Impact of kinesiophobia on initiation of cardiac rehabilitation: a prospective cohort path analysis

ObjectivesTo identify factors associated with kinesiophobia (fear of movement) after cardiac hospitalisation and to assess the impact of kinesiophobia on cardiac rehabilitation (CR) initiation.DesignProspective cohort study.SettingAcademic Medical Centre, Department of Cardiology.ParticipantsWe performed a prospective cohort study in cardiac patients recruited at hospital discharge. In total, 149 patients (78.5% male) with a median age of 65 years were included, of which 82 (59%) were referred for CR.Primary and secondary outcome measuresWe assessed kinesiophobia with the Tampa Scale for Kinesiophobia (TSK). For this study, the total score was used (range 13-52). We assessed baseline factors (demographics, cardiac disease history, questionnaire data on anxiety, biopsychosocial complexity and self-efficacy) associated with kinesiophobia using linear regression with backward elimination. For linear regression, the standardised beta (beta) was reported. Prospectively, the impact of kinesiophobia on probability of CR initiation, in the first 3 months after hospital discharge (subsample referred for CR), was assessed with logistic regression. For logistic regression, the OR was reported.ResultsModerate and severe levels of kinesiophobia were found in 22.8%. In the total sample, kinesiophobia was associated with cardiac anxiety (beta=0.33, 95% CI: 0.19 to 0.48), social complexity (beta=0.23, 95% CI: 0.06 to 0.39) and higher education (beta=-0.18, 95% CI: -0.34 to -0.02). In those referred for CR, kinesiophobia was negatively associated with self-efficacy (beta=-0.29, 95% CI: -0.47 to -0.12) and positively with cardiac anxiety (beta=0.43, 95% CI: 0.24 to 0.62). Kinesiophobia decreased the probability of CR initiation (ORRange13-52 points=0.92, 95% CI: 0.85 to 0.99).ConclusionIn patients hospitalised for cardiovascular disease, kinesiophobia is associated with cardiac anxiety, social complexity, educational level and self-efficacy. Kinesiophobia decreased the likelihood of CR initiation with 8% per point on the TSK.

Automated summary

Factors associated with kinesiophobia after cardiac hospitalisation include cardiac anxiety, social complexity, educational level, and self-efficacy. Kinesiophobia decreased the probability of CR initiation by 8% per point on the TSK.