The effect of pain-related fear on postoperative pain and difficulty during mobilization in patients undergoing total hip replacement

This descriptive study aimed to examine the effect of pain-related fear on pain and difficulty levels during the first postoperative mobilization in patients undergoing total hip replacement and to provide updated contributions to the literature. The study was carried out between October 18, 2024, and March 21, 2025, in the orthopedic and traumatology inpatient wards of a city hospital located on the European side of Istanbul. A total of 75 patients, determined through G*Power analysis (version 3.1), who met the inclusion criteria and agreed to participate voluntarily, constituted the study sample. Ethical approval was obtained from the Non-Invasive Clinical Research Ethics Committee of Istanbul University-Cerrahpaşa, in addition to institutional permissions and authorizations from the developers who adapted the scales into Turkish. Data collection was performed through face-to-face interviews using the "Patient Information Form," "Pain Anxiety Symptoms Scale-III (PASS-III)," and the "Patient Mobility and Observer Mobility Scales." Patients' vital signs during mobilization were documented using the Vital Signs Monitoring Chart. Statistical analyses were conducted with SPSS version 27 (IBM Corp., Armonk, NY, USA), with results evaluated at a 95% confidence interval and a significance level of p<0.05 (two-tailed). Findings revealed that patients had high levels of pain-related fear, with mean total and subscale scores of 100.11±16.32 for total fear, 38.12±4.49 for severe pain-related fear, 30.89±7.03 for minor pain-related fear, and 31.09±6.86 for medical pain-related fear. The mean score of the Patient Mobility Scale, reflecting pain and difficulty during the first mobilization, was 104.11±13.71, whereas the mean Observer Mobility Scale score, indicating dependency, was 16.61±1.84. Significant positive correlations were observed between patients' pain and difficulty levels and their total pain-related fear (r=0.382; p<0.001), severe pain-related fear (r=0.365; p<0.001), minor pain-related fear (r=0.348; p=0.001), and medical pain-related fear (r=0.312; p=0.006). Likewise, dependency levels assessed with the Observer Mobility Scale were significantly associated with total pain-related fear (r=0.436; p<0.001), minor pain-related fear (r=0.471; p<0.001), and medical pain-related fear (r=0.418; p=0.006), though no significant association was found with severe pain-related fear (p>0.05). In addition, a significant positive correlation was determined between patients' pain and difficulty levels (Patient Mobility Scale) and dependency levels (Observer Mobility Scale) during the first mobilization (r=0.465; p<0.001). In conclusion, the study demonstrates that patients undergoing total hip replacement exhibit high levels of pain-related fear, which significantly contributes to increased pain, difficulty, and dependency during the early mobilization process. These findings highlight the importance of addressing pain-related fear in perioperative care to facilitate smoother postoperative recovery and promote patient independence.