Kinesiophobia and Its Response to Nurse-Led Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Cross-Sectional and Prospective Controlled Study

Abstract Objective To investigate the prevalence and associated factors of kinesiophobia in hospitalized patients with chronic obstructive pulmonary disease (COPD), develop a practical prediction model, and evaluate the response of kinesiophobia and respiratory-related outcomes to nurse-led pulmonary rehabilitation. Methods The cross-sectional phase was conducted from January to June 2025. Of 340 questionnaires distributed, 300 were valid (valid response rate, 88.2%). A prospective controlled intervention phase was conducted from August 2025 to January 2026 and included 100 patients, with 50 receiving nurse-led pulmonary rehabilitation and 50 receiving routine care. Kinesiophobia was assessed using the 17-item Tampa Scale for Kinesiophobia (TSK-17), and a total score > 37 was defined as the presence of kinesiophobia. Logistic regression was used to identify independent associated factors and construct a prediction model. The intervention incorporated cognitive-behavioral support, breathing training, graded exercise, symptom self-management, and follow-up supervision. Outcomes were assessed over 8 weeks. Results Kinesiophobia was identified in 199 of 300 patients with COPD (66.3%). Older age, more frequent acute exacerbations in the previous year, and higher modified Medical Research Council dyspnea scores were independently associated with kinesiophobia. The prediction model showed good discrimination, with an area under the curve of 0.915. In the intervention phase, patients receiving nurse-led pulmonary rehabilitation showed greater improvements in TSK-17 score, dyspnea, health status, arterial blood gas indices, and pulmonary function-related outcomes than those receiving routine care. Conclusion Kinesiophobia is common among hospitalized patients with COPD and is associated with age, exacerbation frequency, and dyspnea severity. A simple clinical prediction model may help identify patients at risk, and nurse-led pulmonary rehabilitation may reduce kinesiophobia and improve respiratory-related outcomes.