Concept development of kinesiophobia in total knee arthroplasty patients: an analysis using Rodgers' evolutionary approach

Background Kinesiophobia, the fear of movement, is a prevalent psychological barrier in patients recovering from total knee arthroplasty (TKA). This condition, often influenced by factors such as pain, low self-efficacy, and cognitive biases, can significantly impair rehabilitation adherence and prolong recovery. However, the concept of kinesiophobia in TKA patients remains poorly defined, with inconsistent use across the literature. Therefore, this study aimed to clarify the concept of kinesiophobia in TKA patients by systematically identifying its antecedents, attributes, and consequences, in order to inform the development of targeted interventions that may enhance postoperative rehabilitation adherence, functional recovery, and quality of life. Methods A concept analysis was conducted using Rodgers' evolutionary approach. We systematically searched CNKI, Wanfang, VIP, CBM, PubMed, Web of Science, Embase, Cochrane Library, ProQuest, PsycINFO, and Scopus databases for studies on the concept of kinesiophobia in TKA patients. The search covered all available literature up to June 9, 2026. Studies addressing the concept of kinesiophobia in TKA patients were included, while duplicates, inaccessible full-text articles, off-topic papers, and literature not published in either Chinese or English were excluded. Findings from the 50 included studies were then synthesized using Rodgers' evolutionary concept analysis framework to identify the antecedents, attributes, and consequences of kinesiophobia. Results Fifty papers were finally included in the literature. The synthesis of evidence identified four antecedents: (a) demographic factors; (b) disease-related factors; (c) personal cognitive factors; and (d) psychosocial factors. The primary attributes included misconception, deliberate avoidance, and excessive fear. The consequences were poor adherence to rehabilitative exercises, clinical adverse outcomes, and an increased psychological burden. Conclusion This study identified the key antecedents, attributes, and impacts of kinesiophobia in TKA patients and proposed a conceptual framework integrating these elements. These findings may inform future research and targeted interventions to improve rehabilitation adherence, functional recovery, and quality of life in TKA patients.