Identifying potential action points for reducing kinesiophobia among atrial fibrillation patients: a network and DAG analysis.

Purpose: Kinesiophobia is prevalent among patients with atrial fibrillation (AF), leading to a notable decrease in exercise tolerance and quality of life (QoL). AF-related kinesiophobia encompasses a complex cascade reaction, influenced by psycho-physiological and behavioral factors. To investigate the complex interconnections associated with kinesiophobia among AF patients and identify potential intervention points for its management.

Methods: From June 2021 to November 2022, we collected data through paper surveys, using convenience sampling to invite patients with AF. 541 AF patients were included in this study. Data were collected using Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Atrial Fibrillation Effect on Quality-of-Life (AFEQT), the Brief Illness Perception Questionnaire (BIPQ), and Medical Coping Modes Questionnaire (MCMQ), respectively. Network analysis and directed acyclic graphs (DAG) were used to visualize the intricate relationships of the factors.

Results: The network structure identifies "Avoidance of Exercise" as a central node, which, alongside "Illness Perception" and "Resignation," acting as bridges that link and activate other factors of AF-related kinesiophobia. The DAG suggests that AF symptoms, located upstream, may act as a trigger, initiating a cascade effect impacting illness perception and coping styles.

Conclusions: "AF symptoms," along with psychological factors such as "illness perception," and "coping styles," may serve as potential action points to reduce AF-related kinesiophobia and ultimately improve the overall QoL for AF patients.