Family Function and Kinesiophobia in Patients after Hip Replacement Surgery: A Cross-Sectional Study on the Mediating Role of Illness Perception

Summary

Family-provided social support may reduce postoperative kinesiophobia through illness perception in patients after hip replacement surgery. These findings support the development of family-centered rehabilitation strategies to improve postoperative recovery and functional outcomes.

Abstract

This study investigated the association between family function and kinesiophobia in patients after hip replacement surgery and examined whether illness perception mediated this relationship. A total of 200 postoperative patients were included. On postoperative day 3, family function, illness perception, and kinesiophobia were assessed using the Family APGAR Index, Brief Illness Perception Questionnaire (BIPQ), and Tampa Scale of Kinesiophobia (TSK-17), respectively. Descriptive, univariate, and correlation analyses were conducted using SPSS software. Mediation analysis was performed using Model 4 of Hayes’ PROCESS 3.5 macro. Among the 200 participants, 59% experienced kinesiophobia. Family function was negatively correlated with kinesiophobia, whereas illness perception was positively correlated with kinesiophobia (r = -0.678 and 0.690, respectively; p < 0.001). Higher levels of family support were associated with lower levels of movement-related fear. Illness perception partially mediated the relationship between family function and kinesiophobia (β = -0.208, p < 0.05). The prevalence of postoperative kinesiophobia among patients after hip replacement surgery was high. The findings suggest that better family functioning may be associated with lower kinesiophobia, mediated by more positive illness perceptions. These results indicate that family support and cognitive appraisal should be considered when developing postoperative rehabilitation interventions.

Introduction

Hip replacement surgery (HRS) is commonly used to treat end-stage hip joint diseases. The procedure replaces the damaged joint with a prosthetic implant to relieve pain, correct deformity, and restore hip function. With advances in surgical techniques and perioperative management, HRS has become one of the most effective orthopedic procedures¹. Nearly 100,000 hip replacement procedures were performed in Italy in 2018², and the number of procedures is projected to continue increasing in both the United States and the United Kingdom^3,4. However, successful postoper....

Protocol

This study was approved by the Institutional Review Board of Guizhou Medical University (Approval No.: 2024 Ethical Review No. 157). All participants received a detailed explanation of the study procedures before enrollment and provided written informed consent. All procedures were conducted in accordance with the Declaration of Helsinki and relevant institutional ethical guidelines.

1. Study design

A cross-sectional study design was adopted, and convenience sampling was conducted at three tertiary general hospitals in Guizhou Province between November 2024 and June 2025. These hospitals were selected because of th....

Results

1. Descriptive findings: Scores on family function, illness perception, and kinesiophobia

Among the 200 HRS patients, the mean kinesiophobia score was 43.15 ± 9.64. This indicates a high prevalence rate of 59%. The family function score and illness perception score averaged 6.27 ± 2.34 points. Illness perception was represented by the weighted index of its cognitive and emotional components, which yielded an average score of 40.32 ± 9.59.

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Discussion

During the postoperative rehabilitation period, patients undergoing hip replacement surgery often experience reduced self-care ability and increased dependence on family caregivers. Therefore, this study examined the relationships among family function, illness perception, and postoperative kinesiophobia.

The findings demonstrated that better family function was associated with lower levels of illness perception and kinesiophobia. Family members represent an important source of emotional and i.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Broadbent et al. [25]	Standard scale	Measurement of illness perception
Smilkstein G. [23]	Standard scale	Assessment of family function
IBM Corp. (Armonk, NY, USA)	Version 27.0; RRID: SCR_002865	Descriptive and inferential statistics
Research Team (Pilot-tested)	N/A	Collection of demographic and clinical data
Microsoft Corp. (Redmond, WA, USA)	Microsoft 365	Data entry and management
Andrew F. Hayes	Version 3.5; RRID: SCR_021369	Mediation analysis
Kori et al. [28]	Standard scale	Evaluation of kinesiophobia