Nomogram-based prediction of postoperative kinesiophobia in patients with coronary heart disease

This study aimed to identify the factors influencing postoperative kinesiophobia in patients with coronary heart disease (CHD) and to develop a risk nomogram model to assist in preliminary clinical risk assessment.

A prospective observational study was conducted among 225 patients with CHD who underwent surgical interventions (such as coronary angiography, percutaneous transluminal coronary angioplasty, or intracoronary stenting) at a tertiary general hospital in Anhui Province between January and December 2025. Participants were selected using a convenience sampling method. The Chinese version of the Tampa Scale for Kinesiophobia-Heart (TSK-SV Heart) was employed to evaluate the levels of kinesiophobia. Patients were categorized into two groups: the kinesiophobia group (≥ 37 points) and the non-kinesiophobia group (< 37 points). LASSO regression was utilized for variable selection, while multivariate logistic regression analysis was performed to identify independent factors influencing kinesiophobia and to construct a nomogram. The model's discrimination, accuracy, and potential clinical utility were assessed using receiver operating characteristic (ROC), calibration, and decision curve analysis (DCA). Internal validation was performed through 10-fold cross-validation and bootstrap resampling (1000 iterations).

Of the 225 patients included, 136 individuals (60.44%) exhibited postoperative kinesiophobia. Multivariate logistic regression identified hypertension (OR = 3.336), cerebrovascular disease (OR = 5.695), and pain score (OR = 2.350) as independent risk factors. Conversely, higher scores on the Herth Hope Index (HHI) (OR = 0.897) and the Family Care Index (APGAR) (OR = 0.792) were independent protective factors. The model demonstrated an area under the curve (AUC) of 0.798 (95% CI: 0.740-0.855), with a calibration curve indicating strong concordance between predicted probabilities and observed outcomes (P = 0.477). Internal validation yielded a mean cross-validated AUC of 0.785 and a bootstrap-validated C-statistic of 0.781. DCA showed that the model offered a net benefit within a threshold probability range of 0.22 to 0.94.

Postoperative kinesiophobia is prevalent among patients with CHD. The developed nomogram exhibited robust internal predictive performance and potential clinical utility. In the absence of external validation, this model should be considered exploratory and hypothesis-generating, serving as a scientific basis to assist healthcare professionals in the early identification of high-risk patients, facilitating targeted interventions to enhance pain management, hope and family support. However, further multicenter studies are required for external validation.