Unravelling the pathway to postoperative frailty in patients undergoing cardiac surgery: the serial mediating roles of kinesiophobia and sedentary time from illness perception

Abstract Introduction Cardiac surgical patients are prone to develop frailty given their inherent risk profiles and the significant stress induced by surgery. According to the Common-Sense Model of Self-Regulation, patients can develop a threatening perception of illness that shapes subsequent emotional responses and illness behaviours considering the advanced cardiac conditions they experienced. Fear of movement (also known as kinesiophobia) associated with the perceived cardiac insufficiency and sedentary lifestyle may represent a potential psycho-behavioural pathway linking threatening illness perception and frailty in patients undergoing cardiac surgery. Purpose This study aimed to examine the association between illness perception and postoperative frailty among patients undergoing cardiac surgery, and the sequential mediating roles of kinesiophobia and sedentary time in explaining such relationship. Methods This was a multicentre prospective cohort study involving 267 patients undergoing coronary artery and/or valvular surgeries recruited from August 2023 to September 2024. Frailty of participants was assessed three months postoperatively. The mediating effects of kinesiophobia and sedentary time in the association between illness perception and postoperative frailty were analysed via serial mediation analysis using bootstrapping approach, controlling for preoperative frailty status, as well as various sociodemographic, clinical, and surgery-related factors that may affect patient’s frailty severity after surgery. Results Mean age of participants was 63.2±9.6 years, with 70% of them were male. After controlling for covariates, mediation analysis (Table 1) showed that a more threatening perception of illness had a significant direct impact on frailty three months after surgery (direct effect: 0.30, 95%CI: 0.18–0.67). Kinesiophobia and sedentary time mediated the relationship between illness perception and postoperative frailty both independently (indirect effect[kinesiophobia]: 0.24, 95%CI: 0.07–0.43; indirect effect[sedentary time]: 0.11, 95%CI: 0.02–0.25) and serially (indirect effect[kinesiophobia and sedentary time]: 0.13, 95%CI: 0.06–0.22). Conclusion A threatening illness perception had a direct impact on frailty after patients receiving cardiac surgery, and the association was partially mediated by kinesiophobia and sedentary time. Cognitive-behavioural interventions on changing maladaptive beliefs may be promising to promote healthy behaviours and reduce postoperative frailty among cardiac surgical patients.