Analysis of risk factors for kinesiophobia after coronary artery bypass grafting and construction of a nomogram prediction model

Background Kinesiophobia, or the irrational fear of movement, is a significant barrier to effective cardiac rehabilitation and recovery in patients after coronary artery bypass grafting (CABG). This study sought to identify the risk factors for kinesiophobia in post-CABG patients and to develop and validate a nomogram prediction model to estimate individual risk. Methods A retrospective case-control study was conducted on 138 patients who underwent CABG in the Cardiovascular ICU between February 2023 and November 2024. Using the Tampa Scale for Kinesiophobia-Heart (TSK-Heart), patients were categorized into a kinesiophobia group (TSK-Heart >37, n = 95) and a non-kinesiophobia group ( n = 43). Risk Factors were identified with multivariable logistic regression. The resulting coefficients furnished a nomogram for individual risk estimation. Calibration was evaluated with the Hosmer-Lemeshow test and a bootstrap-corrected calibration plot; discrimination was quantified by the receiver operating characteristic (ROC) curve and calibration curve. Results The incidence of kinesiophobia in this cohort was 68.84%. The logistic regression analysis identified six risk factors: advanced age ( OR = 1.127, P = 0.003), lower educational level ( OR = 0.246, P = 0.001), higher degree of disability in activities of daily living (ADL) ( OR = 3.880, P = 0.007), lower self-efficacy in cardiac rehabilitation exercise ( OR = 0.898, P = 0.024), pain catastrophizing ( OR = 4.513, P = 0.023), and fear of falling ( OR = 1.212, P = 0.004). The constructed nomogram demonstrated excellent discrimination, with an AUC of 0.939 (95% CI : 0.898–0.981), and high sensitivity (93.7%) and specificity (83.7%). Calibration was confirmed by the Hosmer-Lemeshow test ( χ 2 = 5.97, P = 0.65) and a bootstrap-corrected calibration plot showing close agreement between predicted and observed probabilities. Conclusions Advanced age, low educational attainment, ADL dependency, poor cardiac rehabilitation self-efficacy, pain catastrophizing, and fear of falling were significant risk factors for kinesiophobia after CABG. The developed nomogram was a reliable and accurate tool for early identification of high-risk patients, enabling clinicians to implement individualized preventative strategies and optimize postoperative recovery.