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June 14, 2026Journal of Pain ResearchOpen Access

Better family functioning links to less kinesiophobia, mediated through pain and pain catastrophizing.

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Why the study?

Kinesiophobia is common after pacemaker implantation and may hinder cardiac rehabilitation, but how family functioning, pain, and pain catastrophizing interrelate to influence it remains unclear.

Population

211 patients after permanent pacemaker implantation at a tertiary hospital in China

Design

Cross-sectional study

Key result

Family functioning was negatively associated with kinesiophobia, with pain and pain catastrophizing demonstrating a significant serial indirect effect (effect -0.06) in this relationship.

Authors

M(Min Xu (15203)T(Tao Zhang (43681)JMJing Ma

Discussion

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Overview

Supports family functioning pathways in kinesiophobia; hypothesis-generating and should not yet change practice.

Key Points

  • This study explores how family functioning relates to kinesiophobia in patients post-pacemaker implantation, focusing on pain and pain catastrophizing.
  • Cross-sectional design involving 211 patients who underwent permanent pacemaker implantation.
  • Data collected via questionnaires including Family APGAR Index, Numeric Rating Scale, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia Heart.
  • Statistical analysis performed using Pearson correlation and serial mediation analysis with PROCESS macro version 4.0.
  • 59.7% of patients displayed kinesiophobia.
  • Family functioning showed a negative correlation with kinesiophobia (r = -0.39, p < 0.001) and pain (r = -0.30, p < 0.001).
  • Significant serial indirect effect of family functioning on kinesiophobia through pain and pain catastrophizing (effect = -0.06, 95% CI: -0.14 to -0.01).

Study Design

Type

Cross-Sectional (n=211)

Multicenter

No

Structured PICO

P
Population
211 adult patients (mean age 66.1 years, 53.1% female) who underwent first-time permanent pacemaker implantation, assessed 2-3 days postoperatively.
O
Outcome
Kinesiophobia, assessed using the short version of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) on postoperative days 2–3.patient reported

Main Result

Effect estimate: effect -0.06 (95% CI -0.14 to -0.01)

Better family functioning is associated with reduced kinesiophobia in patients after pacemaker implantation, an effect that is sequentially mediated by lower pain intensity and reduced pain catastrophizing.

Limitations

  • Cross-sectional design limits the ability to establish causal relationships
  • Assessments were conducted on postoperative days 2-3, reflecting only acute pain and early concerns rather than long-term patterns
  • Kinesiophobia was assessed using a self-reported scale without objective measures of physical activity or shoulder range of motion
  • Convenience sampling from a single tertiary hospital may introduce selection bias and limit generalizability
  • Unmeasured variables such as anxiety, depression, preoperative pain, and comorbidities were not included in the analysis
  • Causal conclusions cannot be drawn because of the cross-sectional design
  • Longitudinal studies are needed to confirm findings

Cite This Study

(15203) et al. (2026) conducted a cross-sectional in Patients after permanent pacemaker implantation (n=211). Family functioning was evaluated on Serial indirect effect of family functioning on kinesiophobia through pain and pain catastrophizing (effect -0.06, 95% CI -0.14 to -0.01). Family functioning was negatively associated with kinesiophobia, with pain and pain catastrophizing demonstrating a significant serial indirect effect (effect -0.06) in this relationship.

synapsesocial.com/papers/6a2e4524b1cc60ccdea8a576https://doi.org/10.2147/jpr.s608536
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Also Consider

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  5. 5Proposing an explanatory framework based on the fear-avoidance model: a mixed-methods analysis of kinesiophobia in patients after percutaneous coronary intervention in home-based cardiac rehabilitation2026