Trajectories of kinesiophobia and associated factors after esophagectomy for esophageal cancer: a prospective longitudinal study

Background Kinesiophobia defined as an excessive and irrational fear of movement, may hinder postoperative recovery in cancer patients. However, its longitudinal patterns and associated factors following esophagectomy for esophageal cancer remain unclear. Objective To identify distinct kinesiophobia trajectories in patients undergoing surgery and to explore nursing-sensitive factors associated with trajectory class membership. Methods A prospective longitudinal study was conducted in a tertiary hospital in China. A total of 320 patients who underwent MIE were enrolled between March 2023 and June 2026. Kinesiophobia was assessed using the 11-item Tampa Scale for Kinesiophobia (TSK-11) at four timepoints: postoperative days 3–5 (T0), 1 month (T1), 3 months (T2), and 6 months (T3). Latent class growth analysis (LCGA) was used to identify trajectory classes, and multinomial logistic regression was applied to examine factors associated with of class membership. Results Three distinct kinesiophobia trajectories were identified: high-level rapid decline (Class 1, 25.6%, n = 82), persistent low-level (Class 2, 55.0%, n = 176), and high-level slow decline (Class 3, 19.4%, n = 62). Compared with the persistent low-level class, patients in the high-level slow decline class reported significantly higher baseline pain (7.9 ± 1.7 vs. 5.6 ± 1.7), fatigue (6.3 ± 1.0 vs. 5.1 ± 1.1), anxiety (11.9 ± 4.1 vs. 7.6 ± 3.7), depression (9.1 ± 3.7 vs. 6.6 ± 3.4), and pain catastrophizing (24.7 ± 8.0 vs. 20.2 ± 8.0), as well as lower social support (47.8 ± 11.8 vs. 55.4 ± 9.8) and resilience (56.8 ± 12.1 vs. 64.7 ± 11.8) (all p < 0.001). Conclusion Kinesiophobia trajectories after surgery are heterogeneous, with pain, fatigue, psychological distress, pain catastrophizing, social support, and resilience identified as key factors associated with trajectory class membership. Early screening and nursing interventions targeting these factors should be prioritized to optimize postoperative rehabilitation.