The Fear Of Movement And Associated Factors In Patients With Chronic Heart Failure Using The Fear-Avoidance Model

Objectives:The aims of this study are to investigate the prevalence of the fear of movement in chronic heart failure patients and to explore the factors associated with fear of movement using the Fear-Avoidance Model.These may help to develop targeted intervention strategies,to reduce the level of fear of movement in patient with chronic heart failure,and further increase the patients' activity participation level,and improve the prognosis of patients with heart failure.Methods:This is a cross-sectional study using a convenient sampling method.From November 2018 to October 2019,305 patients with chronic heart failure were enrolled in cardiovascular units of a tertiary hospital.Data were collected with the Self-designed general information questionnaire,the Tampa Scale for Kinesiophobia Heart,Brief Fatigue Inventory,Baseline Dyspnea Index,Brief Pain Inventory,Cardiac Anxiety Questionnaire,Self-efficacy for Exercise,MacArthur Scale of Subjective Socioeconomic Status,Self-designed objective socioeconomic status questionnaire and Social Support Rating Scale.These scales were used to evaluate the level of fear of movement and its associated factors in patients with heart failure.The IBM SPSS 25.0 software package was used to analyze the data,including characteristics comparison,correlation analysis and establishment of the multiple linear regression models.Results:1.The average score for fear of movement in patients with chronic heart failure was(39.45±6.91)with a range of 25?59.Out of the 305 patients with chronic heart failure,178(58.4%)patients had significant fear of movement symptoms(the scores of the Tampa Scale for Kinesiophobia Heart?38 points).2.The general characteristics of patients with chronic heart failure and the relationship with fear of movementThe patients who were women,with a history of hospitalization for heart disease,with the duration of heart failure? 6 months and with the New York Heart Association(NYHA)functional class III showed higher level of fear of movement than the patients who were men,without history of hospitalization for heart disease,with the duration of heart failure<6 months,and with the NYHA functional class II.3.The painful experiences factors,psychological factors and environmental factors of patients with chronic heart failure and the relationship with fear of movementPainful experiences factors:the average score for fatigue was(3.46±2.44),and it was positively correlated with the score for fear of movement(r=0.344,P<0.001).The average score for dyspnea was(3.63±1.74),and it was negatively correlated with the score for fear of movement(r=-0.249,P<0.001).A total of 168 patients(55.1%)experienced pain symptoms,and the patients who had higher levels of pain symptoms had greater levels of fear of movement compared with those without pain symptoms(P=0.007).Psychological factors:the average score for cardiac anxiety was(27.38±8.17),and it was positively correlated with the score for fear of movement(r=0.418,P<0.001).The average score for self-efficacy for exercise was(35.22±8.06),and it was negatively correlated with the score for fear of movement(r=-0.435,P<0.001).Environmental factors:The average score for subjective socioeconomic status was(9.66±3.47),and it was negatively correlated with the score for fear of movement(r=-0.224,P<0.001).Among the objective socioeconomic status factors,the patients who were with lower educational level,not in employment status and lower monthly income had higher levels of fear of movement(P<0.01).The average score for social support was(39.93±4.64),and it was negatively correlated with the score for fear of movement(r=-0.125,P=0.029).4.The results of the multiple regression analysis of fear of movement in patients with chronic heart failureThe factors associated with fear of movement in patients with chronic heart failure were fatigue,cardiac anxiety,self-efficacy for exercise,subjective socioeconomic status,objective socioeconomic status factors(educational level,employment status),and the NYHA functional class.Seven variables accounted for 42.4%of the variance in fear of movement in patients with chronic heart failure(adjusted R2=0.424).Conclusions1.Patients with chronic heart failure have a higher level of fear of movement,and more than half of them have significant fear of movement symptoms.2.The positive factors of fear of movement in patients with chronic heart failure were fatigue,cardiac anxiety,unemployment status and the NYHA functional class,and the negative factors of fear of movement were self-efficacy for exercise,subjective socioeconomic status and educational level.3.Clinical health-care providers should evaluate fear of movement in patients with chronic heart failure in time,and develop intervention strategies to reduce the level of patients' fear of movement according to the above painful experiences factors,psychological factors and environmental factors.