Coping mechanisms of bullying survivors: Experiences of secondary school learners at Mamusa sub-district in the North West province, South Africa.

In recent years, with the advancement of minimally invasive thoracic surgery and the widespread adoption of Enhanced Recovery After Surgery (ERAS) protocols, video-assisted thoracoscopic surgery (VATS) has emerged as the primary modality for treating pulmonary diseases (). Compared with traditional thoracotomy, VATS entails less chest wall trauma and avoids significant neuromuscular injury. Nevertheless, the incidence of postoperative acute pain remains as high as 65% (). Despite the availability of multimodal analgesic strategies such as paravertebral nerve block, intercostal nerve block, and intravenous patient-controlled analgesia, the incidence of moderate-to-severe pain within the first 48 h postoperatively can still reach 15.6% (). Kinesiophobia is defined as an excessive, irrational fear of physical movement or activity, arising from heightened pain sensitivity triggered by injury or persistent pain (). Its development is closely intertwined with pain perception. Painful insults increase nociceptive sensitivity, which in turn reinforces fear-avoidance beliefs. Once kinesiophobia becomes established, patients often experience marked anxiety and depression; without appropriate management, this condition may ultimately culminate in a pathological state, diminished quality of life, and suboptimal postoperative recovery (). To date, research on postoperative kinesiophobia specifically in patients undergoing thoracoscopic lung surgery remains scarce in China, and standardized assessment and rehabilitation protocols for thoracic and abdominal surgical populations are still lacking (, ). Therefore, this study was designed to investigate the current status and influencing factors of postoperative kinesiophobia in VATS patients, with the aim of providing evidence for risk factor control, targeted intervention strategies, and postoperative rehabilitation guidance.