Assessment of Kinesiophobia in Postoperative Cardiac Patients: A Cross-Sectional Study
Abstract
Background: Cardiac surgeries are commonly and successfully performed to treat various cardiovascular disorders. Postoperative cardiac rehabilitation is essential to minimize the negative effects of surgery. Despite this, cardiac rehabilitation is not routinely practiced in many developing countries. Subsequently, patients often avoid physical activity and exercise due to fear or lack of guidance.
Objective: To evaluate the level of fear of movement and exercise in patients attending cardiac rehabilitation.
Methodology: This was a cross-sectional study conducted on post-operative cardiac patients visiting cardiac rehabilitation department at Peshawar Institute of Cardiology. A total of 277 patients (mean age 50.9±15 years) were recruited in the study through convenience sampling technique. Both male (n= 126) and female (n=91) were included in the study. All the patients were assessed for fear of movement by using Tampa scale for kinesiophobia. Data was analyzed through Statistical Package for the Social Sciences (SPSS).
Results: The results of this study reported that fear of movement was significantly higher in male; majority reporting severe to debilitating kinesiophobia (49.44%). Overall (62.6%) patients reported severe form of fear to movement, (16.4%) reported debilitating kinesiophobia while 38% reported mild fear post-operatively in all phases of outpatient cardiac rehabilitation.
Conclusion: It was established that severe debilitating fear of movement is prevalent across all age groups and phases of cardiac rehabilitation, though these factors did not show a statistically significant association with fear levels. The only statistically significant association observed was between gender and fear; males reporting higher levels of kinesiophobia compared to females.
Keywords: Cardiac rehabilitation, Fear of movement, Kinesiophobia
References
Vervoort D, Meuris B, Meyns B, Verbrugghe P. Global cardiac surgery: access to cardiac surgical care around the world. J Thorac Cardiovasc Surg. 2020;159(3):987-96. e6
Zubair F, Nawaz SK, Nawaz A, Nangyal H, Amjad N, Khan MS. Prevalence of cardiovascular diseases in Punjab, Pakistan: a cross-sectional study. Journal of Public Health. 2018;26(5):523-9.
Goldsborough E, Osuji N, Blaha MJ. Assessment of cardiovascular disease risk: a 2022 update. Endocrinol Metab Clin North Am. 2022;51(3):483-509.
Doenst T, Caldonazo T, Schneider U, Moschovas A, Tkebuchava S, Safarov R, Diab M, Färber G, Kirov H. Cardiac surgery 2020 reviewed. Thorac Cardiovasc Surg. 2021.
Kourek C, Dimopoulos S. Cardiac rehabilitation after cardiac surgery: An important underutilized treatment strategy. World J Cardiol. 2024;16(2):67.
Zaree A, Dev S, Khan IY, Arain M, Rasool S, Rana MAK, Kanwal K, Bhagat R, Prachi F, Puri P. Cardiac rehabilitation in the modern era: optimizing recovery and reducing recurrence. Cureus. 2023;15(9):e46006.
Grace SL, Bennett S, Ardern CI, Clark AM. Cardiac rehabilitation series: Canada. Prog Cardiovasc Dis. 2014;56(5):530-5.
Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. Bmj. 2015;351:h5000.
Khadanga S, Gaalema DE, Savage P, Ades PA. Underutilization of cardiac rehabilitation in women: barriers and solutions. J Cardiopulm Rehabil Prev. 2021;41(4):207-13.
Chauvet-Gelinier J-C, Bonin B. Stress, anxiety and depression in heart disease patients: A major challenge for cardiac rehabilitation. Ann Phys Rehabil Med 2017;60(1):6-12.
Campkin LM, Boyd JM, Campbell DJ. Coronary artery disease patient perspectives on exercise participation. J Cardiopulm Rehabil Prev. 2017;37(5):305-14.
Yohannes AM, Yalfani A, Doherty P, Bundy C. Predictors of drop-out from an outpatient cardiac rehabilitation programme. Clin Rehabil. 2007;21(3):222-9.
Alpalhao V, Cordeiro N, Pezarat-Correia P. Kinesiophobia and fear avoidance in older adults: a scoping review on the state of research activity. J Aging Phys Act. 2022;30(6):1075-84.
Goubran M, Farajzadeh A, Lahart IM, Bilodeau M, Boisgontier MP. Kinesiophobia and physical activity: A systematic review and meta-analysis. MedRxiv. 2023:2023.08. 17.23294240.
McHale S, Astin F, Neubeck L, Dawkes S, Hanson CL. A systematic review and thematic synthesis exploring how a previous experience of physical activity influences engagement with cardiac rehabilitation. Eur J Cardiovasc Nurs. 2020;19(1):31-43.
Gardner G, Elliott D, Gill J, Griffin M, Crawford M. Patient experiences following cardiothoracic surgery: an interview study. Eur J Cardiovasc Nurs. 2005;4(3):242-50.
Martens EJ, de Jonge P, Na B, Cohen BE, Lett H, Whooley MA. Scared to death? Generalized anxiety disorder and cardiovascular events in patients with stable coronary heart disease: The Heart and Soul Study. Arch Gen Psychiatry. 2010;67(7):750-8.
Lee M, Wood T, Chan S, Marziali E, Tang T, Banner D, Lear SA. Cardiac rehabilitation program: an exploration of patient experiences and perspectives on program dropout. Worldviews Evid Based Nurs. 2022;19(1):56-63.
Bäck M, Caldenius V, Svensson L, Lundberg M. Perceptions of kinesiophobia in relation to physical activity and exercise after myocardial infarction: a qualitative study. Phys Ther. 2020;100(12):2110-9.
Weermeijer JD, Meulders A. Clinimetrics: Tampa scale for kinesiophobia. J Physiother. 2018;64(2):126.
Dupuis F, Cherif A, Batcho C, Massé-Alarie H, Roy J-S. The Tampa Scale of Kinesiophobia: a systematic review of its psychometric properties in people with musculoskeletal pain. Clin J Pain. 2023;39(5):236-47.
Kaneko H, Yano Y, Okada A, Itoh H, Suzuki Y, Yokota I, Morita K, Fujiu K, Michihata N, Jo T. Age‐dependent association between modifiable risk factors and incident cardiovascular disease. J Am Heart Assoc. 2023;12(2):e027684.
Consortium GCR. Global effect of modifiable risk factors on cardiovascular disease and mortality. N Engl J Med. 2023;389(14):1273-85.
Poulter N. Global risk of cardiovascular disease. Heart. 2003;89(suppl 2):ii2-ii5.
Liu L, Yang Q, Li T, Xie H, Zeng B, Zha L, Zhang W, Su S. Prevalence and influencing factors of kinesiophobia in patients with heart disease: a meta-analysis and systematic review. Sci Rep. 2024;14(1):18956.
Knapik A, Dąbek J, Brzęk A. Kinesiophobia as a problem in adherence to physical activity recommendations in elderly polish patients with coronary artery disease. Patient Prefer Adherence. 2019:2129-35.
Nedder VJ, Raju AG, Moyal AJ, Calcei JG, Voos JE. Impact of psychological factors on rehabilitation after anterior cruciate ligament reconstruction: a systematic review. Sports Health. 2025;17(2):291-8.
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