Kinesiophobia and related influencing factors in stroke patients with hemiplegia: a cross-sectional study and parallel mediation analysis

Objective This study aimed to investigate the mediating role of pain catastrophizing and self-efficacy in the association between anxiety and depressive symptoms and kinesiophobia among stroke patients with hemiplegia. Methods A cross-sectional study was conducted between March 2023 and September 2024 in a tertiary hospital in Jiangsu Province, China. A total of 260 stroke patients with hemiplegia were enrolled and completed assessments including a demographic questionnaire, the Tampa Scale for Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), the Hospital Anxiety and Depression Scale (HADS), and the Self-Efficacy for Exercise Scale (SEE). Multiple linear regression was performed to identify independent factors associated with kinesiophobia. Parallel mediation analysis was applied to examine whether psychoemotional factors mediated the relationship with kinesiophobia. Results Multivariate linear regression revealed that age ( β = −0.054, p = 0.027), fall history ( β = 0.082, p = 0.002), pain catastrophizing ( β = 0.569, p < 0.001), self-efficacy ( β = −0.267, p < 0.001), and anxiety and depressive symptoms ( β = 0.115, p = 0.004) were significantly associated with kinesiophobia in stroke patients with hemiplegia. Anxiety and depressive symptoms exhibited a significant total effect on kinesiophobia (total effect = 0.788, p < 0.001), with pain catastrophizing and self-efficacy acting as mediators along two separate pathways. Conclusion Kinesiophobia in stroke patients with hemiplegia was associated with pain catastrophizing, anxiety and depressive symptoms, self-efficacy, and fall history. The structural equation modeling (SEM) revealed that negative emotions may increase kinesiophobia through greater pain catastrophizing and reduced self-efficacy. Thus, interventions aimed at building self-efficacy and mitigating pain catastrophizing may effectively decrease kinesiophobia and facilitate recovery.