Family fear of pain linked to shorter walking distance after thoracic surgery

Patients recovering from thoracic surgery tend to walk shorter distances on the third day after their operation when their family members hold stronger pain-related fear beliefs, according to a prospective paired study published in BioPsychoSocial Medicine. The finding suggests that the attitudes of the people around a patient, and not only the patient’s own fears, may be tied to early mobilization after surgery.

Researchers recruited 180 patient–family member pairs from the thoracic surgery department of a tertiary hospital between March 2025 and October 2025. Fifteen patients were excluded after postoperative transfer to the intensive care unit, leaving 165 pairs for postoperative follow-up, and 157 pairs with complete core variables were included in the main analysis. The study used a preoperative–postoperative two-timepoint paired prospective design.

One day before surgery, both patients and their family members completed the Fear of Pain Questionnaire-9, a brief measure of pain-related fear beliefs. On postoperative day 3, patients completed the Tampa Scale for Kinesiophobia-11, the Perceived Overprotection Scale-6, and a Numeric Rating Scale for pain, and they performed a 2-minute walk test to measure early mobilization function.

The data showed that patients’ preoperative fear of pain scores averaged 25.64, significantly higher than the family members’ average of 22.69, and the two scores were positively correlated. The average 2-minute walk distance was 82.45 meters.

After controlling for demographic and clinical factors, both patient and family fear beliefs were independently and negatively associated with walking distance. Each point on the family fear measure was associated with roughly one meter less walking distance, and the patient’s own fear beliefs showed a similarly sized negative association. The interaction between patient and family member fear beliefs was not statistically significant, indicating that the two beliefs contributed independently rather than amplifying each other.

The study also examined perceived overprotection, the degree to which patients felt their family members were being overprotective. In the adjusted model, the estimated statistical indirect association involving perceived overprotection was −0.353, with a 95 percent confidence interval from −0.719 to −0.012, accounting for 26.9 percent of the total association between family fear beliefs and walking distance. When the analysis was additionally adjusted for the patient’s own fear beliefs, the estimated indirect association was −0.378, with a confidence interval from −0.749 to −0.043.

The authors emphasize that these are observational associations and cannot be interpreted causally. The design measured perceived overprotection and walking distance on the same day, which precludes any conclusion about the direction of the relationship, and the statistical mediation analysis describes an indirect association rather than a demonstrated causal mechanism. The study also reflects a single tertiary hospital and a specific surgical population, which limits how far the results can be generalized.

Subject of Research: Associations of patient and family pain-related fear beliefs with early mobilization after thoracic surgery

Article Title: Associations of patient–family pain-related fear beliefs with early mobilization function after thoracic surgery: the role of perceived overprotection

Article References: Li, J., Luo, Y., Zheng, Y., He, Z., He, J., & Wu, X. (2026). Associations of patient–family pain-related fear beliefs with early mobilization function after thoracic surgery: the role of perceived overprotection. BioPsychoSocial Medicine. https://doi.org/10.1186/s13030-026-00374-y

Image Credits: AI Generated

DOI: 10.1186/s13030-026-00374-y

Keywords: thoracic surgery, pain-related fear, family caregivers, early mobilization, kinesiophobia, perceived overprotection, walking distance, postoperative recovery, prospective study, fear avoidance, Associations, patient