{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:36:27Z","timestamp":1793392587466,"version":"4.5.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The purpose of this study is to investigate the influence of kinesiophobia following Total Knee Arthroplasty (TKA) on the rehabilitation outcomes of patients during hospitalization, includes examining the trends in resting pain levels at various time points post-surgery, the trends in active flexion of the knee at various time points post-surgery, and the effects of kinesiophobia on the timing of first postoperative ambulation, the duration of postoperative hospital stay, and the results of the two-minute walk test on the day of discharge. Postoperative kinesiophobia in patients was identified using the Tampa Scale for Kinesiophobia (TSK), with 33 patients scoring &gt;37 points and 35 patients scoring \u226437 points. Resting Pain levels were assessed using the Numerical Rating Scale (NRS) at various time points, including upon return to the ward (T1), the first (T2), second (T3), third (T4), fifth(T5) postoperative days, and the day of discharge (T6). Furthermore, active flexion of the knee joint was measured at different time points for both groups, including the first (T1*), third (T2*), and fifth (T3*) postoperative days, and the day of discharge (T4*). The first time out of bed activities of the two groups of patients were compared, along with the results of the 2-Minute Walk Test (2-MWT) on the day of discharge. The pain scores of patients in the kinesiophobia group at different time points after surgery were worse than those in the non-kinesiophobia group (P&lt;0.05). There were significant time effects (F = 131.297;P&lt;0.01), inter-group effects (F = 15.016; P&lt;0.01), and interaction effects (F = 5.116; P&lt;0.05). The active knee flexion of patients in the kinesiophobia group at different time points after surgery were worse than those in the non-kinesiophobia group (P&lt;0.05).There were significant time effects (F = 628.258;P&lt;0.01), inter-group effects (F = 16.546; P&lt;0.01), and interaction effects (F = 66.025; P&lt;0.01). Patients in the kinesiophobia group delayed getting out of bed for the first time (35.39\u00b19.82vs28.77\u00b19.81hours; P&lt;0.01), had shorter activity time (4.12\u00b11.36vs5.80\u00b11.96minutes; P&lt;0.01) and distance (19.12\u00b13.36vs30.17\u00b15.64meters;P&lt;0.01), and experienced higher pain scores during activity (6.30\u00b11.10vs5.48\u00b10.95scoresP&lt;0.05). Additionally, patients in the kinesiophobia group walked shorter distances in the 2-MWT test on the day of discharge compared to the non-kinesiophobia group (37.60\u00b15.76vs50.68\u00b15.37meters;P&lt;0.05), and had longer hospitalization time (8.11\u00b11.31vs50.68\u00b15.37days; P&lt;0.05). In short, compared to patients without kinesiophobia, the presence of kinesiophobia after TKA surgery significantly impacts the efficacy of early rehabilitation exercises during hospitalization. This impact is observed in pain perception, knee joint mobility, the 2-minute walk test, etc. Early identification of patients with kinesiophobia after TKA and timely intervention are necessary and beneficial.<\/jats:p>","DOI":"10.1371\/journal.pone.0317774","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T18:30:18Z","timestamp":1738175418000},"page":"e0317774","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Study on the impact of Kinesiophobia after Total Knee Arthroplasty on the rehabilitation of patients during hospitalization: A pilot study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7024-5850","authenticated-orcid":true,"given":"Yichao","family":"Yao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoning","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xumeng","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"pone.0317774.ref001","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S2665-9913(21)00324-6","article-title":"Prediction models for the risk of total knee replacement: development and validation using data from multicentre cohort studies","volume":"4","author":"L Qiang","year":"2022","journal-title":"The Lancet Rheumatology"},{"key":"pone.0317774.ref002","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.apmr.2012.10.003","article-title":"Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: a randomized controlled trial","volume":"94","author":"M Marco","year":"2013","journal-title":"Arch. Phys. Med. Rehabil"},{"key":"pone.0317774.ref003","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1093\/rheumatology\/kes075","article-title":"Predictors of outcomes of total knee replacement surgery","volume":"51","author":"J Andrew","year":"2012","journal-title":"Rheumatology"},{"issue":"3","key":"pone.0317774.ref004","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/j.pain.0000000000001745","article-title":"Implications of the putamen in pain and motor deficits in complex regional pain syndrome","volume":"161","author":"G M\u00f3nica Azqueta","year":"2019","journal-title":"Pain"},{"issue":"1","key":"pone.0317774.ref005","doi-asserted-by":"crossref","first-page":"e000435","DOI":"10.1136\/bmjopen-2011-000435","article-title":"What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients","volume":"2","author":"Andrew D Beswick","year":"2012","journal-title":"BMJ open"},{"issue":"3","key":"pone.0317774.ref006","doi-asserted-by":"crossref","DOI":"10.3390\/jcm9030738","article-title":"High Levels of Kinesiophobia at Discharge from the Hospital May Negatively Affect the Short-Term Functional Outcome of Patients Who Have Undergone Knee Replacement Surgery","volume":"9","author":"H. De Vroey","year":"2020","journal-title":"Journal of clinical medicine"},{"issue":"2","key":"pone.0317774.ref007","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1589\/jpts.35.128","article-title":"Association between knee function and kinesiophobia 6 months after anterior cruciate ligament reconstruction","volume":"35","author":"Y. Isaji","year":"2023","journal-title":"Journal of physical therapy science"},{"issue":"2","key":"pone.0317774.ref008","first-page":"155","article-title":"Kinesiophobia negatively influences recovery of joint function following total knee arthroplasty","volume":"51","author":"F Doury-Panchout","year":"2015","journal-title":"Eur J Phys Rehabil Med"},{"issue":"6","key":"pone.0317774.ref009","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1080\/09593985.2017.1318988","article-title":"Does kinesiophobia affect the early functional outcomes following total knee arthroplasty?","volume":"33","author":"H. G\u00fcney-Deniz","year":"2017","journal-title":"Physiother Theory Pract"},{"issue":"9S","key":"pone.0317774.ref010","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1249\/01.mss.0000878812.64796.8b","article-title":"Physical Activity Intervention Within Outpatient Physical Therapy For Knee Replacement","volume":"54","author":"Christine A. Pellegrini","year":"2022","journal-title":"Med Sci Sports Exerc"},{"issue":"11\/12","key":"pone.0317774.ref011","first-page":"56","article-title":"Development aid for China\u2013country without physiotherapists","volume":"15","author":"M. B\u00f6hm","year":"2017","journal-title":"Physiopraxis"},{"issue":"1","key":"pone.0317774.ref012","first-page":"92","article-title":"The Comparison of Psychological Barriers Between Individuals with a History of Anterior Knee Pain, Anterior Cruciate Ligament Reconstruction, and Healthy Individuals","volume":"18","author":"E.F Zuk","year":"2023","journal-title":"International journal of sports physical therapy"},{"issue":"9","key":"pone.0317774.ref013","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1016\/j.pain.2013.04.033","article-title":"Widespread sensitization in patients with chronic pain after revision total knee arthroplasty","volume":"154","author":"ST Skou","year":"2013","journal-title":"PAIN\u00ae"},{"issue":"4","key":"pone.0317774.ref014","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1007\/s11999.0000000000000085","article-title":"What Is the Relationship of Fear Avoidance to Physical Function and Pain Intensity in Injured Athletes?","volume":"476","author":"S.F Fischerauer","year":"2018","journal-title":"Clinical orthopaedics and related research"},{"issue":"2","key":"pone.0317774.ref015","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1523\/JNEUROSCI.1082-19.2019","article-title":"Mesocorticolimbic pathways encode cue-based expectancy effects on pain","volume":"40","author":"Y Tu","year":"2020","journal-title":"J Neurosci"},{"key":"pone.0317774.ref016","doi-asserted-by":"crossref","first-page":"825408","DOI":"10.3389\/fpubh.2022.825408","article-title":"Association of use of tourniquets during total knee arthroplasty in the elderly patients with post-operative pain and return to function","volume":"10","author":"J Zhao","year":"2022","journal-title":"Frontiers Public Health"},{"issue":"11","key":"pone.0317774.ref017","doi-asserted-by":"crossref","first-page":"3417","DOI":"10.1007\/s00167-016-4201-3","article-title":"Kinesiophobia and depression affect total knee arthroplasty outcome in a multivariate analysis of psychological and physical factors on 200 patients","volume":"25","author":"G Filardo","year":"2017","journal-title":"KNEE SURG SPORT TRA"},{"key":"pone.0317774.ref018","doi-asserted-by":"crossref","first-page":"933483","DOI":"10.3389\/fnbeh.2022.933483","article-title":"Treatments for kinesiophobia in people with chronic pain: A scoping review","volume":"16","author":"M Bordeleau","year":"2022","journal-title":"Front Behav Neurosci"},{"issue":"3","key":"pone.0317774.ref019","doi-asserted-by":"crossref","first-page":"e601","DOI":"10.1097\/PR9.0000000000000601","article-title":"The impact of pain-related fear on neural pathways of pain modulation in chronic low back pain","volume":"2","author":"ML Meier","year":"2017","journal-title":"Pain reports"},{"key":"pone.0317774.ref020","doi-asserted-by":"crossref","first-page":"3993","DOI":"10.2147\/JPR.S432106","article-title":"Pain Catastrophizing, Kinesiophobia and Exercise Adherence in Patients After Total Knee Arthroplasty: The Mediating Role of Exercise Self-Efficacy","volume":"16","author":"Y Zhou","year":"2023","journal-title":"J Pain Res"},{"key":"pone.0317774.ref021","first-page":"130","article-title":"The relationship of kinesiophobia and pain catastrophizing with pain, range of motion, muscle strength and function in osteoarthritis","volume":"4","author":"O. G\u00fcr","year":"2021","journal-title":"J. SPORT HEALTH SCI"},{"issue":"2","key":"pone.0317774.ref022","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.arth.2010.02.008","article-title":"Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty?","volume":"26","author":"N Brandon","year":"2011","journal-title":"J. Arthroplasty"},{"key":"pone.0317774.ref023","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1136\/annrheumdis-2018-eular.6170","article-title":"Measures of Physical Activity and Fear Avoidance in People with Chronic Pain","volume":"77","author":"A. Bremander","year":"2018","journal-title":"ANN RHEUM DIS"},{"issue":"14","key":"pone.0317774.ref024","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12144858","article-title":"Preoperative and Postoperative Kinesiophobia Influences Postoperative Outcome Measures Following Anterior Cruciate Ligament Reconstruction: A Prospective Study","volume":"12","author":"U.G Longo","year":"2023","journal-title":"Journal of clinical medicine"},{"issue":"24","key":"pone.0317774.ref025","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11247355","article-title":"Efficacy of Visual Feedback Training for Motor Recovery in Post-Operative Subjects with Knee Replacement: A Randomized Controlled Trial","volume":"11","author":"S. Carozzo","year":"2022","journal-title":"Journal of clinical medicine"},{"issue":"2","key":"pone.0317774.ref026","first-page":"309","article-title":"Effect of Intelligent Health Education Based on Health Belief Model on Patients With Kinesophobia After Surgical Treatment of Cervical Spondylosis","volume":"55","author":"H. Liu","year":"2024","journal-title":"Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317774","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T18:30:33Z","timestamp":1738175433000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317774"}},"subtitle":[],"editor":[{"given":"Andr\u00e9","family":"Pontes-Silva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0317774","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]}}}