Applying the fear-avoidance model to exercise rehabilitation after coronary artery bypass grafting a nurse-led intervention study

OBJECTIVE: To examine whether a nurse-led intervention grounded in the Fear-Avoidance Model (FAM) reduces postoperative kinesiophobia indirectly by improving patients' perceived physical capability. METHOD: We conducted a single-center, parallel-group randomized controlled trial. A total of 122 patients who underwent coronary artery bypass grafting (CABG) were randomized 1:1 to an intervention group or a usual-care control group (n = 61 each). The intervention included graded activity, functional feedback, goal setting, structured education, and post-discharge follow-up. Perceived physical capability and kinesiophobia were assessed 30 days after discharge. Mediation analysis was used to test whether perceived physical capability mediated the effect of the intervention on kinesiophobia. RESULTS: The intervention was associated with higher perceived physical capability (a = 2.43, p = 0.031). Perceived physical capability was inversely associated with kinesiophobia (b = - 0.775, p < 0.001). The indirect effect of the intervention on kinesiophobia through perceived physical capability was significant (ab = - 1.879; bootstrapped 95% CI [- 3.702, - 0.288]). In contrast, the total effect (c = - 1.557, p = 0.433) and the direct effect (c'=0.322, p = 0.860) were not statistically significant. CONCLUSIONS: These findings suggest a rehabilitation-relevant pathway in which strengthening perceived capability may help reduce avoidance-oriented responses after CABG. A nurse-led approach that combines graded mobilization, performance feedback, and goal-based progression may support engagement in early recovery activities and may offer a practical framework for transitional rehabilitation support.