Geriatric nursing (New York, N.Y.) · 2026
Understanding kinesiophobia in older postoperative patients admitted to the ICU: A narrative review of conceptual models, assessment tools, and clinical implications.
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Gu Lulu, Huai Wenting, Ye Ye, Yang Yang, Chen Chulin
Аннотация
BACKGROUND: Early mobilization is a key component of recovery for older patients in intensive care units (ICUs). However, psychological resistance to movement-particularly fear-based avoidance-remains poorly understood and frequently overlooked in critical care settings.
OBJECTIVE: This narrative review aims to explore the conceptual relevance of kinesiophobia (fear of movement) in older postoperative patients admitted to the ICU, examine its potential assessment challenges, and outline nursing-sensitive strategies for identification and intervention.
METHODS: A purposive literature search was conducted in PubMed,MEDLINE, CINAHL, Scopus, Web of Science Core Collection, and Embase (supplemented by PsycINFO) to identify literature on kinesiophobia/fear-avoidance, early mobilization, and ICU care among older postoperative patients. Evidence was synthesized thematically to develop a context-adapted conceptual framework.
RESULTS: The traditional fear-avoidance model, while well-established in musculoskeletal and rehabilitation contexts, has not been adapted for ICU settings. In older postoperative patients admitted to the ICU, fear of movement may manifest nonverbally through emotional withdrawal or passive resistance, especially in those with sedation, cognitive impairment, or mechanical ventilation. Common assessment tools such as the Tampa Scale for Kinesiophobia lack validity in this population. Nurses are uniquely positioned to detect behavioral signs of fear and support mobilization through emotional attunement, reassurance, and trauma-informed communication. A conceptual model is proposed to illustrate the ICU-specific fear-avoidance pathway and key nursing intervention points.
CONCLUSION: Kinesiophobia may represent a hidden but modifiable barrier to mobilization in older postoperative patients admitted to the ICU. Integrating fear-based constructs into ICU care can improve functional outcomes and promote more holistic, emotion-sensitive nursing practices. Future research should focus on tool development, qualitative exploration of patient experiences, and intervention trials tailored to critical care contexts.
OBJECTIVE: This narrative review aims to explore the conceptual relevance of kinesiophobia (fear of movement) in older postoperative patients admitted to the ICU, examine its potential assessment challenges, and outline nursing-sensitive strategies for identification and intervention.
METHODS: A purposive literature search was conducted in PubMed,MEDLINE, CINAHL, Scopus, Web of Science Core Collection, and Embase (supplemented by PsycINFO) to identify literature on kinesiophobia/fear-avoidance, early mobilization, and ICU care among older postoperative patients. Evidence was synthesized thematically to develop a context-adapted conceptual framework.
RESULTS: The traditional fear-avoidance model, while well-established in musculoskeletal and rehabilitation contexts, has not been adapted for ICU settings. In older postoperative patients admitted to the ICU, fear of movement may manifest nonverbally through emotional withdrawal or passive resistance, especially in those with sedation, cognitive impairment, or mechanical ventilation. Common assessment tools such as the Tampa Scale for Kinesiophobia lack validity in this population. Nurses are uniquely positioned to detect behavioral signs of fear and support mobilization through emotional attunement, reassurance, and trauma-informed communication. A conceptual model is proposed to illustrate the ICU-specific fear-avoidance pathway and key nursing intervention points.
CONCLUSION: Kinesiophobia may represent a hidden but modifiable barrier to mobilization in older postoperative patients admitted to the ICU. Integrating fear-based constructs into ICU care can improve functional outcomes and promote more holistic, emotion-sensitive nursing practices. Future research should focus on tool development, qualitative exploration of patient experiences, and intervention trials tailored to critical care contexts.