Heterogeneity in kinesiophobia among postoperative aortic dissection survivors: associations with exercise self-efficacy, family support, and coping styles.

BACKGROUND

Early postoperative kinesiophobia in aortic dissection survivors is associated with reduced exercise adherence, worsening physical and mental health, and diminished quality of life. This study aimed to identify kinesiophobia subtypes 1 month after surgery and to explore the associative pathways linking exercise self-efficacy, family support, coping styles, and kinesiophobia, thereby providing a theoretical basis for the future development of targeted interventions.

METHODS

This cross-sectional study enrolled 309 aortic dissection survivors (September 2024-July 2025) from three university hospitals 1 month post-surgery. Data were collected using a general information questionnaire, the Tampa Scale for Kinesiophobia Heart, the Self-Efficacy for Exercise Scale, the Family Apgar Index, and the Medical Coping Modes Questionnaire. Latent profile analysis identified kinesiophobia subtypes, followed by testing a chain mediation model integrating exercise self-efficacy, family support, coping styles, and kinesiophobia.

RESULTS

Of the 309 patients, 73.14% (n = 226) reported kinesiophobia. These patients were categorized into three subtypes: Subtype A (25.2%), Subtype B (17.7%), and Subtype C (57.1%). Participants with older age, Stanford Type A dissection, no spouse, lower education, and high invasive surgery correlated with higher fear. Exercise self-efficacy demonstrated a direct negative association with kinesiophobia, accounting for 38% of the total effect (-0.149, 95% CI: -0.237 to -0.081). Family support and adaptive coping style mediated this relationship by 45% (-0.178, 95% CI: -0.250 to -0.123) and 12% (-0.049, 95% CI: -0.089 to -0.023), respectively, with a significant but modest chain mediation effect of 5% (-0.019, 95% CI: -0.044 to -0.007).

CONCLUSION

Aortic dissection survivors exhibit high kinesiophobia with marked phenotypic heterogeneity. The relationships between exercise self-efficacy, family support, coping styles, and kinesiophobia must be strictly interpreted as associative rather than causal. While these pathways underscore potential intervention targets, they remain strictly hypothesis-generating. These findings provide a roadmap for future trials to validate before clinical translation and inform risk-stratified screening by identifying high-risk phenotypes (Subtype C) and the dominant role of family support.