Association of Kinesiophobia with Pain, Anxiety, Depression, and Quality of Life in Acute Stroke Patients: An Investigation Using Brain Magnetic Resonance Imaging Findings

Objective:To determine whether kinesiophobia independently predicts stroke-specific health-related quality of life (HRQoL) in patients with mild acute stroke and to explore its association with amygdala volumetry.Methods:This cross-sectional study included 26 patients aged 25–70 years with ischemic stroke and Modified Rankin Scale (mRS) ≤2. Kinesiophobia was assessed using the Tampa Kinesiophobia Scale (TKS). Pain intensity was measured with the Visual Analog Scale (VAS), depressive symptoms with the Beck Depression Inventory (BDI), anxiety with the Beck Anxiety Inventory (BAI), and HRQoL with the Stroke-Specific Quality of Life Scale (SSQOL). Amygdala volumes were obtained from T1-weighted MRI images using automated volBrain segmentation. Spearman correlation and multiple linear regression analyses were performed.Results:Kinesiophobia showed a moderate negative correlation with SSQOL (r =-0.56, p = 0.003). In multivariable regression analysis, both kinesiophobia (β =-0.41, 95% CI: -0.07 to -0.01, p = 0.021) and functional disability (mRS; β =-0.52, p = 0.004) independently predicted HRQoL. The model explained 48% of the variance in SSQOL (Adjusted R² = 0.48) with a large effect size (Cohen’s f² = 0.92). In hierarchical regression analysis, kinesiophobia remained an independent predictor even after controlling for mood variables (ΔR² = 0.029, p = 0.018).Conclusion:Kinesiophobia is an independent and clinically meaningful determinant of stroke-specific quality of life in patients with mild acute stroke. Movement-related fear may represent a modifiable psychological barrier in rehabilitation. Structural amygdala volumetry was not associated with kinesiophobia, highlighting the need for future functional neuroimaging studies.