# The trajectory of kinesiophobia in patients following total knee arthroplasty: a longitudinal qualitative study

## TL;DR

This study tracks how fear of movement changes in patients after knee replacement surgery, identifying key psychological and behavioral patterns to guide rehabilitation.

## Contribution

The study identifies a dynamic progression of kinesiophobia post-surgery, offering a novel framework for stage-specific rehabilitation strategies.

## Key findings

- Kinesiophobia after knee arthroplasty involves cognitive assessment dysfunction and impaired behavioral control.
- The fear trajectory shifts from cognitive appraisal imbalance to behavioral control impairment over time.
- Tailored interventions based on the phased characteristics of kinesiophobia can improve postoperative outcomes.

## Abstract

Based on Cognitive Dissonance Theory and the Lewin’s Change Model, this longitudinal study examines the developmental trajectory of exercise phobia in patients following total knee arthroplasty, aiming to provide evidence-based support for formulating rehabilitation strategies tailored to different stages.

To use purposive sampling, from December 2024 to June 2025, eight patients who underwent total knee arthroplasty at a Grade III Class A hospital in Zhejiang Province were selected as research subjects. To track the trajectory of kinesiophobia symptoms within 3 months post-surgery and complete data analysis with thematic analysis, we conducted a thematic analysis.

The trajectory of kinesiophobia in patients following total knee arthroplasty primarily manifests in two key aspects: cognitive assessment dysfunction (self-objectification and health literacy bias) and impaired behavioral control (pain central sensitization and rehabilitation motivation disorder).

Following total knee arthroplasty, patients undergo a dynamic progression of kinesiophobia, characterized by a shift from cognitive appraisal imbalance to behavioral control impairment, driven by the persistent conflict between rehabilitation needs and fear-based cognition. To optimize postoperative quality of life, healthcare professionals should implement targeted interventions tailored to the phased characteristics of kinesiophobia.