Manuscript Title: Analysis of the Present Status and Influencing Factors of Early Postoperative Kinesiophobia in Patients with Head and Neck Cancer: A Cross-Sectional Study

Ze-Ying Hu, Guan-Mian Liang, Jian-Wen Hou Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, People’s Republic of ChinaCorrespondence: Jian-Wen Hou, Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, People’s Republic of China, Tel +86 13567147265, Fax +86 0571-88128221, Email [email protected]: The purpose of this study was to investigate the status and influencing factors of kinesiophobia in patients during the early postoperative period following head and neck cancer (HNC) surgery.Patients and Methods: This prospective cross-sectional study employed convenience sampling to recruit 367 patients undergoing radical head and neck surgery between September 1, 2024, and April 30, 2025. Participants were interviewed by trained researchers using a self-designed general information questionnaire, the Tampa Scale for Kinesiophobia-11 (TSK-11), the Chinese version of the Brief Fatigue Inventory (BFI-C), and the General Self-Efficacy Scale (GSES). Univariate analysis was performed using the chi-square test, Mann–Whitney U-test, or Fisher’s exact test. Correlation analysis was conducted using Pearson’s correlation coefficient. Multivariate analysis was conducted using multiple linear regression.Results: The average score of kinesiophobia was 18.42 ± 4.97. The completion rate reached 98.65%. Males accounted for 51.77%, while females comprised 48.23%. Pearson correlation analysis demonstrated a significant positive correlation between TSK-11 and BFI-C scores in patients with HNC (r = 0.801, p < 0.001). TSK-11 scores were significantly negatively correlated with GESE scores (r = − 0.816, p < 0.001). The results of the multiple linear regression analysis indicated that the included independent variables explained 82.1% of the variance in the dependent variable. Skin flap transplantation (t=7.996, 95% Cl 2.306– 3.811, p< 0.001), immobilization (t=6.483, 95% Cl 2.224– 4.162, p< 0.001), lymph node dissection (t=6.608, 95% Cl 1.540– 2.845, p< 0.001), tracheotomy (t=7.666, 95% Cl 1.749– 2.956, p< 0.001), GESE (t=− 3.406, 95% Cl − 0.229– 0.061, p< 0.001), and BFI-C (t=3.028, 95% Cl 0.169– 0.795, p< 0.001) were significant influencing factors for kinesiophobia in patients during the early postoperative period following HNC surgery.Conclusion: The proportion of head and neck cancer patients experiencing kinesiophobia in the early postoperative period is relatively high. Research has demonstrated that this phenomenon is closely associated with self-efficacy, fatigue levels, and the type of surgical procedure. Therefore, it is recommended that healthcare professionals should consider kinesiophobia as a core indicator in postoperative rehabilitation assessments, with particular attention to patients undergoing complex surgery or exhibiting low self-efficacy and high fatigue levels. Early identification of high-risk individuals and the implementation of multidimensional intervention strategies—including enhancing self-efficacy through cognitive behavioral therapy, implementing stepwise fatigue management programmes, and providing personalized rehabilitation guidance for patients undergoing specific surgeries—will ultimately reduce the incidence of kinesiophobia.Keywords: head and neck cancer, kinesiophobia, self-efficacy, fatigue, influencing factors