The construct validity of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in patients with (sub-)acute non-traumatic neck pain

Tineke Pieterson; Sophie Konings; Rebecca Stellato; Arjan Boshuijzen; Martine J Verwoerd

doi:10.1016/j.msksp.2025.103324

The construct validity of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in patients with (sub-)acute non-traumatic neck pain

Tineke Pieterson, Sophie Konings, Rebecca Stellato, Arjan Boshuijzen, Martine J Verwoerd^*

^*Corresponding author for this work

Julius Center, dept. Data Science & Biostatistics

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Neck pain is common and may transition from acute to chronic, often influenced by psychological factors like kinesiophobia, pain catastrophizing, depression, and stress. Early screening for these factors in patients with (sub-)acute neck pain is crucial to prevent chronicity.

OBJECTIVES: To examine the construct validity and internal consistency of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in Dutch patients with (sub-)acute, non-traumatic neck pain.

DESIGN: Cross sectional study.

METHOD: Hypotheses were formulated for convergent and divergent validity. Screening questions were compared with established questionnaires: the Tampa Scale for Kinesiophobia (TSK-11) for kinesiophobia, the Pain Catastrophizing Scale (PCS-6) for pain catastrophizing, and the Depression, Anxiety, and Stress Scale (DASS-21) for depression and stress. When strong convergent validity (r ≥ 0.7) was observed, internal consistency was assessed.

RESULTS: Moderate correlations were observed for kinesiophobia (r = 0.526, TSK-11), depression (r = 0.660 DASS-21 depression), and stress (r = 0.506. DASS-21 distress). Pain catastrophizing showed a strong correlation with the PCS-6 (r = 0.771). Divergent validity was supported by correlations ≤0.5 with unrelated constructs for kinesiophobia, pain catastrophizing, and stress, but not for depression. Internal consistency for pain catastrophizing was 0.692. Scatterplots showed wide dispersion for kinesiophobia and stress. For pain catastrophizing, the scatterplot revealed that low screening scores were associated with high reference standard scores.

CONCLUSIONS: Investigating the complex constructs of kinesiophobia, pain catastrophizing, depression and stress with one or two questions cannot currently be recommended. Further research is needed to confirm the ability to screen for psychological constructs.

Original language	English
Article number	103324
Number of pages	9
Journal	Musculoskeletal Science and Practice
Volume	77
Early online date	3 Apr 2025
DOIs	https://doi.org/10.1016/j.msksp.2025.103324
Publication status	E-pub ahead of print - 3 Apr 2025

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Pieterson, T., Konings, S., Stellato, R., Boshuijzen, A., & Verwoerd, M. J. (2025). The construct validity of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in patients with (sub-)acute non-traumatic neck pain. Musculoskeletal Science and Practice, 77, Article 103324. Advance online publication. https://doi.org/10.1016/j.msksp.2025.103324

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title = "The construct validity of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in patients with (sub-)acute non-traumatic neck pain",

abstract = "BACKGROUND: Neck pain is common and may transition from acute to chronic, often influenced by psychological factors like kinesiophobia, pain catastrophizing, depression, and stress. Early screening for these factors in patients with (sub-)acute neck pain is crucial to prevent chronicity.OBJECTIVES: To examine the construct validity and internal consistency of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in Dutch patients with (sub-)acute, non-traumatic neck pain.DESIGN: Cross sectional study.METHOD: Hypotheses were formulated for convergent and divergent validity. Screening questions were compared with established questionnaires: the Tampa Scale for Kinesiophobia (TSK-11) for kinesiophobia, the Pain Catastrophizing Scale (PCS-6) for pain catastrophizing, and the Depression, Anxiety, and Stress Scale (DASS-21) for depression and stress. When strong convergent validity (r ≥ 0.7) was observed, internal consistency was assessed.RESULTS: Moderate correlations were observed for kinesiophobia (r = 0.526, TSK-11), depression (r = 0.660 DASS-21 depression), and stress (r = 0.506. DASS-21 distress). Pain catastrophizing showed a strong correlation with the PCS-6 (r = 0.771). Divergent validity was supported by correlations ≤0.5 with unrelated constructs for kinesiophobia, pain catastrophizing, and stress, but not for depression. Internal consistency for pain catastrophizing was 0.692. Scatterplots showed wide dispersion for kinesiophobia and stress. For pain catastrophizing, the scatterplot revealed that low screening scores were associated with high reference standard scores.CONCLUSIONS: Investigating the complex constructs of kinesiophobia, pain catastrophizing, depression and stress with one or two questions cannot currently be recommended. Further research is needed to confirm the ability to screen for psychological constructs.",

author = "Tineke Pieterson and Sophie Konings and Rebecca Stellato and Arjan Boshuijzen and Verwoerd, {Martine J}",

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The construct validity of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in patients with (sub-)acute non-traumatic neck pain. / Pieterson, Tineke; Konings, Sophie; Stellato, Rebecca et al.
In: Musculoskeletal Science and Practice, Vol. 77, 103324, 06.2025.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The construct validity of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in patients with (sub-)acute non-traumatic neck pain

AU - Pieterson, Tineke

AU - Konings, Sophie

AU - Stellato, Rebecca

AU - Boshuijzen, Arjan

AU - Verwoerd, Martine J

PY - 2025/4/3

Y1 - 2025/4/3

N2 - BACKGROUND: Neck pain is common and may transition from acute to chronic, often influenced by psychological factors like kinesiophobia, pain catastrophizing, depression, and stress. Early screening for these factors in patients with (sub-)acute neck pain is crucial to prevent chronicity.OBJECTIVES: To examine the construct validity and internal consistency of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in Dutch patients with (sub-)acute, non-traumatic neck pain.DESIGN: Cross sectional study.METHOD: Hypotheses were formulated for convergent and divergent validity. Screening questions were compared with established questionnaires: the Tampa Scale for Kinesiophobia (TSK-11) for kinesiophobia, the Pain Catastrophizing Scale (PCS-6) for pain catastrophizing, and the Depression, Anxiety, and Stress Scale (DASS-21) for depression and stress. When strong convergent validity (r ≥ 0.7) was observed, internal consistency was assessed.RESULTS: Moderate correlations were observed for kinesiophobia (r = 0.526, TSK-11), depression (r = 0.660 DASS-21 depression), and stress (r = 0.506. DASS-21 distress). Pain catastrophizing showed a strong correlation with the PCS-6 (r = 0.771). Divergent validity was supported by correlations ≤0.5 with unrelated constructs for kinesiophobia, pain catastrophizing, and stress, but not for depression. Internal consistency for pain catastrophizing was 0.692. Scatterplots showed wide dispersion for kinesiophobia and stress. For pain catastrophizing, the scatterplot revealed that low screening scores were associated with high reference standard scores.CONCLUSIONS: Investigating the complex constructs of kinesiophobia, pain catastrophizing, depression and stress with one or two questions cannot currently be recommended. Further research is needed to confirm the ability to screen for psychological constructs.

AB - BACKGROUND: Neck pain is common and may transition from acute to chronic, often influenced by psychological factors like kinesiophobia, pain catastrophizing, depression, and stress. Early screening for these factors in patients with (sub-)acute neck pain is crucial to prevent chronicity.OBJECTIVES: To examine the construct validity and internal consistency of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in Dutch patients with (sub-)acute, non-traumatic neck pain.DESIGN: Cross sectional study.METHOD: Hypotheses were formulated for convergent and divergent validity. Screening questions were compared with established questionnaires: the Tampa Scale for Kinesiophobia (TSK-11) for kinesiophobia, the Pain Catastrophizing Scale (PCS-6) for pain catastrophizing, and the Depression, Anxiety, and Stress Scale (DASS-21) for depression and stress. When strong convergent validity (r ≥ 0.7) was observed, internal consistency was assessed.RESULTS: Moderate correlations were observed for kinesiophobia (r = 0.526, TSK-11), depression (r = 0.660 DASS-21 depression), and stress (r = 0.506. DASS-21 distress). Pain catastrophizing showed a strong correlation with the PCS-6 (r = 0.771). Divergent validity was supported by correlations ≤0.5 with unrelated constructs for kinesiophobia, pain catastrophizing, and stress, but not for depression. Internal consistency for pain catastrophizing was 0.692. Scatterplots showed wide dispersion for kinesiophobia and stress. For pain catastrophizing, the scatterplot revealed that low screening scores were associated with high reference standard scores.CONCLUSIONS: Investigating the complex constructs of kinesiophobia, pain catastrophizing, depression and stress with one or two questions cannot currently be recommended. Further research is needed to confirm the ability to screen for psychological constructs.

U2 - 10.1016/j.msksp.2025.103324

DO - 10.1016/j.msksp.2025.103324

M3 - Article

C2 - 40203587

SN - 2468-8630

VL - 77

JO - Musculoskeletal Science and Practice

JF - Musculoskeletal Science and Practice

M1 - 103324

ER -

The construct validity of screening questions for kinesiophobia, pain catastrophizing, depression, and stress in patients with (sub-)acute non-traumatic neck pain

Abstract

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