Introduction

The definition of kinesiophobia was first introduced by Kori, Miller, and Todd in 1990 and was described as an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or reinjury (Kori et al. 1990). However, this issue is more complex than it might initially appear, and its etiology has been a subject of speculation for many years within the context of the fear-avoidance model and personality trait theories. Both theories contribute to a comprehensive understanding of the behavioral and psychological origins of the fear of movement, with one common goal: protecting the body from injury. Patients may associate movement with pain, fall-related injury, or a combination of both, leading to a perceived limitation in functionality (Knapik et al. 2011; Kori et al. 1990; Roelofs et al. 2007).

Although every neurological patient struggles with varying degrees of physical limitations that affect their daily functioning, the common goal for these individuals is to strive to regain independence and actively participate in private and social life (de Vries et al. 2025; Khan and Amatya 2017). The complexity of neurological conditions highlights the importance of a biopsychosocial approach as a fundamental component of effective care (de Vries et al. 2025). Therefore, every clinician should bear in mind that the process of optimal neurorehabilitation cannot be limited solely to the restoration of physical capacity, but must simultaneously address the patient’s psychological condition. Only such an integrated, holistic approach offers the chance to effectively overcome the fear of movement and enable the patient to achieve the maximum possible functional independence (de Vries et al. 2025; Krucoff et al. 2016; Li et al. 2023).

According to current literature, fear of movement significantly hinders kinesiotherapy, which is a key form of therapy for neurological patients (Li et al. 2023; Wasiuk-Zowada et al. 2021). Kinesiophobia negatively affects rehabilitation outcomes by weakening patient motivation and, consequently, lowering their compliance with exercise recommendations. It also represents a significant barrier to achieving an adequate level of physical activity in post-stroke individuals or those with other neurological conditions (Bąk et al. 2022; Li et al. 2023; Wasiuk-Zowada et al. 2022).

Although the negative impact of kinesiophobia on physical activity levels and quality of life has been widely documented in patients with chronic musculoskeletal pain (Bąk et al. 2022; Li et al. 2023; Roelofs et al. 2007; Vlaeyen et al. 1995), this problem remains relatively under-investigated in the context of neurological disorders. The few studies conducted to date indicate a high prevalence of this phenomenon. Wasiuk-Zowada et al. recorded a high level of kinesiophobia in nearly 67% of surveyed post-stroke patients, as well as patients with multiple sclerosis (MS) and Parkinson’s disease, demonstrating its negative relationship with physical activity levels and self-assessed fitness (Wasiuk-Zowada et al. 2021). In turn, Bąk et al. (2022) observed kinesiophobia in 78% of elderly patients following ischemic stroke, associating it with frailty syndrome, higher anxiety levels, and low disease acceptance. Furthermore, reports from patients with Parkinson’s disease confirm that kinesiophobia directly translates into impaired balance and an intensified fear of falling (Oğuz et al. 2023). However, there is still a lack of comprehensive studies comparing these phenomena and analyzing specific predictors determining the fear of movement across various neurological conditions (Bąk et al. 2022; Wasiuk-Zowada et al. 2022).

The present study aims to address this gap by evaluating the correlation between kinesiophobia and physical activity levels in neurological patients and identifying the groups most susceptible to this phenomenon. It is anticipated that the obtained results will enrich current knowledge by identifying key psychophysical barriers within this population, which will ultimately enable clinicians to recognize kinesiophobia early and optimize individualized neurorehabilitation programs in the future.

Material and methods

All study participants provided their voluntary consent to participate, with the option to withdraw at any time. The individuals participating in the study were informed about the objectives, procedures, and the intended use of the information collected by the researcher.

Study participants were recruited using convenience sampling. The study group (n = 40, with 10 individuals per diagnosis) consisted of patients from the Neurology and Epilepsy Treatment Clinic and the Cerebrovascular Diseases Clinic of Jan Biziel University Hospital No. 2 in Bydgoszcz. The control group was recruited from healthy residents of the Kuyavian-Pomeranian Voivodeship with no prior neurological history.

A non-anonymous survey was conducted with the explicit written consent of each participant. The non-anonymous nature of the study was essential to confirm the diagnosis. The research group comprised 40 individuals with neurological disorders, including 10 patients who had suffered a stroke within the past 5 years, 10 individuals with discopathic incidents within the past 5 years diagnosed with lumbosacral spondylosis, another 10 with Parkinson’s disease diagnosed within the past 5 years, and a group of 10 individuals with relapsing-remitting multiple sclerosis in remission, diagnosed within the past 5 years.

The control group included healthy individuals over 18 years of age, residing in the Kuyavian-Pomeranian Voivodeship, without any neurological disorders. This group of 47 individuals was surveyed anonymously using an online questionnaire on the Forms platform.

To ensure confidentiality and maximize recruitment, the control group (47 individuals) completed the survey anonymously via an online platform. This difference in methodology (online vs. face-to-face) and anonymity (anonymous vs. non-anonymous) constitutes a limitation of the study.

Inclusion criteria included: age over 18 years, provision of informed written consent, functional independence level above 80 points on the Activities of Daily Living (ADL) scale, and a disease duration of no more than 5 years since diagnosis (for MS and Parkinson’s disease) or no more than 5 years since the occurrence of an acute incident (for stroke and an acute discopathic episode in the course of spondylosis). Exclusion criteria included: pregnancy, active malignancy, cardiorespiratory failure, severe renal or hepatic failure, an ADL score < 80, psychiatric disorders, dementia symptoms, aphasia, anxiety-depressive syndrome, exacerbation phase of the disease (MS relapse or acute sciatica), and a history of other chronic musculoskeletal diseases. It should be explicitly emphasized that the presence of kinesiophobia was not an inclusion criterion for the patients; rather, it constituted the evaluated dependent variable.

The study used a questionnaire consisting of three main sections. The first section contains sociodemographic questions related to the disease diagnosis, age, sex, marital status, size of the place of residence, educational level, occupational activity, interests, and an assessment of chronic pain intensity using the Visual Analogue Scale (VAS). The second tool is the Tampa Scale of Kinesiophobia (TSK), and the third section measures the respondent’s average physical activity level over the past 12 months using the Modified Baecke Physical Activity Questionnaire.

To measure the level of kinesiophobia, the TSK was used, originally developed by Kori et al. (1990) and later validated by Roelofs et al. (2004). This tool consists of 17 items rated on a 4-point Likert scale (ranging from 17 to 68 points). A score above 37 points indicates a high level of fear of movement. The present study used the Polish version of the TSK (TSK-PL), which had been previously translated and subjected to cultural and linguistic adaptation in accordance with international guidelines. The Polish adaptation of the questionnaire has been repeatedly tested for its psychometric properties and successfully used by other researchers in the Polish patient population (Bąk et al. 2025; Misterska et al. 2015). This tool is characterized by very good psychometric parameters; its excellent reliability and high internal consistency have been proven, with a Cronbach’s α coefficient of 0.80 (Bąk et al. 2022).

To assess physical activity over the past 12 months, the Modified Baecke Physical Activity Questionnaire was applied. This tool was specifically adapted to the realities of older adults and patients with mobility limitations, for whom the assessment of classical occupational activity is often inadequate or impossible to examine. For this reason, in the modified version, the domain concerning occupational work was replaced with an assessment of activities related to daily household chores and locomotion (Hertogh et al. 2008). Both the original and modified versions of the questionnaire are characterized by proven validity and reliability, and have been successfully validated not only in healthy populations but also in clinical samples, including patients with musculoskeletal dysfunctions and pain (e.g., hip joint disorders) (Hertogh et al. 2008; Ono et al. 2007). The final total score of the questionnaire can range from 3 to 15 points, with a higher score indicating a higher level of habitual physical activity for the patient.

The Visual Analogue Scale was used to assess the intensity of chronic pain, as it is widely applied due to its high sensitivity and reliability in evaluating pain intensity.

The data were analyzed statistically using STATISTICA 13 software (StatSoft). The study was exploratory (pilot) in nature, and participants were recruited using convenience sampling based on the availability of patients meeting the inclusion criteria. Consequently, an a priori statistical power analysis to determine the sample size was not performed, which constitutes a limitation of the study. Descriptive statistics (mean, median, standard deviation) were applied. The normality of the data distribution was verified using the Shapiro-Wilk W test. Pearson’s r correlation coefficient was used to analyze the strength and direction of the relationships between the kinesiophobia scores (TSK) and physical activity (Modified Baecke Physical Activity Questionnaire). The level of statistical significance was set at p < 0.05.

Results

The sociodemographic and clinical characteristics of the individual patient groups and the total study sample are presented in Table 1. An equal sex distribution (50% women, 50% men) was maintained in the study group (n = 40). The majority of patients (73%) were occupationally inactive, and their employment history was dominated by manual labor (65%). The presence of chronic pain lasting more than 3 months was reported by 82.5% of all neurological patients, including 100% of the patients with lumbosacral spondylosis.

An important feature of the study sample was the attempt to minimize the influence of confounding variables and comorbidities through rigorous patient selection criteria. All participants eligible for inclusion in the study were independent and communicative, which was confirmed by a score of over 80 points on the ADL scale. Individuals diagnosed with other chronic musculoskeletal diseases, active malignancy, cardiorespiratory failure, and severe renal or hepatic failure were excluded from the analysis. Additionally, to avoid the influence of psychological and cognitive factors on the reliability of the questionnaire measurements, patients exhibiting psychiatric disorders, dementia symptoms, aphasia, and those suffering from anxiety-depressive syndrome were eliminated from participation. The phase of the patients’ underlying disease was also a crucial variable; individuals in the acute phase of the condition were excluded, including patients experiencing a multiple sclerosis relapse and those with acute sciatica. Furthermore, an additional inclusion criterion was a diagnosis of the underlying neurological disorder within the preceding 60 months.

In comparing the Tampa scale scores between the study and control groups, healthy individuals exhibited a lower mean level of kinesiophobia than their neurological counterparts. The control group demonstrated lower values for both minimum and maximum scores, each being 7 units lower. In the study group, a mean kinesiophobia score exceeding 37 points was recorded, indicating a high level of kinesiophobia among the participants, in accordance with the literature definition. Neurological patients showed significantly elevated levels of kinesiophobia (M = 45.5, SD = 6.44), with the highest mean observed in patients with MS (M = 47.8, SD = 4.54). The Pearson correlation coefficient (r) for the relationship between the TSK scores and the Baecke questionnaire scores was statistically significant (p < 0.05) for the group of patients with lumbosacral spondylosis, with a value of r = –0.6951. Patients with multiple sclerosis exhibited the highest mean level of kinesiophobia, while post-stroke patients showed the lowest. Across the entire study group, values exceeding 37 points on the Tampa scale were observed, indicating a high kinesiophobia score for every patient profile (Table 2).

In the linear dependence test conducted on the study group divided by diagnosis and the control group, analyzing the correlation between the Tampa scale and the total score of the Baecke Questionnaire, 5 out of 6 records showed a negative correlation, indicating an inversely proportional relationship between these two variables. Only one correlation value proved to be statistically significant (p < 0.05), which was observed in the group of patients with lumbosacral spondylosis. The remaining correlations demonstrated a weak or moderate degree of interdependence.

The calculated Pearson correlation coefficient (r = –0.6951) reveals a strong negative and statistically significant association between kinesiophobia and physical activity levels in patients with lumbosacral spondylosis. This correlation was the strongest observed among all analyzed relationships in both the study and control groups. The findings suggest that higher levels of kinesiophobia are associated with lower levels of physical activity in this patient subgroup (Fig. 1).

Discussion

The study conducted on a cohort of 40 patients at the Specialist Clinic of the University Hospital No. 2 in Bydgoszcz confirms previous research hypotheses. In line with the initial assumptions, it suggests a correlation between the level of kinesiophobia and the degree of physical activity in neurological patients. However, a statistically significant (p < 0.05), strong negative correlation (r = –0.6951) between kinesiophobia (TSK) and physical activity (Baecke) was evident exclusively in the subgroup of patients diagnosed with lumbosacral spondylosis. This specificity can be explained by the fact that the TSK was originally developed for a group of respondents experiencing chronic lower back pain and musculoskeletal disorders (Li et al. 2023; Misterska et al. 2015). This suggests increased reliability in this specific population, despite the validation of the scale for other conditions, including neurological ones (Monticone et al. 2015). Furthermore, this specific group is noteworthy because all participants confirmed the presence of chronic pain lasting longer than 3 months, which is the main driving factor in the classic fear-avoidance model (Leeuw et al. 2007; Roelofs et al. 2007).

Despite the aforementioned significance of the correlation in the group of patients with lumbosacral spondylosis, the highest kinesiophobia score was demonstrated in the group of patients with MS (M = 47.8, SD = 4.54). This result is consistent with literature reports confirming a high prevalence of fear of movement in this population compared to healthy individuals (Ruiz-Sánchez et al. 2022; Wasiuk-Zowada et al. 2021). This phenomenon suggests that the continuous variability of the patient’s functional status can significantly affect the fear of physical activity (Wasiuk-Zowada et al. 2022). As is widely known, the relapsing-remitting form of MS is characterized by periods of disease exacerbation and remission. Exacerbating symptoms – including the severe chronic fatigue specific to this disease – can disrupt the patient’s existing capabilities and compel adaptation to new, sometimes significantly limited, motor functions (Kese et al. 2023). The present study corroborates previous assertions that in this disease, physical activity is a priority aspect for maintaining fitness and, consequently, patient independence. Therefore, enforcing and implementing physical activity, despite the presence of kinesiophobia, is absolutely crucial for mitigating the negative effects of akinesia and enhancing the functional capabilities of all body systems (Kubsik-Gidlewska et al. 2017).

Despite yielding interesting results, the study has significant methodological limitations that affect their interpretation. The primary weakness is the small sample size in the individual disease subgroups (n = 10 for each subgroup). The project was pilot in nature; therefore, convenience sampling was used based on the availability of patients in the clinics, rather than random sampling. Consequently, an a priori statistical power analysis to determine the minimum sample size was not performed. The small size of the subgroups results in low statistical power for the correlation analyses, which increases the risk of a Type II error (failure to detect an existing relationship) within the patient groups. For the same reason, the strong correlation detected in the patients with spondylosis, although significant, must be interpreted with great caution. Another limitation is the cross-sectional design of the study, which only allows for the identification of associations and precludes drawing definitive conclusions about cause-and-effect relationships. Furthermore, the surveys in the study group were administered face-to-face, whereas the control group answered the questions via an anonymous online form, which may have introduced a certain methodological bias related to the specific nature of data collection. Despite the aforementioned limitations, the study also possesses strengths that contribute to its reliability. The most important of these is the highly rigorous control of confounding variables. The study included exclusively patients capable of logical communication and who were functionally independent (ADL score > 80), which allowed for the elimination of the influence of severe motor disability and cognitive or dementia disorders on the potential bias of the questionnaire results. Furthermore, standardized research instruments validated for the Polish population were used (the TSK-PL and the Modified Baecke Physical Activity Questionnaire), which were adapted to the realities of individuals with motor deficits. It is also worth emphasizing that even pilot studies of this type, based on small cohorts, have a significant impact on the development of science and the expansion of knowledge in relatively under-explored areas. They provide primary clinical data and preliminary suggestions, enabling the identification of new trends, which constitutes an innovative contribution to the current state of knowledge. These observations serve as an essential foundation and a starting point upon which the design of large-scale, multicenter studies can be based in the future, allowing for the definitive verification of these relationships, which are still lacking in the field of kinesiophobia.

As previous studies indicate, kinesiophobia is a significant problem among neurological patients and manifests independently of the primary etiology of the disease. Researchers are investigating the origins of this phenomenon by analyzing factors such as the fear of experiencing pain, misconceptions about the harmfulness of movement, and various patient personality traits (Li et al. 2023). Research on kinesiophobia in post-stroke patients, individuals with Parkinson’s disease, and those with MS is still in the early stages of exploration (Bąk et al. 2022; Knapik et al. 2011; Vlaeyen et al. 1995; Wasiuk-Zowada et al. 2021, 2022). Recent studies suggest that kinesiophobia may be associated with balance disorders, fear of falling, and a greater degree of disease severity, as assessed using scales such as the Unified Parkinson’s Disease Rating Scale (UPDRS; for Parkinson’s disease) or Expanded Disability Status Scale (EDSS; for multiple sclerosis) (Li et al. 2023; Wasiuk-Zowada et al. 2022). Furthermore, numerous studies confirm a negative correlation between the degree of kinesiophobia and reduced levels of physical activity in neurological patients (Li et al. 2023). However, the strength of these correlations reported in the literature varies significantly. These differences may stem from the fact that the scientific community still lacks a consensus on the gold standard for measuring physical activity levels in individuals with neurological dysfunctions. Most researchers rely on diverse subjective tools (e.g., the IPAQ or Baecke questionnaires), which carry the risk of self-reporting bias and social desirability bias. In contrast, highly reliable, objective measurement methods (such as multi-day accelerometry) are still less frequently utilized in this field (Bąk et al. 2022; Ferrari et al. 2019; John et al. 2023; Ruiz-Sánchez et al. 2022; Uluğ et al. 2016; Wasiuk-Zowada et al. 2022).

The documented high prevalence of kinesiophobia in various neurological disorders requires an interdisciplinary therapeutic approach. The most effective forms of therapy for neurological patients with a high level of fear of movement are still being sought; however, according to existing literature, they are primarily based on studies of patients with non-specific low back pain (NSLBP) (Li et al. 2023). To date, promising effects have been documented for combining psychological therapy, particularly cognitive-behavioral therapy (CBT), with kinesiotherapy (aerobic exercises, specialized neurological techniques, or standard general rehabilitation procedures). Such an integrated approach reduces psychophysical disability and kinesiophobia in neurological patients more effectively than isolated exercise programs (Sethy and Sahoo 2018). Over the years, there have been increasing reports regarding the effectiveness of virtual reality therapy (Wang et al. 2023). Recent studies demonstrate that training in a virtual environment, especially when integrated with kinesiotherapy, brings significantly greater benefits to patients in reducing kinesiophobia and improving function compared to classical forms of therapy (including isokinetic exercises or standard rehabilitation procedures) (Nambi et al. 2021; Wang et al. 2023; Yilmaz Yelvar et al. 2017). Furthermore, the effectiveness of incorporating relaxation methods has been confirmed among the studied patients with MS. It has been shown that relaxation techniques (including progressive muscle relaxation and the Benson technique), applied alongside kinesiotherapy, effectively reduce secondary fear of movement, pain complaints, and the feeling of fatigue (Kesik 2022; Wasiuk-Zowada et al. 2022). However, it should be noted that these most effective therapeutic methods (CBT, immersive VR environments) often fall outside the scope of conventional treatment procedures and still remain non-standard rehabilitation pathways. Thanks to scientific advancements, patients with chronic neurological disorders have the opportunity to receive the most effective assistance; however, advanced therapy is still not universally available to all those in need (Wang et al. 2023).

Conclusions

In the analyzed pilot cohort, the highest mean level of kinesiophobia was observed in patients with MS, whereas post-stroke patients exhibited the lowest mean level.

Preliminary results suggest that the level of kinesiophobia is significantly and negatively correlated with the physical activity level in the examined patients with lumbosacral spondylosis (r = –0.6951, p < 0.05).

Across the entire cohort of neurological patients, no statistically significant correlation was found between kinesiophobia and physical activity, with the exception of the subgroup of patients with lumbosacral spondylosis.

Disclosures

This research received no external funding.

The study was approved by the Bioethics Committee of the Nicolaus Copernicus University in Toruń functioning at Collegium Medicum in Bydgoszcz (Approval No. KB 547/2021).

The authors declare no conflict of interest.

References