Post-discharge kinesiophobia trajectories and rehabilitation outcomes in post-stroke hemiplegia

Kinesiophobia may reduce participation in post-stroke rehabilitation and impede functional recovery, but its course after discharge and its clinical significance remain unclear. This study identified 6-month trajectories of kinesiophobia in patients with post-stroke hemiplegia and examined their associations with motor recovery and rehabilitation exercise adherence.

In this single-center prospective longitudinal study, 296 patients with post-stroke hemiplegia were assessed at discharge and at 1, 3, and 6 months after discharge. Baseline discharge assessment occurred a mean of 18.7 ± 5.8 days after stroke onset, so the follow-up window captured both early subacute and later community recovery phases. Kinesiophobia was measured with the validated Chinese Tampa Scale for Kinesiophobia (TSK-17), motor recovery with the Fugl-Meyer Assessment (FMA), and rehabilitation exercise adherence with the validated Chinese Engagement in Exercise Rehabilitation Scale for Patients with Stroke (EERS), assessed from month 1 onward. Self-report measures could be completed by standardized face-to-face or telephone interview when outpatient attendance was not possible, whereas FMA was assessed only by trained raters during outpatient or home-based in-person visits. Kinesiophobia trajectories were identified using latent class growth analysis. Associations with repeated FMA and EERS outcomes were analyzed using adjusted linear mixed-effects models, and baseline predictors of trajectory membership were examined with a bias-adjusted three-step multinomial logistic model.

A three-class solution showed the best fit: persistent-low (138/296, 46.6%), decreasing-moderate (112/296, 37.8%), and persistent-high (46/296, 15.5%). Trajectory membership was significantly associated with both motor recovery and rehabilitation exercise adherence over time (time-by-class interaction, both p <.001). At 6 months, adjusted mean FMA scores were 74.2, 65.9, and 50.6 across the three classes, and corresponding EERS scores were 70.5, 66.8, and 55.8. Compared with the persistent-low class, the persistent-high class had markedly poorer motor recovery (mean difference, 23.6 points; 95% CI, 19.2-28.0) and lower exercise adherence (mean difference, 14.7 points; 95% CI, 10.8-18.6), while the decreasing-moderate class showed intermediate deficits. Older age, history of falls, higher anxiety and depression, and lower exercise self-efficacy independently predicted unfavorable trajectories.

Post-discharge kinesiophobia follows heterogeneous trajectories in patients with post-stroke hemiplegia. Persistently high kinesiophobia identifies a vulnerable subgroup with poorer motor recovery and lower rehabilitation exercise adherence. Early screening and targeted support may improve post-discharge rehabilitation outcomes.