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已发表论文
胸外科手术后针对运动恐惧症采用综合保护动机与暴露干预：一项随机对照试验
Authors Peng J, Luo Y , Feng L, Xiao J, Feng F, Zheng Y, Bao L, Yang S, Wu X
Received 18 June 2025
Accepted for publication 18 November 2025
Published 19 December 2025 Volume 2025:18 Pages 6911—6920
DOI https://doi.org/10.2147/JPR.S544205
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Jinlei Li
Jiao Peng,1,* Yang Luo,2,* Lijuan Feng,2 Juan Xiao,2 Fang Feng,2 Yi Zheng,2 Lihong Bao,3 Sai Yang,3 Xiao Wu2
1Department of Respiratory and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan, Hubei Province, People’s Republic of China; 2Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 3Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xiao Wu; Sai Yang, Email wuxiao200707@163.com; yangsai@hust.edu.cn
Background: Kinesiophobia is a significant barrier to recovery after thoracic surgery. We aimed to determine the efficacy of an integrated intervention combining Protection Motivation Theory (PMT) and exposure therapy for reducing kinesiophobia and improving postoperative outcomes.
Methods: In this single-center, randomized, double-blind, controlled trial, we enrolled 144 patients with kinesiophobia (Tampa Scale for Kinesiophobia [TSK-17-C] score ≥ 37) following thoracoscopic pulmonary surgery. Participants were randomized 1:1 to receive either a structured PMT-based psychological and graded exposure-behavioral intervention on postoperative day 1 (POD1) (experimental group, n=72) or routine care with standard pain education (control group, n=72). The primary outcome was the TSK-17-C score on POD3.
Results: The experimental group exhibited a significantly lower adjusted mean TSK-17-C score on POD3 compared to the control group (28.26 vs 36.13, respectively; adjusted mean difference, − 7.86; 95% CI, − 8.37 to − 7.35; P < 0.001). The intervention also led to a more improved pain trajectory (P=0.048 for time-by-group interaction) and superior cough capacity on POD3 (P < 0.001). The intervention was safe and well-tolerated.
Conclusion: An integrated psychological-behavioral intervention combining PMT and exposure therapy effectively reduces kinesiophobia, alleviates pain, and improves cough capacity in the early postoperative period for patients undergoing thoracic surgery. This nurse-led protocol provides a non-pharmacological approach that may enhance recovery and help mitigate the “pain-fear-avoidance” cycle.
Keywords: kinesiophobia, thoracic surgery, protection motivation theory, exposure therapy, postoperative recovery, pain management, randomized controlled trial
1Department of Respiratory and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan, Hubei Province, People’s Republic of China; 2Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 3Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xiao Wu; Sai Yang, Email wuxiao200707@163.com; yangsai@hust.edu.cn
Background: Kinesiophobia is a significant barrier to recovery after thoracic surgery. We aimed to determine the efficacy of an integrated intervention combining Protection Motivation Theory (PMT) and exposure therapy for reducing kinesiophobia and improving postoperative outcomes.
Methods: In this single-center, randomized, double-blind, controlled trial, we enrolled 144 patients with kinesiophobia (Tampa Scale for Kinesiophobia [TSK-17-C] score ≥ 37) following thoracoscopic pulmonary surgery. Participants were randomized 1:1 to receive either a structured PMT-based psychological and graded exposure-behavioral intervention on postoperative day 1 (POD1) (experimental group, n=72) or routine care with standard pain education (control group, n=72). The primary outcome was the TSK-17-C score on POD3.
Results: The experimental group exhibited a significantly lower adjusted mean TSK-17-C score on POD3 compared to the control group (28.26 vs 36.13, respectively; adjusted mean difference, − 7.86; 95% CI, − 8.37 to − 7.35; P < 0.001). The intervention also led to a more improved pain trajectory (P=0.048 for time-by-group interaction) and superior cough capacity on POD3 (P < 0.001). The intervention was safe and well-tolerated.
Conclusion: An integrated psychological-behavioral intervention combining PMT and exposure therapy effectively reduces kinesiophobia, alleviates pain, and improves cough capacity in the early postoperative period for patients undergoing thoracic surgery. This nurse-led protocol provides a non-pharmacological approach that may enhance recovery and help mitigate the “pain-fear-avoidance” cycle.
Keywords: kinesiophobia, thoracic surgery, protection motivation theory, exposure therapy, postoperative recovery, pain management, randomized controlled trial