Objectives: To determine the psychometric properties of a questionnaire to assess fear of movement (kinesiophobia): the Tampa Scale for Kinesiophobia (TSK-NL Heart), and to investigate the prevalence of kinesiophobia in patients attending cardiac rehabilitation.Methods: A total of 152 patients were evaluated with the TSK-NL Heart during intake and 7 days later. Internal consistency, test-retest reliability and construct validity were assessed. For construct validity, the Cardiac Anxiety Questionnaire (CAQ) and the Hospital Anxiety and Depression Scale (HADS) were used. The factor structure of the TSK-NL Heart was determined by a principal component analysis (PCA).Results: After removal of 4 items due to low internal consistency, the TSK-NL Heart showed substantial reliability (intraclass correlation coefficient; ICC: 0.80). A strong positive correlation was found between the TSK-NL Heart and the CAQ (rs: 0.61). Strong positive correlations were found between the TSK-NL Heart and de HADS (Anxiety) (rs: 0.60) and between the TSK-NL Heart and the CAQ (rs: 0.61). The PCA revealed a 3-factor structure as most suitable (fear of injury, avoidance of physical activity, perception of risk). High levels of kinesiophobia were found in 45.4% of patients.Conclusion: The 13-item TSK-NL Heart has good psychometric properties, and we recommend using this version to assess kinesiophobia, which is present in a substantial proportion of patients referred for cardiac rehabilitation.Keywords: Tampa Scale for Kinesiophobia; cardiac rehabilitation; exercise; fear of movement; physical activity; cardiovascular disease
Background: Fear of movement (kinesiophobia) after an acute cardiac hospitalization (ACH) is associated with reduced physical activity (PA) and non-adherence to cardiac rehabilitation (CR). Purpose: To investigate which factors are related to kinesiophobia after an ACH, and to investigate the support needs of patients in relation to PA and the uptake of CR. Methods: Patients were included 2-3 weeks after hospital discharge for ACH. The level of kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK-NL Heart). A score of > 28 points is defined as 'high levels of kinesiophobia' (HighKin) and ≤ 28 as 'low levels of kinesiophobia' (LowKin). Patients were invited to participate in a semi-structured interview with the fear avoidance model (FAM) as theoretical framework. Interviews continued until data-saturation was reached. All interviews were analyzed with an inductive content analysis. Results: Data-saturation was reached after 16 participants (median age 65) were included in this study after an ACH. HighKin were diagnosed in seven patients. HighKin were related to: (1) disrupted healthcare process, (2) negative beliefs and attitudes concerning PA. LowKin were related to: (1) understanding the necessity of PA, (2) experiencing social support. Patients formulated 'tailored information and support from a health care provider' as most important need after hospital discharge. Conclusion: This study adds to the knowledge of factors related to kinesiophobia and its influence on PA and the uptake of CR. These findings should be further validated in future studies and can be used to develop early interventions to prevent or treat kinesiophobia and stimulate the uptake of CR. Keywords: Acute cardiac hospitalization; Cardiac rehabilitation; Cardiovascular disease; Exercise; Fear of movement; Physical activity.
Funding Acknowledgements Type of funding sources: None. Background An important factor related to low physical activity in cardiac patients is fear of movement (kinesiophobia). The setting of cardiac rehabilitation (CR) seems suitable for targeting kinesiophobia. Nevertheless, the impact of CR on kinesiophobia is currently unknown, partly due to the absence of information on the responsiveness of instruments to measure kinesiophobia. Purpose To determine the responsiveness of the Dutch version of the Tampa Scale for Kinesiophobia questionnaire (TSK-NL Heart), to asses changes in kinesiophobia during participation in CR and to assess predictors of high levels of kinesiophobia at completion of CR. Methods This study was performed among 109 patients (mean age: 61 years; 76% men) who participated in a 6- till 12-week CR program. Kinesiophobia was measured using the TSK-NL Heart questionnaire. To determine the responsiveness of the TSK-NL Heart, the Cardiac Anxiety Questionnaire (CAQ) and the general anxiety scale of the Hospital Anxiety and Depression Scale (HADS-A) were used as external measures. All questionnaires were completed pre- and post-CR. Internal responsiveness was estimated by calculating the effect size (ES) and standardized response mean (SRM). External responsiveness was determined by calculating the correlation between change scores on the TSK-NL heart and on the external measures. Furthermore, univariate logistic regression analysis was performed with the dichotomized TSK-NL Heart score post-CR as dependent variable (high vs low scores) and baseline characteristics (age, sex, reason for referral and pre-CR scores on the TSK-NL Heart, CAQ and HADS) as predictor variables. Results Prevalence of a high levels of kinesiophobia improved from 40.4% pre-CR to 25.7% at completion of CR (p = 0.05). Both the ES and the SRM of the TSK change score were moderate for patients with an improved CAQ and HADS-A score (respectively ES = 0.52; SRM = 0.57 and ES = 0.54; SRM = 0.60) and small for patients with a stable score (ES = 0; SRM = 0 and ES = 0.26; SRM = 0.36). There was a moderate correlation between the TSK-NL Heart change score and the CAQ (Rs = 0.30, p = 0.023) and a small correlation between the TSK-NL Heart change score and the HADS-A (Rs =0.21, p = 0.107). The odds of having high kinesiophobia levels post-CR were increased by having a high level of kinesiophobia pre-CR (OR= 9.83, 95%CI: 3.52-27.46), a higher baseline score on the CAQ (OR = 1.12, 95%CI: 1.06-1.19), and a higher baseline score on the HADS-A (OR = 1.26, 95% CI: 1.11-1.42). Conclusion The TSK-NL Heart has moderate responsiveness. In addition, this study shows that there are reductions in kinesiophobia during the course of CR. Nevertheless, a large number of patients (26%) still had high levels of kinesiophobia at completion of CR. Interventions targeting kinesiophobia should focus on patients that enter CR with high levels of kinesiophobia, cardiac anxiety and generic anxiety.
The latest IPCC Report (2022) provided by the UN shows us that, to guarantee a safe future for upcoming generations, we must change how we lead our lives on several levels. However, the increasing urgency to act and behave in a way that is not damaging the climate is bringing many psychological concerns to young generations. Worldwide reports are demonstrating how the issue of eco-anxiety is increasing daily, and how young people are feeling more hopeless than ever. Climate change has become a climate crisis, and individuals are experiencing pressure and fear incessantly (Marks et al., 2021). We, as Climate Streamers, have often found ourselves in this situation as well, but rather than freezing, we decided to take this challenge and think of solutions. Therefore, with the support of Breda University of Applied Sciences, the Performatory community, the BUas Startup Support Team, and outside mentors, we created Climate Streamers Foundation: a new youth-led non-profit organisation and a movement working towards a more inclusive and less polarised climate action. By working with leisure elements and a positive and appreciative approach, we want to give back hope, voice and power to the youth and inspire each other genuinely and sustainably. The purpose of this application is to allow us to elaborate a feasibility study concerning our MVP (minimum viable product), the card game, and boost the overall concept. We intend to implement the researched data to improve the design and sales management. The card game aims to stimulate appreciative conversations by giving space to players to express their opinions and personal stories and it is designed so everyone can play it, regardless of background and knowledge. After giving 200 games in production, we launched the card game in July 2022.
The admission of patients to intensive care units (ICU) is sometimes planned after a large operation. However, most admissions are acute, because of life-threatening infections or trauma as a result of accidents. Their stay can last from a couple of days to a couple of weeks. ICU patients are often in pain, in fragile health condition, and connected to various devices such as a ventilator, intravenous drip, and monitoring equipment. The resulting lack of mobilization, makes patients lose 1-3% of muscle power for each day they are in the ICU. Within 2 weeks, patients can lose up to 50% of their muscle mass. Early mobilization of ICU patients reduces their time on a respirator and their hospital length of stay. Because of this, ICUs have started early mobilization physical therapy. However, there is a lack of solutions for patients that properly handle fear of movement, are sufficiently personalized to the possibilities and needs of the individual and motivate recurring use in this context. Meanwhile, various technological advances enable new solutions that might bring benefits for this specific use case. Hospitals are experimenting with screens and projections on walls and ceilings to improve their patients’ stay. Standalone virtual reality and mixed reality headsets have become affordable, available and easy to use. In this project, we want to investigate: How can XR-technologies help long-stay ICU patients with early mobilization, with specific attention to the issues of fear of movement, personalization to the individual’s possibilities, needs and compliance over multiple sessions? The research will be carried out in co-creation with the target group and will consist of a state-of-the-art literature review and an explorative study.
