Abstract text (incl. figure legends and references)

Objective: Identify the optimal cut-off value for kinesiophobia in migraine patients using the Tampa Scale for Kinesiophobia (TSK).

Methods: Fifty women aged between 18 and 55 years (mean 33.9; SD 9.69) with migraine were evaluated. Migraine diagnosis followed the third edition of the International Headache Society criteria. All participants completed the questionnaires TSK and Migraine Disability Scale (MIDAS). The disability is a variable associated with kinesiophobia. The MIDAS was used as a binary variable and the TSK as a continuous variable. Thus, receiver operating characteristic analyses were conducted to identify a clinically relevant cut-off score capable of distinguishing kinesiophobia in migraine patients.The diagnostic accuracy was interpreted as follows: 0.9- 1, excellent; 0.8- 0.9, very good; 0.7- 0.8, good; 0.6- 0.7, sufficient; and 0.5- 0.6, bad, and <0.5 not useful. The local ethics committee approved the study (6862/2016).

Results: The cut-off value for kinesiophobia in migraine individuals is > 34 points. This tool presented sensibility of 74.3% (95% CI 57.87% to 86.96%) and specificity of 63,6% (95% CI 30.79% to 89.07%), with good accuracy of 72% (95% CI 57.51% to 83.77%) to differentiate kinesiophobia in individuals with migraine. Furthermore, there was a low diagnostic value positive likelihood ratio of 2.04 (95% CI 0.92 to 4.57) and a negative likelihood ratio of 0.40 (95% CI 0.20 to 0.81), positive predictive values ranged from 76.46% to 94.18% and negative predictive values from 25.86% to 58.42%.

Conclusion: The optimal TSK cut-off of 34 points in migraine patients has been established with good accuracy. This cut-off is beneficial for clinicians to assess the presence of kinesiophobia in patients with migraine. The cut-off score can help identify patients who need additional attention and treatment, such as pain neuroscience education and cognitive-behavioral therapy.