Key result
Pain-related helplessness emerges as the key bridge linking pain catastrophizing and kinesiophobia in stable CHD.
Why the study?
Kinesiophobia and pain catastrophizing are psychological barriers to physical activity in patients with coronary heart disease, but their dimension-level interconnected network structure remains unclear.
Cross-Sectional (n=395)
Yes
In patients with stable coronary heart disease, pain-related helplessness acts as the central psychological dimension and primary bridge linking pain catastrophizing to kinesiophobia (specifically activity avoidance and fear of cardiac outcomes), highlighting it as a key candidate target for future behavioral interventions.
Helplessness centrality may identify a target in stable CHD networks; leaves open whether interventions reduce kinesiophobia or boost activity.
Background: Kinesiophobia and pain catastrophizing are psychological barriers to physical activity in patients with coronary heart disease (CHD). Their dimension-level interconnected structure remains unclear. Objectives: To characterize the network structure of kinesiophobia and pain catastrophizing dimensions in stable CHD, identify central dimensions, and identify bridge dimensions. Methods: A cross-sectional survey was conducted among 395 patients with stable CHD from two tertiary hospitals in Xinjiang, China. The Tampa Scale for Kinesiophobia-Heart version (four dimensions) and Pain Catastrophizing Scale (three dimensions) were used. A Gaussian Graphical Model was estimated using gLASSO with EBIC. Strength and expected influence were used for centrality, and bridge expected influence (one-step) for cross-community connectivity. Stability was assessed by bootstrap; the correlation-stability coefficient was 0.749. Results: In total, 68.61% scored above the reference TSK threshold (> 37), and 11.90% scored at or above the reference PCS threshold (≥ 38). The network was predominantly positively connected. The strongest within-community edge was PCS Helplessness–Rumination (0.463). Cross-community edges linked PCS Helplessness to TSK Avoidance of activity (0.187) and Fear of adverse cardiac outcomes (0.154). One weak negative edge was observed: PCS Rumination–TSK Avoidance (− 0.066). PCS Helplessness had the highest Strength (1.243), Expected Influence (1.243), and Bridge Expected Influence (0.446). TSK Danger had the lowest Strength (0.579). Conclusions: In this exploratory cross-sectional sample, kinesiophobia and pain catastrophizing formed a predominantly positively connected network. Pain-related helplessness showed the highest centrality and bridge centrality. These hypothesis-generating findings suggest that helplessness may be relevant for future longitudinal and intervention research; the cross-sectional design precludes causal inference.
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Ruo-han Wang (2026) conducted a cross-sectional in Stable coronary heart disease (n=395). Pain catastrophizing and kinesiophobia dimensions (PCS and TSK-SV Heart) was evaluated on Network centrality and bridge centrality of kinesiophobia and pain catastrophizing dimensions (PCS Helplessness). Pain-related helplessness exhibited the highest strength (1.243), expected influence (1.243), and bridge expected influence (0.446) connecting pain catastrophizing and kinesiophobia in stable CHD.
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