Trajectories of kinesiophobia over the first six months after cardiac pacemaker or defibrillator implantation: clinical, psychological, and rehabilitation predictors and their relation to functional capacity

Objective Kinesiophobia, an excessive fear of physical movement, is common after implantation of a cardiac pacemaker or implantable cardioverter defibrillator and may limit rehabilitation and recovery. Because fear of movement changes over time, a single measurement cannot capture how it evolves. We aimed to identify distinct trajectories of kinesiophobia during the first six months after implantation, to relate them to functional capacity, and to identify baseline factors that predict an unfavourable course. Methods In a single centre retrospective cohort based on routinely collected structured follow-up data, 160 consecutive patients undergoing first implantation of a pacemaker or defibrillator were assessed 24 to 48 h after the procedure and again at 1, 3, and 6 months. Kinesiophobia was measured with the Tampa Scale for Kinesiophobia Heart and functional capacity with the six-minute walk distance. Group-based trajectory modelling identified latent trajectories. Baseline characteristics were compared across classes, and multinomial logistic regression identified independent predictors of class membership. Results Mean kinesiophobia fell from 42.9 to 35.2 over six months, and the proportion above the high-fear threshold fell from 76.2% to 37.5%. Three trajectories emerged: low and declining (28.8%), moderate and declining (45.0%), and high and persistent (26.2%). The persistent group stayed above the clinical threshold throughout and walked the shortest distance at every visit. Compared with the low group, independent predictors of a persistent course were higher depression (odds ratio 2.26), higher anxiety (1.68), lower exercise self-efficacy (0.89), shorter baseline walk distance (0.55 per 10 m), and absence of exercise guidance (0.04 for having received guidance). Conclusion Kinesiophobia after device implantation follows three trajectories, separated mainly by the overall level of fear. About one quarter of patients remain persistently fearful and physically limited; they can be identified early by distress, low self-efficacy, poor functional capacity, and lack of exercise guidance. Early screening and targeted exercise-based rehabilitation are warranted.