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Family Functioning and Kinesiophobia in Patients After Pacemaker Implantation: A Cross-Sectional Serial Mediation
1School of Nursing, Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China.
Aim:
This cross-sectional study aimed to explore the relationships among family functioning, pain, pain catastrophizing, and kinesiophobia in patients after permanent pacemaker implantation, and to examine the serial indirect effects of pain and pain catastrophizing.
Background:
Kinesiophobia is common among patients after pacemaker implantation and may hinder participation in cardiac rehabilitation. Although previous studies have reported associations between family functioning, pain, pain catastrophizing, and kinesiophobia, how these factors are interrelated remains unclear.
Methods:
This was a cross-sectional study. A convenience sample of 211 patients who underwent permanent pacemaker implantation was recruited from October 2025 to January 2026 in a tertiary hospital in Yinchuan, Ningxia, China. Data were collected using questionnaires including the Family APGAR Index, Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), and Tampa Scale for Kinesiophobia Heart (TSK-SV Heart). Data were analysed using descriptive statistics, Pearson correlation analysis, and serial mediation analysis with Model 6 of the PROCESS macro version 4.0.
Reporting Method:
This study followed the STROBE reporting guideline.
Results:
A total of 211 patients were included (mean age 66.08 years, SD = 12.67). The prevalence of kinesiophobia was 59.7%. Pearson correlation analysis showed that family functioning was negatively correlated with kinesiophobia (r = -0.39, p < 0.001), pain (r = -0.30, p < 0.001), and pain catastrophizing (r = -0.34, p < 0.001). Pain was positively correlated with kinesiophobia (r = 0.39, p < 0.001) and pain catastrophizing (r = 0.33, p < 0.001). Pain catastrophizing was positively correlated with kinesiophobia (r = 0.49, p < 0.001). Serial mediation analysis revealed significant indirect effects. The serial indirect effect of family functioning on kinesiophobia through pain and pain catastrophizing was significant (effect = -0.06, 95% CI: -0.14 to -0.01). The total indirect effect was -0.58 (95% CI: -0.88 to -0.32).
Conclusion And Relevance To Clinical Practice:
In this cross-sectional study, family functioning was associated with kinesiophobia, and pain and pain catastrophizing showed significant serial indirect effects in this relationship. These findings suggest that family support, pain management, and pain catastrophizing may be important areas for future intervention research aimed at reducing kinesiophobia and promoting cardiac rehabilitation participation. However, causal conclusions cannot be drawn because of the cross-sectional design, and longitudinal studies are needed to confirm these findings.
