Shuyi Zhu,1 Yanxin Xu,1 Lin Wang,2 Jing Chen,1 Aoxiang Luo1 

1School of Nursing, Guangdong Pharmaceutical University, Guangzhou, Guangdong, 510310, People’s Republic of China; 2Department of Spinal Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, 510317, People’s Republic of China

Correspondence: Aoxiang Luo, School of Nursing, Guangdong Pharmaceutical University, No. 283 Jiang-Hai Lane, Haizhu District, Guangzhou, Guangdong, 510310, People’s Republic of China, Email zhenjun01@163.com

Background: Kinesiophobia presents a significant barrier to rehabilitation across multiple conditions. While cognitive behavioral therapy (CBT) holds potential for addressing phobic responses, its specific efficacy against kinesiophobia requires clarification.
Purpose: To systematically evaluate CBT’s efficacy in reducing kinesiophobia among adults.
Methods: Following Cochrane guidelines, two independent reviewers searched six international databases (PubMed, Cochrane Library, Embase, EBSCO, Web of Science, Scopus) and four Chinese databases (SinoMed, CNKI, VIP, WanFang) for randomized controlled trials (RCTs) on CBT interventions targeting kinesiophobia, from inception through November 2024. Independent dual review was conducted for study selection, data extraction, and quality assessment (Cochrane Risk of Bias tool). Random-effects meta-analyses were performed using RevMan 5.4 and Stata 12, with heterogeneity quantified by I² statistics.
Results: Eight trials with 938 participants were included. CBT demonstrated significantly greater reduction in kinesiophobia scores versus controls (MD=− 5.67, [95% CI:− 6.99, − 4.35], P< 0.001). Notably, effects were more pronounced for lumbar conditions (MD=− 6.97, 95% CI [− 9.97, − 3.96], P< 0.01). Compared with CBT combined with other therapies (MD=− 5.23, 95% CI [− 7.95, − 2.51], P< 0.01), monotherapy CBT demonstrates greater superiority(MD=− 5.96, 95% CI [− 7.66,-4.26], P< 0.01). In terms of follow-up duration, medium and long-term (3 months < follow-up time ≤ 6 months) (MD=− 8.61, 95% CI [− 9.72,-7.50], P< 0.01), 6 months < follow-up time ≤ 12 months (MD=− 11.63, 95% CI [− 13.41,-9.84], P< 0.01) achieves better outcomes in reducing patients’ kinesiophobia levels than short-term (follow-up time ≤ 3 months) (MD=− 7.69, 95% CI [− 9.47,-5.90], P< 0.01).
Conclusion: This meta-analysis provides robust evidence that CBT effectively reduces kinesiophobia, particularly as monotherapy for lumbar conditions with sustained follow-up. Clinicians should prioritize CBT implementation to enhance recovery. While results are compelling, confirmatory trials with rigorous methodology and adequate power are warranted.

Keywords: kinesiophobia, cognitive behavioral therapy, meta-analysis, randomized controlled trials