Construction and validation of a predictive model for post-operative kinesiophobia in total hip arthroplasty patients

Total hip arthroplasty (THA) is an effective treatment for end-stage hip disease, which can significantly relieve pain, rebuild joint function, and improve patients' quality of life. Early post-operative functional exercises are essential to promote the recovery of hip function and minimize complications. However, some patients are afraid of exercise due to the risk of pain or dislocation of the prosthesis, resulting in poor adherence to rehabilitation exercises. Kinesiophobia has now become a key factor hindering the rehabilitation process and leading to poor functional recovery. Therefore, early identification of high-risk groups and implementation of targeted interventions are essential to improve patient prognosis.

To construct and validate a risk prediction model for post-operative kinesiophobia in total hip arthroplasty (THA) patients.

This study is a single-center cross-sectional study with only internal validation. Through the convenience sampling method, 205 patients who underwent total hip arthroplasty (THA) at the Second Affiliated Hospital of Shandong First Medical University from October 2024 to May 2025 were selected as the study subjects. Independent predictors associated with the occurrence of kinesiophobia were screened by univariate analysis and multifactorial logistic regression analysis. A nomogram risk prediction model was constructed using R software, and the Hosmer-Lemeshow test, receiver operating characteristic (ROC) curve, area under the curve (AUC), calibration curves, and decision analysis curves (DCA) were used to evaluate the model's goodness-of-fit, discriminability, calibration, and clinical utility, respectively. The Bootstrap method was used to perform 1,000 repeated samplings for internal validation of the model.

A total of 126 out of 205 post-operative THA patients developed kinesiophobia, and the incidence of kinesiophobia was 61.5%. Logistic regression showed that pain history duration, anxiety, hip function, coping style, and rehabilitation self-efficacy were the influencing factors for the development of kinesiophobia in post-operative patients with THA (P < 0.05). The AUC value of the constructed model was 0.947 (95% CI 0.919∼0.975), the specificity was 0.873, and the sensitivity was 0.911. The Hosmer-Lemeshow test (χ ² = 2.287, P = 0.971) and the calibration curve showed that the predicted probability of the model was consistent with the probability of the actual occurrence, and the model predicted the effect well; the DCA curve indicates that the model has good clinical utility. Internal validation using the Bootstrap method yielded an AUC value of 0.912 (95% CI 0.875-0.949).

THA patients with a pain history duration (> 1 year), anxiety, poor hip function, low active coping, and poor rehabilitation self-efficacy are more likely to develop kinesiophobia after surgery. The constructed model has good predictive efficacy, which is helpful for early clinical identification of high-risk patients and provides a reference for developing individualized interventions.