{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T09:08:00Z","timestamp":1779354480170,"version":"3.51.4"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early postoperative kinesiophobia in aortic dissection survivors is associated with reduced exercise adherence, worsening physical and mental health, and diminished quality of life. This study aimed to identify kinesiophobia subtypes 1 month after surgery and to explore the associative pathways linking exercise self-efficacy, family support, coping styles, and kinesiophobia, thereby providing a theoretical basis for the future development of targeted interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study enrolled 309 aortic dissection survivors (September 2024\u2013July 2025) from three university hospitals 1 month post-surgery. Data were collected using a general information questionnaire, the Tampa Scale for Kinesiophobia Heart, the Self-Efficacy for Exercise Scale, the Family Apgar Index, and the Medical Coping Modes Questionnaire. Latent profile analysis identified kinesiophobia subtypes, followed by testing a chain mediation model integrating exercise self-efficacy, family support, coping styles, and kinesiophobia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 309 patients, 73.14% (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f226) reported kinesiophobia. These patients were categorized into three subtypes: Subtype A (25.2%), Subtype B (17.7%), and Subtype C (57.1%). Participants with older age, Stanford Type A dissection, no spouse, lower education, and high invasive surgery correlated with higher fear. Exercise self-efficacy demonstrated a direct negative association with kinesiophobia, accounting for 38% of the total effect (\u22120.149, 95% CI: \u22120.237 to \u22120.081). Family support and adaptive coping style mediated this relationship by 45% (\u22120.178, 95% CI: \u22120.250 to \u22120.123) and 12% (\u22120.049, 95% CI: \u22120.089 to \u22120.023), respectively, with a significant but modest chain mediation effect of 5% (\u22120.019, 95% CI: \u22120.044 to \u22120.007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Aortic dissection survivors exhibit high kinesiophobia with marked phenotypic heterogeneity. The relationships between exercise self-efficacy, family support, coping styles, and kinesiophobia must be strictly interpreted as associative rather than causal. While these pathways underscore potential intervention targets, they remain strictly hypothesis-generating. These findings provide a roadmap for future trials to validate before clinical translation and inform risk-stratified screening by identifying high-risk phenotypes (Subtype C) and the dominant role of family support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1800841","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T08:14:02Z","timestamp":1779351242000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Heterogeneity in kinesiophobia among postoperative aortic dissection survivors: associations with exercise self-efficacy, family support, and coping styles"],"prefix":"10.3389","volume":"17","author":[{"given":"Xin","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Chongqing Emergency Medical Center","place":["Chongqing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Peripheral Vessel, The First Affiliated Hospital of Xi'an Jiaotong University","place":["Xi'an, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.ijcard.2011.12.107","article-title":"The impact on kinesiophobia (fear of movement)by clinical variables for patients with coronary artery disease","volume":"167","author":"B\u00e4ck","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1080\/09593985.2016.1229828","article-title":"Kinesiophobia mediates the influences on attendance at exercise- based cardiac rehabilitation in patients with coronary artery disease","volume":"32","author":"B\u00e4ck","year":"2016","journal-title":"Physiother. Theory Pract."},{"key":"ref3","volume-title":"Social Foundations of Thought and Action: A social Cognitive Theory","author":"Bandura","year":"1986"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1177\/0049124187016001004","article-title":"Practical issues in structural modeling","volume":"16","author":"Bentler","year":"1987","journal-title":"Sociol. Methods Res."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"6584","DOI":"10.3390\/jcm12206584","article-title":"What really matters to survivors of acute type a aortic dissection-a survey of patient-reported outcomes in the dutch national aortic dissection advocacy group","volume":"12","author":"Breel","year":"2023","journal-title":"J. Clin. Med."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/BF00845384","article-title":"Measuring social support: a synthesis of current approaches","volume":"7","author":"Bruhn","year":"1984","journal-title":"J. Behav. Med."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"641","DOI":"10.3760\/cma.j.issn.1001-4497.2017.11.001","article-title":"Chinese expert consensus on diagnosis and treatmentof aortic dissection","volume":"33","year":"2017","journal-title":"Chinese J. Thoracic Cardiovas. Surgery"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1002\/clc.22481","article-title":"Exercise and physical activity for the post-aortic dissection patient the clinician\u2019s conundrum","volume":"38","author":"Chaddha","year":"","journal-title":"Clin. Cardiol."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1002\/clc.22418","article-title":"Survivors of aortic dissection: activity, mental health, and sexual function","volume":"38","author":"Chaddha","year":"","journal-title":"Clin. Cardiol."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1728","DOI":"10.1177\/1359105314564812","article-title":"Differential pathways of positive and negative health behavior change in congestive heart failure patients","volume":"21","author":"Chaves","year":"2016","journal-title":"J. Health Psychol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"56","DOI":"10.3969\/j.issn.2097-1826.2024.02.013","article-title":"Impacts of two-way social support and family care on the general well-being of senior citizens in community","volume":"41","author":"Chen","year":"2024","journal-title":"Military Nurs."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"30","DOI":"10.3969\/j.issn.1008-3448.2014.03.004","article-title":"Users' active behavior in SNSs: integrating commitment, social support, sunk cost and social influence perspective","volume":"17","author":"Chen","year":"2014","journal-title":"Nankai Bus. Rev."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"293","DOI":"10.3969\/j.issn.1006-9143.2019.03.012","article-title":"Research on influence factors of kinesiophobia in patients with coronary disease","volume":"27","author":"Cui","year":"2019","journal-title":"Tianjin J. Nurs."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"691","DOI":"10.13819\/j.issn.2096-708X.2024.06.022","article-title":"Chain mediating effect of symptom distress and exercise self-efficacy between social support and kinesiophobia in home-based peritoneal dialysis patients","volume":"43","author":"Cui","year":"2024","journal-title":"Journal of Hubei University of Medicine."},{"key":"ref15","first-page":"267","volume-title":"Social Support: An Interactional View","author":"Dunkel-Schetter","year":"1990"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1097\/00006842-198711000-00007","article-title":"Coping strategies and associated features of medically ill patients","volume":"49","author":"Feifel","year":"1987","journal-title":"Psychosom. Med."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"64","DOI":"10.31083\/j.rcm2302064","article-title":"Attitudes and behavioral intentions of aortic dissection survivors towards exercise: an application of the health action process approach framework","volume":"23","author":"Feng","year":"2022","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref18","volume-title":"Kinesiophobia in Patients with Cardiovascular Diseases and its Path Analysis in the Process of Affecting Exercise Adherence","author":"Gao","year":"2023"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"785","DOI":"10.16821\/j.cnki.hsjx.2025.08.001","article-title":"The latent profile analysis and influencing factor for kinesiophobia in patient with chronic heart failure","volume":"40","author":"Gao","year":"2025","journal-title":"J. Nurses Train."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1186\/s12905-021-01564-2","article-title":"The role of health beliefs and health literacy in women\u2019s health promoting behaviours based on the health belief model:a descriptive study","volume":"21","author":"Ghorbani-Dehbalaei","year":"2021","journal-title":"BMC Womens Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.3969\/j.issn.1674-3806.2018.11.13","article-title":"A survey study on medical coping modes questionnaire scoreand its influencing factors in patients with HIV\/AIDS","volume":"11","author":"He","year":"2018","journal-title":"Chin. J. New Clin. Med."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1097\/HCR.0000000000000446","article-title":"Cardiopulmonary exercise testing following open repair for a proximal thoracic aortic aneurysm or dissection","volume":"40","author":"Hornsby","year":"2020","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"314","DOI":"10.3969\/j.issn.1008-0074.2021.03.16","article-title":"Research progress of comprehensive influence of exercise training onpatients with cardiovascular disea-ses","volume":"30","author":"Hou","year":"2021","journal-title":"Chinese J. Cardiovas. Rehabi Med."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12955-025-02392-w","article-title":"Latent profile analysis of health-related quality of life and its associated factors in postoperative aortic dissection patients: a cross-sectional study","volume":"23","author":"Huang","year":"2025","journal-title":"Health Qual. Life Outcomes"},{"key":"ref25","volume-title":"Stress, Appraisal, and Coping","author":"Lazarus","year":"1984"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.3969\/j.issn.1672-1756.2019.11.009","article-title":"Reliability and validity test of Chinese version of the Tampa scale forKinesiophobia heart","volume":"19","author":"Lei","year":"2019","journal-title":"Chinese Nursing Management."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"773","DOI":"10.13342\/j.cnki.cjhp.2019.05.011","article-title":"Relationship between self-efficacy and depression of postgraduates in medical university: the multiple mediating effect of coping style","volume":"27","author":"Li","year":"2019","journal-title":"Chin. J. Health Psychol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"700","DOI":"10.2522\/ptj.20100330","article-title":"Impact of psychological factors in the experience of pain","volume":"91","author":"Linton","year":"2011","journal-title":"Phys. Ther."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3969\/j.issn.1673-9701.2025.18.008","article-title":"Mediating effects of coping style on exercise fear and exercise rehabilitation compliance in UAP patients after PCI","volume":"63","author":"Liu","year":"2025","journal-title":"Chin. Mod. Doctor."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1597999","DOI":"10.3389\/fpsyg.2025.1597999","article-title":"Self-efficacy\u2013kinesiophobia correlation in postoperative patients with primary liver cancer: the chain-mediating effect of postoperative fatigue and negative emotions","volume":"16","author":"Liu","year":"2025","journal-title":"Front. Psychol."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2749","DOI":"10.12102\/j.issn.2095-8668.2022.20.008","article-title":"Research progress of early exercise for patients after type a aortic dissection","volume":"8","author":"Luo","year":"2022","journal-title":"Chinese Evid. Based Nursing"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC guidelines for the management of peripheral arterial andaortic diseases","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"119","DOI":"10.15517\/ap.v30i121.23458","article-title":"Health action process approach (HAPA) as a theoretical framework to understand behavior change","volume":"30","author":"Schwarzer","year":"2016","journal-title":"Archivos de Psicolog\u00eda."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1016\/j.athoracsur.2021.04.010","article-title":"Is compliance with guideline recommended follow-up after aortic dissection associated with survival","volume":"113","author":"Sharma","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3760\/cma.j.issn.1674-6554.2000.01.008","article-title":"Report on application of Chinese version of MCMQ in 701 patients","volume":"9","author":"Shen","year":"2000","journal-title":"Chinese J. Behav. Med. Sci."},{"key":"ref36","volume-title":"Association Among Health Literacy, Exercise Self-Efficacy, and Exercise Adherence","author":"Shi","year":"2024"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"59","DOI":"10.3969\/j.issn.2097-1826.2023.03.014","article-title":"Mediating effect of positive coping style between self-efficacy and kinesophobia among postop-erative breast cancer patients","volume":"40","author":"Shi","year":"2023","journal-title":"Military Nurs."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1037\/t90278-000","article-title":"The family APGAR: a proposal for a family function test and its use by physicians","volume":"6","author":"Smilkstein","year":"1978","journal-title":"J. Fam. Pract."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"378","DOI":"10.19485\/j.cnki.issn2096-5087.2024.05.003","article-title":"Mediating effect of self-efficacy for exercise on social support and kinesiophobia in patients with rheumatoid arthritis","volume":"36","author":"Sun","year":"2024","journal-title":"Prev. Med."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"2696","DOI":"10.1093\/eurheartj\/ehv428","article-title":"Cardiovascular disease in Europe-epidemiological update 2015","volume":"36","author":"Townsend","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e93","DOI":"10.1161\/CIR.0000000000001123","article-title":"Heart disease and stroke Statistics-2023 update: a report from the American Heart Association","volume":"147","author":"Tsao","year":"2023","journal-title":"Circulation"},{"key":"ref42","volume-title":"Research on Segmentation of Aortic Dissection Images","author":"Wang","year":"2021"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"27","DOI":"10.3870\/j.issn.1001-4152.2022.14.027","article-title":"Longitudinal study on kinesiophobia in patients with acute myocardial infarction: the influencing factors","volume":"37","author":"Wang","year":"2022","journal-title":"J. Nurs. Sci."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"23","DOI":"10.3870\/j.issn.1001-4152.2022.07.023","article-title":"Causes of high level kinesiophobia in first-episode patients with acute myocardial infarction: a qualitative study","volume":"37","author":"Wang","year":"2022","journal-title":"J. Nurs. Sci."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"3074","DOI":"10.1111\/jocn.16397","article-title":"Effect of virtual reality technology as intervention for people with kinesiophobia: a meta-analysis of randomised controlled trials","volume":"32","author":"Wang","year":"2023","journal-title":"J. Clin. Nurs."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1648","DOI":"10.16766\/j.cnki.issn.1674-4152.003703","article-title":"Mediating effect of coping mode and anxiety on the relationship between self-efficacy for exercise and kinesiophobia in patients with heart failure with preserved ejection fraction","volume":"22","author":"Wen","year":"2024","journal-title":"Chin. J. Gen. Pract."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"4071","DOI":"10.12102\/j.issn.1009-6493.2023.22.017","article-title":"Research progress on risk-benefit perception in exercise rehabilitation of patients with coronary heart disease","volume":"37","author":"Zhang","year":"2023","journal-title":"Chin. Nurs. Res."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12872-024-04435-4","article-title":"Postoperative self-management experiences among patients with aortic dissection: a phenomenological approach","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Cardiovasc. Disord."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"836","DOI":"10.16821\/j.cnki.hsjx.2016.09.025","article-title":"Validation of the exercise self-efficacy scale for stroke patients inChina","volume":"31","author":"Zhang","year":"2016","journal-title":"Journal of Nurses Training."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"3418","DOI":"10.12102\/j.issn.1009-6493.2020.19.008","article-title":"Correlation between family care, meaning in life and depression in the elderly","volume":"34","author":"Zhou","year":"2020","journal-title":"Chin. Nurs. Res."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3870\/j.issn.1001-4152.2022.23.036","article-title":"Relationships among exercise self-efficacy, exercise plan and exercise compliance in young and middle-aged stroke patients","volume":"37","author":"Zhu","year":"2022","journal-title":"J. Nurs. Sci."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"4692","DOI":"10.1111\/jocn.17126","article-title":"Kinesophobia and its related factors in patients after percutaneous coronary intervention: a cross-sectional study","volume":"33","author":"Zhu","year":"2024","journal-title":"J. Clin. Nurs."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1800841\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T08:14:23Z","timestamp":1779351263000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1800841\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":52,"alternative-id":["10.3389\/fpsyg.2026.1800841"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1800841","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]},"article-number":"1800841"}}