The relationship between career adaptability, job search self-efficacy, and EFL college students' employment anxiety: the perspective of proactive personality.

Spinal fragility fractures, especially osteoporotic vertebral compression fractures (OVCF), have a high incidence among the older adults. This is an important cause of disability and decreased quality of life in this population (, ). Although surgery can relieve pain and restore vertebral height (), postoperative patients often experience fear of falling (FOF) or kinesiophobia due to pain (, ), decreased balance ability, and concerns about re-fracture. This is manifested as avoidance of daily activities and rehabilitation exercises, seriously affecting the level of physical activity and functional recovery (). Fear of falling (FoF) is defined as a psychological state characterized by reduced confidence and self-efficacy in performing activities, accompanied by activity avoidance behaviors, driven by persistent worry about experiencing a fall despite having the physical capability to do so (). This construct can be explained within the framework of the fear-avoidance model, wherein prior fall experiences or impaired balance are perceived as threats, triggering anxiety and low fall-related self-efficacy, which in turn lead to activity avoidance, muscle weakness, and functional decline (). FoF has been widely reported in various musculoskeletal pain disorders; for instance, patients with fibromyalgia syndrome often exhibit significant FoF due to impaired balance control and widespread pain, which is closely associated with restricted activity. Similarly, patients with inflammatory arthritis, such as rheumatoid arthritis, report FoF prevalence rates ranging from approximately 16% to over 60%, attributed to joint deformities, muscle weakness, and previous fall history. Consequently, FoF represents a critical psychological barrier affecting participation in therapeutic exercise and overall functional prognosis (, ). Epidemiological studies have shown that fear of falling is common among the older adults, particularly in patients with fragility fractures such as OVCF. Fear of falling is not only associated with an increased risk of falling again but also significantly reduces patients’ activity participation and quality of life (, ).