and construct validity were then tested. Five factorial models were proposed to analyze the data structure. We examined the validity evidence of the TSK-SPA based on the relationships with other analyzed variables using the SF12 quality of life Questionnaire, the International Physical Activity Questionnaire, the Hospital Anxiety and Depression Scale and the Beck Depression Inventory. The reliability tests included internal consistency and stability over time.

Results: The results suggested a four-dimensional structure. Models with more than 1 dimension exhibited undesirable factor loadings or inadequate fit indices. Based on these results, a short version of the scale with 13 items is proposed. In terms of reliability, the TSK-SPA Heart was found internally consistent (α=0.79) and stable over time (test-retest = 0.82). An Exploratory Structural Equation Modeling (ESEM) analysis provided an acceptable fit for a hypothesized 4-factor model with the inclusion of a method factor: the root mean squared error of approximation was <0.05 (RMSEA = 0.046), and the comparative fit indices were >0.95 or close (CFI=0.994, TLI=0.934). Significant positive correlations were observed between the TSK-SPA scores and the measures of anxiety and depression, with correlation coefficients ranging from 0.35 to 0.48.

Conclusions: A best-fitting model was identified, and the proposed 13-item TSK-SPA Heart showed sufficient evidence of validity and reliability for Spanish patients with cardiovascular disease. The scale's overall reliability is deemed acceptable, although the factor reliability could be further enhanced.

Clinical rehabilitation impact: Using this questionnaire on fear or avoidance of movement will improve our understanding of cognitive-behavioral factors in patients with cardiovascular disease, aiding their rehabilitation and optimizing their prognosis.