The relationship of fear of pain, pain anxiety, and fear-avoidance beliefs with perceived stress in surgical patients with postoperative kinesiophobia
Kinesiophobia is one of the most prevalent postoperative problems with negative effects on patient mobility. Fear of pain (FOP), pain anxiety (PA), and fear of avoidance beliefs (FABs) are influential factors on postoperative mobility and may be affected by perceived stress (PS). The present study examined whether perceived stress serves to mediate the relationship between fear of pain, pain anxiety, and fear of avoidance beliefs with kinesiophobia (fear of movement) in postoperative patients. The study was conducted in the neurosurgery, general surgery, and orthopedic wards of a hospital in Amol, Iran. A total of 330 patients (178 men and 152 women), aged 18 to 74 years, who had undergone various surgical procedures, were included. Participants were recruited using a consecutive sampling technique over a defined period to account for the staggered timing of surgeries and ensure broader representation. All patients were assessed six hours post-surgery using validated instruments, including the Tampa Scale for Kinesiophobia, Pain Anxiety Symptoms Scale, Fear of Pain Questionnaire, Fear-Avoidance Beliefs Questionnaire, and Perceived Stress Scale. The majority of the sample were men (53.9%), married (80%), with a mean age of 44.38 (SD = 13.49) years. Of the participants, 119 (36.1%) underwent orthopedic surgery, 139 (42.1%) underwent abdominal surgery, and 72 (21.8%) underwent surgery for discopathy. The path analysis revealed that kinesiophobia exhibited a significant relationship with FABs (β = 0.206; p < 0.001; 95% CI: 0.009 to 0.017) and PA (β = 0.474; p < 0.001; 95% CI: 0.021 to 0.031), while no significant relationship was found with FOP (β = 0.072; p = 0.408; 95% CI: -0.011 to 0.011). Also, the findings indicated that PS as mediator had a significant relationship with FABs (ß = 0.191; P < 0.001; 95% CI: 0.009 to 0.017), PA (ß = 0.393; P < 0.001;95% CI: 0.021 to 0.031), and kinesiophobia (ß = 0.812; P < 0.001; 95% CI: 0.021 to 0.031. The study found that pain anxiety and fear-avoidance beliefs are key factors contributing to kinesiophobia after surgery. Addressing these fears is important for improving postoperative mobility. Perceived stress mediated the relationship between these factors and kinesiophobia. Managing stress may be a helpful intervention to improve outcomes for postoperative patients. Healthcare providers should assess and address psychological factors like pain anxiety and fear-avoidance beliefs to promote better recovery and mobility in patients after surgery.