Cited by 475Musculoskeletal pain and rehabilitationFibromyalgia and Chronic Fatigue Syndrome ResearchPain Management and Treatment

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The Tampa Scale for Kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia

Roelofs, Jeffrey, Goubert, Liesbet, Peters, Madelon L., Vlaeyen, Johan W.S., Crombez, Geert·2004·European Journal of Pain

DOI 10.1016/j.ejpain.2003.11.016

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Abstract

The present study attempted to replicate the robustness of a two‐factor model of the Tampa Scale for Kinesiophobia (TSK) in chronic low back pain (CLBP) patients and fibromyalgia patients, by means of confirmatory factor analysis. Construct and predictive validity of the TSK subscales were also examined. Results clearly indicated that a two‐factor model fitted best in both pain samples. These two factors were labelled somatic focus, which reflects the belief in underlying and serious medical problems, and activity avoidance, which reflects the belief that activity may result in (re)injury or increased pain. Construct validity of the TSK and its subscales was supported by moderate correlation coefficients with self‐report measures of pain‐related fear, pain catastrophising, and disability, predominantly in patients with CLBP. Predictive validity was supported by moderate correlation coefficients with performance on physical performance tests (i.e., lifting tasks, bicycle task) mainly in CLBP patients. Implications of the results are discussed and directions for future research are provided.

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“The Dutch version of the TSK has been reported to be reliable and valid [6,13,14].”
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Method
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BackgroundMethod
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BackgroundResult
Pain and pain‐related fear are associated with functional and social disability in an occupational setting: Evidence of mediation by pain‐related fear
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MethodSelf-citation
Fear reduction in patients with chronic pain: a learning theory perspective
den Hollander, M., de Jong, J. R., Volders, S., Goossens, M. E. J. B., Smeets, R., & Vlaeyen, J. W. S. (2010) · Expert Review of Neurotherapeutics · doi:10.1586/ern.10.115 · Cited by 113
Self-citation
Manual Therapy, Therapeutic Patient Education, and Therapeutic Exercise, an Effective Multimodal Treatment of Nonspecific Chronic Neck Pain: A Randomized Controlled Trial
Beltran-Alacreu, H., López-de-Uralde-Villanueva, I., Fernández-Carnero, J., & La Touche, R. (2015) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000000293 · Cited by 107
“The authors used an 11-item version that has shown good psychometric reliability for chronic pain.(30) Each item is scored on a four-point Likert-type scale that ranges from Bstrongly agree[ to Bstrongly disagree.”
Method
The differential role of pain, work characteristics and pain-related fear in explaining back pain and sick leave in occupational settings
Gheldof, E. L. M., Vinck, J., Vlaeyen, J. W. S., Hidding, A., & Crombez, G. (2004) · Pain · doi:10.1016/j.pain.2004.09.040 · Cited by 105
“Results of a confirmatory factor analysis (Goubert et al., 2004c; Roelofs et al., 2004) resulted in the exclusion of the four reversed key items (resulting in a 13-item TSK-AV, adapted version).”
MethodSelf-citation
Blended-learning pain neuroscience education for people with chronic spinal pain: Randomized controlled multicenter trial
Malfliet, A., Kregel, J., Meeus, M., Roussel, N., Danneels, L., Cagnie, B., Dolphens, M., & Nijs, J. (2018) · Physical Therapy · doi:10.1093/ptj/pzx092 · Cited by 100
Test—retest stability of the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia in Chronic Pain over a Longer Period of Time
Lamé, I. E., Peters, M. L., Kessels, A. G., Van Kleef, M., & Patijn, J. (2008) · Journal of Health Psychology · doi:10.1177/1359105308093866 · Cited by 115
“Previously it was found that omitting the reversed key items improved internal consistency (Goubert et al., 2004; Roelofs et al., 2004; Swinkels-Meewisse et al., 2003) and the test–retest stability (Swinkels-Meewisse et al., 2003).”
InfluentialSelf-citation
Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement
Gil‐Martínez, A., Grande‐Alonso, M., López‐de‐Uralde‐Villanueva, I., López‐López, A., Fernández‐Carnero, J., & Touche, R. L. (2016) · The Journal of Headache and Pain · doi:10.1186/s10194-016-0690-1 · Cited by 96
“The score obtained in these groups with chronic TMD is similar to that found in patients with chronic widespread pain (28 points) and lower than that of patients with low back pain (33 points) [53].”
BackgroundResult
The effect of fear of movement beliefs on pain and disability after surgery for lumbar and cervical degenerative conditions
Archer, K. R., Wegener, S. T., Seebach, C., Song, Y., Skolasky, R. L., Thornton, C., Khanna, A. J., & Riley, L. H. (2011) · Spine · doi:10.1097/brs.0b013e3181f8c6f4 · Cited by 95
Pain in people with chronic obstructive pulmonary disease (COPD)
HajGhanbari, B., Holsti, L., ROAD, J. D., & Reid, W. D. (2012) · Respiratory Medicine · doi:10.1016/j.rmed.2012.03.004 · Cited by 95
“The modified version of TSK was used (without reversed key items) as it has been found to improve the internal consistency.(23)”
Method
The role of perceived injustice in the prediction of pain and function after total knee arthroplasty
Yakobov, E., Scott, W., Stanish, W. D., Dunbar, M., Richardson, G. C., & Sullivan, M. J. L. (2014) · Pain · doi:10.1016/j.pain.2014.07.007 · Cited by 95
“High scores on TSK-13 and TSK-17 have been associated with physical disability and pain in patients with various conditions, including OA [24,25,42,46,60].”
Background
The fear‐avoidance model in whiplash injuries
Nieto, R., Miró, J., & Huguet, A. (2008) · European Journal of Pain · doi:10.1016/j.ejpain.2008.06.005 · Cited by 96
Reliability and Validity of the Persian Versions of the Fear Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in Patients With Neck Pain
Ashtiani, A. A., Ebrahimi-Takamejani, I., Torkaman, G., Amiri, M., & Mousavi, S. J. (2014) · Spine · doi:10.1097/brs.0000000000000438 · Cited by 94
Fear-Avoidance Beliefs, Catastrophizing, and Distress
Westman, A., Boersma, K., Leppert, J., & Linton, S. J. (2011) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e318219ab6c · Cited by 100
Myofascial Trigger Points, Pain, Disability, and Sleep Quality in Patients with Chronic Nonspecific Low Back Pain
Iglesias-González, J. J., Muñoz-García, M. T., Rodrigues‐de‐Souza, D. P., Alburquerque‐Sendín, F., & Fernández‐de‐las‐Peñas, C. (2013) · Pain Medicine · doi:10.1111/pme.12224 · Cited by 93
The Role of Fear of Movement and Injury in Selective Attentional Processing in Patients with Chronic Low Back Pain: A Dot-Probe Evaluation
Roelofs, J., Peters, M. L., Fassaert, T. J. L., & Vlaeyen, J. W. S. (2005) · Journal of Pain · doi:10.1016/j.jpain.2004.12.011 · Cited by 94
Self-citation
More is not always better: Cost‐effectiveness analysis of combined, single behavioral and single physical rehabilitation programs for chronic low back pain
Smeets, R., Severens, J. L., Beelen, S., Vlaeyen, J. W. S., & Knottnerus, J. A. (2008) · European Journal of Pain · doi:10.1016/j.ejpain.2008.02.008 · Cited by 94
“…previous treatment(s), level of radiating pain, traumatic onset, pain-related fear (Tampa Scale for Kinesiophobia) (Goubert et al., 2004; Goubert et al., 2000; Roelofs et al., 2004), and physical activity (Baecke Physical Activity Questionnaire) (Baecke et al., 1982; Jacob et al., 2001).”
BackgroundMethodSelf-citation
Randomized trial of two physiotherapy interventions for primary care neck and back pain patients: 'McKenzie' vs brief physiotherapy pain management
Moffett, J. K., Jackson, D. A., Gardiner, E., Torgerson, D. J., Coulton, S., Eaton, S., Mooney, M. P., Pickering, C., Green, A. J., Walker, L. G., et al. (2006) · Rheumatology · doi:10.1093/rheumatology/kel339 · Cited by 88
“From our previous research [14], we anticipated a within-group standard deviation of 5.7 on the full TSK scale.”
MethodInfluential
Group Differences Between Countries and Between Languages in Pain-Related Beliefs, Coping, and Catastrophizing in Chronic Pain: A Systematic Review
Sharma, S., Ferreira-Valente, A., Williams, A. C. D. C., Abbott, J. H., Ribeiro, J. L. P., & Jensen, M. P. (2019) · Pain Medicine · doi:10.1093/pm/pnz373 · Cited by 94
Cross-Cultural Adaptation and Validation of the Norwegian Version of the Tampa Scale for Kinesiophobia
Haugen, A. J., Grøvle, L., Keller, A., & Grotle, M. (2008) · Spine · doi:10.1097/brs.0b013e31817c6c4b · Cited by 81
“84 for both the 13-item TSK(9,12) and the 17-item TSK.(2,4,6,8,13) Studies have demonstrated Cronbach’s alphas ranging from 0.”
BackgroundMethodInfluential
Back Muscle Activation Patterns in Chronic Low Back Pain During Walking: A “Guarding” Hypothesis
van der Hulst, M., Vollenbroek-Hutten, M. M. R., Rietman, J. S., Schaake, L., Groothuis‐Oudshoorn, C. G. M., & Hermens, H. J. (2009) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e3181b40eca · Cited by 82
“Right 10 (16%) Bilateral 41 (65%) VAS (0-100) median/range* Current pain 47 (5-94) — RMDQ (0-24) mean (SD) 11 (4) — TSK activity avoidance (6-24) mean (SD) 15 (4) —”
BackgroundInfluential
Fear of Movement, Quality of Life, and Self-Reported Disability in Obese Patients with Chronic Lumbar Pain
Vincent, H. K., Omli, M. R., Day, T., Hodges, M. J., Vincent, K. R., & George, S. Z. (2010) · Pain Medicine · doi:10.1111/j.1526-4637.2010.01011.x · Cited by 80
Investigation of the relationship between kinesiophobia, physical activity level and quality of life in patients with chronic low back pain1
Altuğ, F., Ünal, A., Ören, G. K., Kavlak, E., Çıtışlı, V., & Cavlak, U. (2016) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-150653 · Cited by 80
Examination of the photograph series of daily activities (PHODA) scale in chronic low back pain patients with high and low kinesiophobia
Trost, Z., France, C. R., & Thomas, J. S. (2009) · Pain · doi:10.1016/j.pain.2008.11.016 · Cited by 76
“Additionally, given the sometimes disputed factor structure of the TSK instrument [9,11,31,32], it is worth investigating the predictive value of the Activity-Avoidance and Somatic Focus subscales on perceptions of pain and harm with respect to the PHODA and movement ratings.”
Background
Extinction of Fear Generalization: A Comparison Between Fibromyalgia Patients and Healthy Control Participants
Meulders, A., Meulders, M., Stouten, I., Bie, J. D., & Vlaeyen, J. W. S. (2016) · Journal of Pain · doi:10.1016/j.jpain.2016.10.004 · Cited by 74
Self-citation
Effects of pain neuroscience education and dry needling for the management of patients with chronic myofascial neck pain: a randomized clinical trial
Valiente-Castrillo, P., Martín‐Pintado‐Zugasti, A., Calvo‐Lobo, C., Beltrán-Alacreu, H., & Fernández‐Carnero, J. (2020) · Acupuncture in Medicine · doi:10.1177/0964528420920300 · Cited by 77
“An 11-item version is also considered to have good psychometric reliability for chronic pain.(35) Each item is scored on a 4-point Likert-type scale that ranges from “strongly agree” to “strongly disagree.”
Background
Kinesiophobia in patients with non-traumatic arm, neck and shoulder complaints: a prospective cohort study in general practice
Feleus, A., van Dalen, T., Bierma‐Zeinstra, S., Bernsen, R. M. D., Verhaar, J. A. N., Koes, B. W., & Miedema, H. S. (2007) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-8-117 · Cited by 73
Predictors of Pain Outcomes in Patients with Chronic Musculoskeletal Pain Co-morbid with Depression: Results from a Randomized Controlled Trial
Ang, D. C., Bair, M. J., Damush, T. M., Wu, J., Tu, W., & Kroenke, K. (2010) · Pain Medicine · doi:10.1111/j.1526-4637.2009.00759.x · Cited by 72
On what patients does the Tampa Scale for Kinesiophobia fit?
Lundberg, M., STYF, J. R., & Jansson, B. (2009) · Physiotherapy Theory and Practice · doi:10.1080/09593980802662160 · Cited by 73
Prognostic factors for perceived recovery or functional improvement in non-specific low back pain: secondary analyses of three randomized clinical trials
Helmhout, P. H., Staal, J. B., Heymans, M. W., Harts, C. C., Hendriks, E. J. M., & de Bie, R. A. (2010) · European Spine Journal · doi:10.1007/s00586-009-1254-8 · Cited by 71
“Baseline values of these eight variables (RMDQ, LBP duration, pain radiation, TSK, GHQ, JCQ subscales, physical activity) were included in the analyses as potential prognostic factors.”
MethodInfluential
Evaluation of Kinesiophobia and Its Correlations with Pain and Fatigue in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type
Celletti, C., Castori, M., La Torre, G., & Camerota, F. (2013) · BioMed Research International · doi:10.1155/2013/580460 · Cited by 81
Activity-related pain in patients with chronic musculoskeletal disorders
Damsgård, E., Thrane, G., Anke, A., Fors, T., & Røe, C. (2010) · Disability and Rehabilitation · doi:10.3109/09638280903567877 · Cited by 76
Reduction of Pain-Related Fear and Disability in Post-Traumatic Neck Pain: A Replicated Single-Case Experimental Study of Exposure In Vivo
de Jong, J. R., Vangronsveld, K. L. H., Peters, M. L., Goossens, M. E. J. B., Onghena, P., Bulté, I., & Vlaeyen, J. W. S. (2008) · Journal of Pain · doi:10.1016/j.jpain.2008.06.015 · Cited by 69
Self-citation
Cognitive-behavioral-based physical therapy to enhance return to sport after anterior cruciate ligament reconstruction: An open pilot study
Coronado, R. A., Sterling, E. K., Fenster, D. E., Bird, M. L., Heritage, A. J., Woosley, V. L., Burston, A., Henry, A. L., Huston, L. J., Vanston, S. W., et al. (2020) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2020.01.004 · Cited by 77
Morbid Obesity Is Associated With Fear of Movement and Lower Quality of Life in Patients With Knee Pain‐Related Diagnoses
Vincent, H., Lamb, K. M., Day, T. I., Tillman, S. M., Vincent, K., & George, S. (2010) · PM & R : the journal of injury, function, and rehabilitation · doi:10.1016/j.pmrj.2010.04.027 · Cited by 73
Effect of Transcutaneous Electrical Nerve Stimulation on Pain, Function, and Quality of Life in Fibromyalgia: A Double-Blind Randomized Clinical Trial
Noehren, B. W., Dailey, D. L., Rakel, B. A., Vance, C. G. T., Zimmerman, M. B., Crofford, L. J., & Sluka, K. A. (2014) · Physical Therapy · doi:10.2522/ptj.20140218 · Cited by 72
Fear of Movement/(Re)Injury: An Update to Descriptive Review of the Related Measures
Liu, H., Huang, L. C., Yang, Z., Li, H., Wang, Z., & Peng, L. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.696762 · Cited by 67
“, 2006), fibromyalgia (Roelofs et al., 2004), neck pain (Lee et al.”
BackgroundMethod
Relationship between different measures of pain-related fear and physical capacity of the spine in patients with chronic low back pain
Demoulin, C., Huijnen, I. P. J., Somville, P.-R., Grosdent, S., Salamun, I., Crielaard, J.-M., Vanderthommen, M., & Volders, S. (2013) · The Spine Journal · doi:10.1016/j.spinee.2013.02.037 · Cited by 64
Kinesiophobia in Migraine
Martins, I. P., Gil‐Gouveia, R., & Parreira, E. (2006) · Journal of Pain · doi:10.1016/j.jpain.2006.01.449 · Cited by 67
Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation
Leaviss, J., Davis, S., Ren, S., Hamilton, J., Scope, A., Booth, A., Sutton, A., Parry, G. D., Buszewicz, M., Moss-Morris, R. E., et al. (2020) · Health Technology Assessment · doi:10.3310/hta24460 · Cited by 71
Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial
Wood, L., Bejarano, G., Csiernik, B., Miyamoto, G. C., Mansell, G., Hayden, J. A., Lewis, M., & Cashin, A. G. (2023) · Journal of physiotherapy · doi:10.1016/j.jphys.2023.05.008 · Cited by 69
Return to Work in a Cohort of Low Back Pain Patients: Development and Validation of a Clinical Prediction Rule
Heymans, M. W., Anema, J. R., van Buuren, S., Knol, D. L., van Mechelen, W., & de Vet, H. C. W. (2009) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-009-9166-3 · Cited by 62
“The Dutch version of the tampa scale for kinesiophobia (TSK, range 17–68) was used to measure the extent to which people feared that exercise can lead to reinjury [20].”
Method
Fear of Movement Is Not Associated With Objective and Subjective Physical Activity Levels in Chronic Nonspecific Low Back Pain
de Carvalho, F. A., Maher, C. G., Franco, M. R., Morelhao, P. K., Oliveira, C. B., Silva, F. G., & Pinto, R. Z. (2016) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2016.09.115 · Cited by 67
Kinesiophobia and Fear-Avoidance Beliefs in Overweight Older Adults with Chronic Low-Back Pain
Vincent, H. K., Seay, A. N., Montero, C., Conrad, B. P., Hurley, R. W., & Vincent, K. R. (2013) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e318287633c · Cited by 60
“Somatic focus represents the belief of underlying and serious medical problems, and activity avoidance focus represents the belief that activity may result in (re)injury or increased pain.(12) Thus, the overall TSK score and the two subscores of somatic focus and activity avoidance focus are presented.”
Background
Physical capacity tasks in chronic low back pain: What is the contributing role of cardiovascular capacity, pain and psychological factors?
Smeets, R., van Geel, A. C., Kester, A. D. M., & Knottnerus, J. A. (2006) · Disability and Rehabilitation · doi:10.1080/09638280600925829 · Cited by 61
“The questionnaire is considered reliable and valid in CLBP [29,42].”
Background
Effect of fully immersive virtual reality treatment combined with exercise in fibromyalgia patients: a randomized controlled trial
Gülşen, Ç., Söke, F., Eldemir, K., Apaydın, Y., Özkul, Ç., Guclu‐Gunduz, A., & Akçalı, D. T. (2020) · Assistive Technology · doi:10.1080/10400435.2020.1772900 · Cited by 59
“Four items (i.e., items 4, 8, 12 and 16) are inversely phrased and the range of scores are from 17 to 68 where the higher scores indicate an increase in the kinesiophobia degree (Roelofs et al., 2004).”
Background
Is the Fear Avoidance Model Associated With the Reduced Level of Aerobic Fitness in Patients With Chronic Low Back Pain?
Smeets, R., van Geel, K. D., & Verbunt, J. (2009) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2008.07.009 · Cited by 62
Relationship between kinesiophobia and pain, quality of life, functional status, disease activity, mobility, and depression in patients with ankylosing spondylitis
Oskay, D., Tunà, Z., Düzgün, İ., Elbasan, B., Yakut, Y., & Tufan, A. (2017) · TURKISH JOURNAL OF MEDICAL SCIENCES · doi:10.3906/sag-1702-93 · Cited by 58
“Kinesiophobia is defined as an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or reinjury (5).”
Background
Young individuals with a more ankle-steered proprioceptive control strategy may develop mild non-specific low back pain
Claeys, K., Dankaerts, W., Janssens, L., Pijnenburg, M., Goossens, N., & Brumagne, S. (2014) · Journal of Electromyography and Kinesiology · doi:10.1016/j.jelekin.2014.10.013 · Cited by 58
“…every three months: a Physical Activity Index (PAI) questionnaire (Baecke et al., 1982), the Fear-Avoidance Beliefs Questionnaire (FABQ) (Waddell et al., 1993), the Four-Dimensional Symptom Questionnaire (4DSQ) (Terluin, 1998) and the Tampa Scale for Kinesiophobia (TSK) (Roelofs et al., 2004).”
Method

Authors: Roelofs, J., Goubert, L., Peters, M. L., Vlaeyen, J. W. S., & Crombez, G.
Affiliations: Maastricht University (NL)
Ghent University (BE)
Corresponding author: Roelofs, Jeffrey
ORCID: Roelofs, Jeffrey
Goubert, Liesbet
Peters, Madelon L.
Vlaeyen, Johan W.S.
Crombez, Geert
Venue: European Journal of Pain
Publisher: Wiley
Published: 2004-10
Volume: 8
Issue: 5
Pages: 495-502
ISSN: 1090-3801 (ISSN-L)
1532-2149
DOI: 10.1016/j.ejpain.2003.11.016
OpenAlex: W2102230060
Cited by: 472
References: 27
Citations by year: 2026: 22 · 2025: 16 · 2024: 20 · 2023: 20 · 2022: 26 · 2021: 28 · 2020: 35 · 2019: 35 · 2018: 24 · 2017: 17 · 2016: 22 · 2015: 15 · 2014: 21 · 2013: 15 · 2012: 21
FWCI: 5.95
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 2658 d)
Locations: European Journal of Pain (publishedVersion)
PubMed (publishedVersion)
Ghent University Academic Bibliography (Ghent University) (submittedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: Tampa Scale for Kinesiophobia, kinesiophobia, chronic low back pain, fibromyalgia, psychometric properties, two-factor model, somatic focus, activity avoidance, pain catastrophizing, disability, physical performance, fear-avoidance beliefs
MeSH terms: Activities of Daily Living, Adult, Chronic Disease, Disability Evaluation, Fear, Female, Fibromyalgia, Humans, Kinesthesis, Male, Middle Aged, Movement, Neuropsychological Tests, Pain Measurement, Phobic Disorders, Physical Fitness, Predictive Value of Tests, Surveys and Questionnaires, Reproducibility of Results, Low Back Pain

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The Tampa Scale for Kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia

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