Construction and validation of a predictive model for postoperative kinesiophobia in total hip arthroplasty patients

Sunjuan Dong¹Xiucheng Guo²Yanling Zhou¹Yinzhong Chen²Chi Wang¹SiJing Peng^1,3Li Wu¹Wenxi Han¹Weiting Liu^1,3*

• ¹School of Nursing, Anhui University of Chinese Medicine, Hefei , Anhui, China, Hefei, China
• ²The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
• ³Key Laboratory of Geriatric Nursing and Health, Anhui University of Chinese Medicine, Hefei, China

Objective: To construct and validate a risk prediction model for postoperative kinesiophobia in total hip arthroplasty (THA) patients. Methods: This study is a single-center cross-sectional study with only internal validation. Through the convenience sampling method, 205 patients who underwent total hip arthroplasty (THA) at the Second Affiliated Hospital of Shandong First Medical University from October 2024 to May 2025 were selected as the study subjects. Independent predictors associated with the occurrence of kinesiophobia were screened by univariate analysis and multifactorial logistic regression analysis. A nomogram risk prediction model was constructed using R software, and the Hosmer-Lemeshow test, receiver operating characteristic (ROC) curve, area under the curve (AUC), calibration curves, and decision analysis curves (DCA) were used to evaluate the model's goodness-of-fit, discriminability, calibration, and clinical utility, respectively. The Bootstrap method was used to perform 1000 repeated samplings for internal validation of the model. Results: A total of 126 out of 205 postoperative THA patients developed kinesiophobia, and the incidence of kinesiophobia was 61.5%.Logistic regression showed that pain history duration, anxiety, This is a provisional file, not the final typeset article hip function, coping style, and rehabilitation self-efficacy were the influencing factors for the development of kinesiophobia in postoperative patients with THA (P < 0.05). The AUC value of the constructed model was 0.947 (95% CI 0.919~0.975), the specificity was 0.873, and the sensitivity was 0.911. The Hosmer-Lemeshow test (χ2 =2.287, P=0.971) and the calibration curve showed that the predicted probability of the model was consistent with the probability of the actual occurrence, and the model predicted the effect well; the DCA curve indicates that the model has good clinical utility. Internal validation using the Bootstrap method yielded an AUC value of 0.912 (95% CI 0.875-0.949). Conclusion: THA patients with a pain history duration (>1 year), anxiety, poor hip function, low active coping, and poor rehabilitation self-efficacy are more likely to develop kinesiophobia after surgery. The constructed model has good predictive efficacy, which is helpful for early clinical identification of high-risk patients and provides a reference for developing individualized interventions.