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

To examine whether a nurse-led intervention grounded in the Fear-Avoidance Model (FAM) reduces postoperative kinesiophobia indirectly by improving patients’ perceived physical capability. 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. 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. 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.