Kinesiophobia in patients with diabetic foot ulcers: A multicenter latent profile analysis of phenotypic characteristics and determinants

PURPOSE: This study aimed to identify the distinct latent profiles of exercise fear trajectories and to explore the factors influencing membership in these profiles among patients with DFU. METHODS: A multicenter, cross-sectional study was conducted from March 2025 to August 2025. Using convenience sampling method, 179 patients with DFU were recruited from five tertiary hospitals in China. Participants completed a battery of questionnaires, including a General Information Form, the Tampa Scale for Kinesiophobia, the Exercise Self-Efficacy Scale, the Mini-Nutritional Assessment, and the Activity of Daily Living Scale. Latent profile analysis was employed to identify distinct subgroups of exercise-related fear. Univariate analysis and multivariate logistic regression were used to determine factors influencing profile membership. RESULTS: The response rate was 98.90%. Latent profile analysis revealed three distinct classes of exercise fear: "low fear-functional adaptation" (n = 40,22.30%), "moderate fear-cautious engagement" (n = 58,32.40%), and "high fear-exercise avoidance" (n = 81,45.30%). Multivariate logistic regression identified that poorer nutritional status、self-paid medical expenses、advanced age、comorbid chronic conditions、higher Wagner grade、and a greater number of DFU-related hospitalizations in the preceding year were significant factors associated with an increased likelihood of belonging to the more severe fear profiles (all P < .05). CONCLUSION: The exercise-related fear trajectory in DFU patients exhibits significant heterogeneity, categorized into three distinct profiles. Healthcare providers should routinely assess patients for kinesiophobia and identify patients' specific profile. Tailored interventions, including nutritional support, psychological counseling for those with financial or comorbidity burdens, and graded exposure exercise protocols for high-fear levels, are recommended to mitigate fear and promote safe physical activity participation.