A Latent Profile and Network Analysis of Kinesiophobia in Patients After Total Joint Arthroplasty

Abstract Aim Based on the ystem-based Model of Stress, this study aimed to classify heterogeneous subgroups of kinesiophobia in patients following total joint arthroplasty using latent profile analysis, and to identify the core symptoms within each subgroup through network analysis. Methods The present study employed a cross-sectional survey design, conducted between April 2025 and June 2026, involving 250 patients after hip or knee arthroplasty at an orthopedic center. The latent profile analysis and receiver operating characteristic curve analysis were performed to identify subgroups of kinesiophobia and to determine cutoff values. Network analysis was conducted to elucidate the interrelationships among kinesiophobia, pain intensity, pain catastrophizing, rehabilitation self-efficacy, and social support, using each scale’s total score as a node. Results In 250 patients after hip or knee arthroplasty, the mean kinesiophobia score was37.654.45, with a prevalence of 48.8%. Two distinct subgroups were identified: “low kinesiophobia-activity acceptance group”（73.6%）and a “high kinesiophobia-fear avoidance group”（26.4%）. Binary logistic regression revealed that higher preoperative physical activity frequency (≥4 times/week) [OR = 7.484, P = 0.045], longer daily pain duration [OR = 2.723, P = 0.010], higher Oswestry Disability Index scores [OR = 1.278, P < 0.001], and negative coping style [OR = 2.142, P = 0.002] were independent risk factors for high Kinesiophobia, whereas higher rehabilitation self-efficacy [OR = 0.842, P < 0.001] was a protective factor.In the “high kinesiophobia-fear avoidance group”, pain catastrophizing(PCS) emerged as the core dimension of kinesiophobia（ r strength =1.424， r closeness =1.224， r betweenness =1.565）. Conversely, in the “low kinesiophobia-activity acceptance group”, rehabilitation self-efficacy(SER)emerged as the core dimension of kinesiophobia（ r strength =1.609， r closeness =1.007， r betweenness =1.095）. Network comparison tests revealed a statistically significant difference in network structure between the two subgroups ( M = 0.29, P = 0.022), but no significant difference in global strength ( S = 3.27, P = 0.078).Conclusion Patients after total joint arthroplasty display heterogeneous symptom characteristics across different latent profiles of kinesiophobia, with fundamental differences in psychological network structures between subgroups rather than in overall connectivity strength. For the high‑kinesiophobia‑fear avoidance subgroup, challenging and restructuring catastrophic thinking is central to reducing kinesiophobia, whereas for the low‑kinesiophobia‑activity acceptance subgroup, enhancing rehabilitation confidence should be regarded as a key intervention component for sustaining rehabilitation behaviors.