There is a questionnaire used to supposedly identify ‘fear of movement’ called the Tampa Scale. While I would certainly agree that it is worth identifying which patients have wrong beliefs about their condition and the effects of exercise, I also have serious concerns over some of the elements of this questionnaire. It just doesn’t seem like a rational questionnaire, and yet is very widely used and, it seems, rarely questioned.
I’m going to start with my suggested alternative, then go over the items on the original Tampa scale that I think are not going to help identify mistaken beliefs that could be causing a patient to avoid exercise and activity.
Suggested alternative to the Tampa Scale (for identifying mistaken beliefs − obviously some are true and some untrue as in the original):
|1. I need to move as little as possible to avoid injury||1||2||3||4|
|2. Just because something aggravates my pain that usually does not mean it is dangerous||1||2||3||4|
|3. Sometimes it is a good idea to exercise even though it’s painful||1||2||3||4|
|4. When people with pain gradually increase their level of activity, they often don’t experience increased pain||1||2||3||4|
|5. Although my condition is painful, I would probably be healthier if I were more physically active||1||2||3||4|
|6. Even though something is causing me a bit of pain, I don’t think it’s actually dangerous||1||2||3||4|
|7. Some people with chronic pain find that exercise reduces their pain levels||1||2||3||4|
|8. If I exercise less, I’ll get weaker and am then likely to experience more pain||1||2||3||4|
|9. Worries about injury put me off exercising||1||2||3||4|
|10. Pain always means I have injured my body||1||2||3||4|
|11. Pain always means I have injured my body||1||2||3||4|
|12. Simply being careful that I do not make any unnecessary movements is the safest thing I can do to prevent my pain from worsening||1||2||3||4|
Now for my analysis of the original
The ones that make sense (ish):
|3. My body is telling me I have something dangerously wrong. (I suppose ‘dangerously’ suggests an element of dramatization if the problem is not life-threatening etc… though surely more a sign of ‘catastrophising’ than movement avoidance?)
Similar to: 11. I wouldn’t have this much pain if there weren’t something potentially dangerous going on in my body.
|7. Pain always means I have injured my body.
(Probably the most useful one in my view, as this is definitely false and a harmful view.)
|8. Just because something aggravates my pain does not mean it is dangerous. (Very similar to number 7. Patients need to be informed this is true, if they are not aware it is. Though I would suggest amending it to ‘Just because something aggravates my pain usually does not mean it is dangerous’ because sometimes pain is a sign of danger, obviously! Pain can warn us we are about to tear or break something.)|
|10. Simply being careful that I do not make any unnecessary movements is the safest thing I can do to prevent my pain from worsening. (Does sound a bit extreme, and shows lack of awareness that inactivity may increase pain long-term.)
Related to: 17. No one should have to exercise when he/she is in pain. (Quite moralistic but I suppose passible. ‘Sometimes it is a good idea to exercise even though it’s painful’ would be better.)
|14. It’s really not safe for a person with a condition like mine to be physically active. (Probably a wrong belief in most cases where the questionnaire would be used, so fair enough.)|
The ones that are problematic either in general or for some conditions (such as Ehlers Danlos):
|2. If I were to try to overcome it, my pain would increase. (Sounds like an unhealthy battle that might well happen that way! Pacing and acceptance of pain are surely more accepted approaches? How about ‘Gradually increasing my level of activity often doesn’t lead to increased pain’?)|
|5. People aren’t taking my medical condition seriously enough. (No comment needed surely?! Whoever thought that was a sensible one?)|
|4. My pain would probably be relieved if I were to exercise. (For many people this won’t be true, so strongly disagreeing is the rational option.)
The same goes for: 12. Although my condition is painful, I would be better off if I were physically active. (What does ‘better off’ mean? Why not say ‘healthier’? That would be true in more cases. Being physically active – another subjective term – might make some people less happy due to the increased pain and fatigue and so ‘better off’ might not feel appropriate to them.)
|6. My accident has put my body at risk for the rest of my life. (Ambiguous. Surely accidents do create a greater risk of re-injury in many cases? Or does it mean at risk of death, which probably would be a wrong belief?)
See also: 1. I’m afraid that I might injure myself if I exercise. (In some cases this might be highly unlikely, in other cases quite likely e.g. if you have EDS and are prone to dislocations and sprains, even during very mild exercise).
The same applies to: 9. I am afraid that I might injure myself accidentally.
A related one is: 13. Pain lets me know when to stop exercising so that I don’t injure myself. (Again, is this really unreasonable in all cases? Since when was completely ignoring pain a good idea?)
And: 15. I can’t do all the things normal people do because it’s too easy for me to get injured. (People with EDS are generally advised to avoid contact sports, for example, so again this is not going to be unreasonable in all cases.)
Also: 16. Even though something is causing me a lot of pain, I don’t think it’s actually dangerous. (Are we really advocating that people do things that cause a lot of pain? I’ve generally not been advised to do that, and indeed if something does cause a lot of pain that could be a sign you are about to or have injured yourself.)
Are you a medical practitioner or patient? I’d love to hear your views!
Do also check out my post on re-examining the concept of kinesiophobia in chronic pain patients.