Development and validation of the pulmonary rehabilitation Kinesiophobia scale for patients with chronic obstructive...

Kinesiophobia is a significant barrier to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). However, there is currently a lack of a specific assessment tool for kinesiophobia in Chinese COPD patients. This study aims to develop the Pulmonary Rehabilitation Kinesiophobia Scale for Patients with COPD and to evaluate its psychometric properties.

This study was conducted in two stages. Stage I (instrument development): Based on literature review, qualitative interviews, and expert consultation, a preliminary version of the scale was developed. Stage II (item evaluation and psychometric testing): From April to September 2024, A total of 323 COPD patients from a tertiary hospital in Guangzhou completed the scale survey via convenience sampling. Data were analyzed for item selection, as well as reliability and validity testing. Reliability was assessed using internal consistency, test-retest reliability, and split-half reliability. Validity was evaluated through content validity, construct validity, and criterion-related validity. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to assess the scale's structure. For criterion-related validity, the correlation was analyzed between scale scores and the Modified Medical Research Council Dyspnea Scale (mMRC), the COPD Assessment Test (CAT), and the 6-minute walk distance (6-MWD).

The scale comprises 17 items. EFA revealed a reasonable distribution of factor loadings across five factors, with a cumulative variance explained of 70.7%. This factor structure was further supported by CFA, and the model fit indicators were: χ²/df = 1.555, RMSEA = 0.053, GFI = 0.906, IFI = 0.958, TLI = 0.946, and CFI = 0.957. Reliability analysis showed a Cronbach's α of 0.910, test-retest reliability of 0.844, and split-half reliability of 0.930. The content validity index I-CVI was 0.83-1.00, the S-CVI/UA was 0.824, and the S-CVI/Ave was 0.971. The correlation coefficients between the scale scores and mMRC, CAT, and 6MWD were 0.753, 0.731, and - 0.538, respectively.

The Pulmonary Rehabilitation Kinesiophobia Scale for Patients with COPD demonstrates good reliability and validity, which can be used to assess kinesiophobia in this population.