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.