Latent profiles of kinesiophobia and their associations with exercise self-efficacy, diabetes distress, and fall risk in older adults with type 2 diabetes: a cross-sectional study

BACKGROUND: Kinesiophobia may hinder exercise participation in older adults with type 2 diabetes mellitus (T2DM), but its heterogeneity and related associations remain unclear. This study aimed to identify latent profiles of kinesiophobia and examine the associations of exercise self-efficacy, diabetes distress, and fall risk with profile membership. METHODS: A cross-sectional design was utilized, enrolling 220 older inpatients with T2DM from a tertiary hospital. Data were collected using the Tampa Scale for Kinesiophobia (TSK), the Self-Efficacy for Exercise (SEE) Scale, the Diabetes Distress Scale (DDS), and the Morse Fall Scale (MFS). Latent profile analysis (LPA) was applied to identify kinesiophobia subtypes. Multiple logistic regression, correlation analysis, and an indirect-association analysis based on cross-sectional data were used to examine the relationships among variables. RESULTS: Kinesiophobia was classified into three latent profiles: low kinesiophobia-low perceived threat (37.27%), moderate kinesiophobia-moderate perceived threat (35.91%), and high kinesiophobia-high perceived threat (26.82%). Compared with the low kinesiophobia-low perceived threat profile, higher exercise self-efficacy was associated with lower odds of belonging to the moderate profile (OR=0.856) and the high profile (OR=0.667). Higher fall risk was associated with higher odds of belonging to the moderate profile (OR=1.035) and the high profile (OR=1.083). Higher diabetes distress was associated only with membership in the high kinesiophobia-high perceived threat profile (OR=1.058). Kinesiophobia profile membership was negatively associated with exercise self-efficacy and positively associated with diabetes distress and fall risk. The hypothesized indirect-association analysis suggested that diabetes distress and fall risk were involved in the association between exercise self-efficacy and kinesiophobia profile membership. CONCLUSIONS: Kinesiophobia among older inpatients with T2DM showed three distinct profiles: low, moderate, and high. More severe profiles were associated with lower exercise self-efficacy, higher diabetes distress, and greater fall risk. These findings support profile-oriented nursing assessment that integrates movement-related fear, exercise confidence, diabetes-related emotional burden, and fall risk.