The Association Between Kinesiophobia and Level of Mobilization in Patients After Open-Heart Surgery

Background/Objectives: Early mobilization following open-heart surgery is a key component of postoperative recovery, yet psychological barriers such as kinesiophobia (fear of movement) may limit patient participation. This study examined the association between kinesiophobia and mobilization level in patients after open-heart surgery and explored sociodemographic and clinical correlates of both variables. Methods: A cross-sectional descriptive design was used. The sample comprised 96 adult cardiac surgery patients recruited consecutively from cardiovascular surgery ICUs at two centers in Istanbul-a public training and research hospital and a foundation-affiliated university hospital-between December 2024 and April 2025. Data were collected via a Personal Information Form, the Tampa Scale of Kinesiophobia (TSK), and the Intensive Care Units Mobility Scale (IMS). Analyses (SPSS 25.0) included Mann-Whitney U and Kruskal-Wallis H tests, Pearson correlation with 95% confidence intervals (CIs) calculated via Fisher's z-transformation, Bonferroni correction for k = 12 subgroup comparisons within each outcome, and a multivariable linear regression adjusted for sex, age, smoking, and history of surgery. Results: Of the 96 patients enrolled, 76.0% were male, with a mean age of 58.30 ± 6.50 years (SD) and a mean body mass index of 27.53 ± 5.84 kg/m². The mean TSK total score was 46.81 ± 6.51 and the mean IMS score was 5.48 ± 0.73. Kinesiophobia and mobilization showed a small inverse association that reached statistical significance (r = -0.104; 95% CI: -0.298 to 0.099; r² = 0.011; p = 0.041), accounting for approximately 1% of the variance in mobilization. After multivariable adjustment, kinesiophobia was no longer a significant predictor (β = -0.092; p = 0.360), whereas smoking (β = -0.279; p = 0.008) and female sex (β = 0.215; p = 0.039) emerged as the strongest independent correlates. Mobilization level differed by gender and smoking, and kinesiophobia level differed by marital status, history of surgery, and family history of heart disease at the uncorrected level; however, none of these subgroup differences remained significant after Bonferroni correction. Conclusions: Higher kinesiophobia scores were associated with lower mobilization levels following open-heart surgery, but the effect size was small and the association did not persist after adjustment for clinical confounders. The cross-sectional design precludes causal inference. Kinesiophobia may be considered as one of several psychosocial factors potentially relevant to postoperative mobilization rather than as a primary determinant.