Latent classes and symptom network analysis of kinesiophobia in older adult patients with chronic obstructive pulmonary disease.

Abstract

Objective: To identify the latent classes of kinesiophobia in older adult patients with chronic obstructive pulmonary disease (COPD), analyze the symptom network structure of different classes, determine the core symptoms, and provide evidence for precision pulmonary rehabilitation interventions.

Methods: A convenience sample of 546 older adult COPD patients was recruited from the Department of Respiratory and Critical Care Medicine, Nantong Sixth People's Hospital, between March 2025 and April 2026. Participants completed a general information questionnaire, the Breathlessness Beliefs Questionnaire (BBQ), and a COPD symptom survey. Latent profile analysis was used to identify potential classes of kinesiophobia. Symptom networks for each subgroup were constructed using R software, and three centrality indices (strength, closeness, and betweenness) were calculated to determine core symptoms.

Results: The prevalence of kinesiophobia in older adult patients with COPD was 88.46%. Latent profile analysis identified two classes: a high-fear-somatic focus group (67.4%) and a lower-fear-activity avoidance group (32.6%). Symptom network analysis revealed that the core symptom was dyspnea (strength = 1.78) in the high-fear group, whereas fatigue (strength = 1.64) was the core symptom in the lower-fear group. The difference in network structure between the two groups was not statistically significant (P > 0.05).

Conclusion: Kinesiophobia in older adult patients with COPD exhibits population heterogeneity, with different core symptoms across subgroups. The findings of this study suggest that dyspnea deserves particular attention in the high-fear group, while fatigue deserves particular attention in the lower-fear group. Future longitudinal or interventional studies are needed to further verify the causal relationships between core symptoms and pulmonary rehabilitation participation, thereby informing the development of individualized pulmonary rehabilitation strategies.