Effect of nurse-led kinesiophobia-focused education on fear of movement and shoulder function after permanent pacemaker implantation

Q: What are the key findings of this study?

Nurse-led kinesiophobia-focused education reduced TSK-Heart fear of movement scores at 8 weeks compared to standard care.

Q: What is the clinical evidence from this study?

Population: First-time permanent pacemaker implantation for bradyarrhythmia (n=94). Intervention: Nurse-led kinesiophobia-focused education program vs. Standard postoperative care (routine wound care instructions, activity restriction guidelines for 4-6 weeks, device monitoring schedule, and printed information booklet). Primary outcome: Fear of movement measured by the Tampa Scale for Kinesiophobia-Heart (TSK-Heart) score at week 8 (MD -8.3, 95% CI 5.6-11.0, p=<0.001).

Q: What does this research mean for the field?

A nurse-led kinesiophobia-focused education program significantly reduces fear of movement and improves shoulder range of motion and upper-extremity function following permanent pacemaker implantation. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the effect of a nurse-led kinesiophobia-focused education program on fear of movement and shoulder function in patients after permanent pacemaker implantation.

Tamara Ennab

doi:10.33545/30790506.2026.v3.i2a.89953

July 1, 2026Journal of Medicine and Surgical NursingOpen Access

Effect of nurse-led kinesiophobia-focused education on fear of movement and shoulder function after permanent pacemaker implantation

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Key result

Nurse-led education reduces fear-of-movement scores by ~8 points vs standard care after device implantation.

MD -8.3
95% CI 5.6-11.0
P<0.001
n=94

Why the study?

Kinesiophobia is increasingly recognized as a barrier to functional recovery after cardiac device implantation, yet targeted nursing interventions addressing this fear of movement and its effect on shoulder function after permanent pacemaker implantation remain underdeveloped.

Does a structured nurse-led kinesiophobia-focused education program reduce fear of movement and improve shoulder function in adults undergoing first-time permanent pacemaker implantation?

Key Points

To examine the effect of a nurse-led kinesiophobia-focused education program on fear of movement and shoulder function in patients after permanent pacemaker implantation.
Quasi-experimental pretest-posttest study with a control group conducted among 94 patients undergoing first-time permanent pacemaker implantation at a tertiary hospital in Irbid, Jordan.
Participants were allocated to an intervention group (n = 47) receiving the kinesiophobia-focused education program or a control group (n = 47) receiving standard postoperative care.
Outcomes were evaluated at baseline, week 4, and week 8 post-implantation using the Tampa Scale for Kinesiophobia-Heart (TSK-Heart), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and goniometric shoulder range of motion.
At week 8, the intervention group had significantly lower TSK-Heart scores compared to the control group (26.8 ± 5.9 vs. 35.1 ± 7.4, p < 0.001; between-group difference 8.3 points, 95% CI: 5.6-11.0).
Shoulder flexion range at week 8 was significantly greater in the intervention group than in controls (171.4∘±8.3 vs. 153.7∘±14.6, p < 0.001; between-group difference 17.7 degrees, 95% CI: 12.9-22.5).
DASH disability scores were significantly lower in the intervention group at week 8 (8.4 ± 4.1 vs. 18.7 ± 7.8, p < 0.001), whereas control group scores worsened from baseline (15.2 ± 5.9 to 18.7 ± 7.8).

Structured PICO

Does a structured nurse-led kinesiophobia-focused education program reduce fear of movement and improve shoulder function in adults undergoing first-time permanent pacemaker implantation?

P

Population

94 adults (mean age 64.3 years, 42.6% female) in Jordan undergoing first-time permanent pacemaker implantation for bradyarrhythmia without pre-existing ipsilateral shoulder pathology, followed for 8 weeks.

I

Intervention

Structured four-phase nurse-led kinesiophobia-focused education program delivered by two trained registered nurses in addition to standard postoperative care over 8 weeks (Phase 1 on Day 1: baseline assessment and structured interview; Phase 2 on Days 2-4: three individual 30-minute sessions covering movement safety, cognitive restructuring, graded activity demonstration, and goal setting; Phase 3 on Days 5-7/discharge: supervised shoulder exercise practice, barrier problem-solving, and self-efficacy reinforcement; Phase 4 at weeks 4 and 8: structured follow-up assessments and reinforcement counseling).

C

Comparator

Standard postoperative care, including routine wound care instructions, activity restriction guidelines for the first 4 to 6 weeks (avoiding raising the ipsilateral arm above shoulder level and lifting more than 5 kilograms), device monitoring schedule, and a printed information booklet, with no specific kinesiophobia assessment or targeted movement education.

O

Outcome

Fear of movement measured by the 17-item self-report Tampa Scale for Kinesiophobia-Heart (TSK-Heart) questionnaire at baseline, week 4, and week 8 post-implantation.patient reported

Main Result

Mean Difference: -8.3 (95% CI 5.6–11)

Absolute Event Rate: 26.8% vs 35.1%

p-value: p=<0.001

A structured nurse-led kinesiophobia-focused education program significantly reduced fear of movement and upper extremity disability while improving shoulder range of motion at 8 weeks following permanent pacemaker implantation.

Limitations

Quasi-experimental design with sequential group allocation does not provide the same level of causal inference as a randomized controlled trial
Single-center setting in Jordan may limit generalizability to healthcare systems with different cultural attitudes
Short eight-week follow-up period does not establish long-term sustainability of functional gains
Participants could not be blinded to group allocation, introducing potential attention effects
Single-center setting in Jordan may limit generalizability to healthcare systems with different cultural attitudes toward device implantation and movement
Eight-week follow-up period does not establish whether kinesiophobia reduction and functional gains are sustained over longer timeframes
Inability to blind participants to group allocation introduces the possibility that attention effects contributed to observed differences

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May support nurse-led education post-pacemaker implantation; hypothesis-generating and requires RCTs before practice change.

Abstract

Background: Kinesiophobia, or fear of movement, is increasingly recognized as a barrier to functional recovery after cardiac device implantation, yet targeted nursing interventions addressing this phenomenon remain underdeveloped. Objective: This research examined the effect of a nurse-led kinesiophobia-focused education program on fear of movement and shoulder function in patients after permanent pacemaker implantation. Methods: A quasi-experimental pretest-posttest design with a control group was used. Ninety-four patients undergoing first-time permanent pacemaker implantation at a tertiary hospital in Irbid, Jordan were allocated to an intervention group (n = 47) receiving the kinesiophobia-focused education program or a control group (n = 47) receiving standard postoperative care. The Tampa Scale for Kinesiophobia-Heart (TSK-Heart), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and goniometric shoulder range of motion were measured at baseline, week 4, and week 8 post-implantation. Results: At week 8, the intervention group demonstrated significantly lower TSK-Heart scores compared to the control group (26.8 ± 5.9 versus 35.1 ± 7.4, p < 0.001) and greater shoulder flexion range (171.4∘±8.3 versus 153.7∘±14.6, p < 0.001). DASH scores were significantly lower in the intervention group (8.4 ± 4.1 versus 18.7 ± 7.8, p < 0.001). TSK-Heart total score was strongly correlated with DASH score (r = 0.71, p < 0.001) and inversely correlated with shoulder flexion (r = -0.63, p < 0.001). Conclusion: The nurse-led kinesiophobia-focused education program significantly reduced fear of movement and improved shoulder function outcomes after permanent pacemaker implantation, supporting integration of kinesiophobia-targeted interventions into postoperative cardiac nursing care.

Discussion

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Cite This Study

Tamara Ennab (2026) studied First-time permanent pacemaker implantation for bradyarrhythmia (n=94). Nurse-led kinesiophobia-focused education program vs. Standard postoperative care (routine wound care instructions, activity restriction guidelines for 4-6 weeks, device monitoring schedule, and printed information booklet) was evaluated on Fear of movement measured by the Tampa Scale for Kinesiophobia-Heart (TSK-Heart) score at week 8 (MD -8.3, 95% CI 5.6-11.0, p=<0.001). Nurse-led kinesiophobia-focused education reduced TSK-Heart fear of movement scores at 8 weeks compared to standard care.

synapsesocial.com/papers/6af0e999de503f37741409d3 https://doi.org/10.33545/30790506.2026.v3.i2a.89953

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Effect of nurse-led kinesiophobia-focused education on fear of movement and shoulder function after permanent pacemaker implantation

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Effect of nurse-led kinesiophobia-focused education on fear of movement and shoulder function after permanent pacemaker implantation

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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