The trajectory of kinesiophobia in patients following total knee arthroplasty: a longitudinal qualitative study

Aim: Based on Cognitive Dissonance Theory and the Lewin's Change Model, this longitudinal study examines the developmental trajectory of exercise phobia in patients following total knee arthroplasty, aiming to provide evidence-based support for formulating rehabilitation strategies tailored to different stages. Method: To use purposive sampling, from December 2024 to June 2025, eight patients who underwent total knee arthroplasty at a Grade III Class A hospital in Zhejiang Province were selected as research subjects. To track the trajectory of kinesiophobia symptoms within 3 months post-surgery and complete data analysis with thematic analysis, we conducted a thematic analysis. Results: The trajectory of kinesiophobia in patients following total knee arthroplasty primarily manifests in two key aspects: cognitive assessment dysfunction (self-objectification and health literacy bias) and impaired behavioral control (pain central sensitization and rehabilitation motivation disorder). Conclusion: Following total knee arthroplasty, patients undergo a dynamic progression of kinesiophobia, characterized by a shift from cognitive appraisal imbalance to behavioral control impairment, driven by the persistent conflict between rehabilitation needs and fear-based cognition. To optimize postoperative quality of life, healthcare professionals should implement targeted interventions tailored to the phased characteristics of kinesiophobia.