Targeting Kinesiophobia After Thoracic Surgery with an Integrated Protection Motivation and Exposure Intervention: A Randomized Controlled Trial

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.