Comparison of Kinesiophobia, Upper Limb Function, and Grip Strength in Patients with Pacemakers and Coronary Artery Disease

Abstract

BACKGROUND: To compare kinesiophobia, shoulder range of motion (ROM), functional disability, and handgrip strength (HGS) between patients with cardiac pacemakers and those with stable coronary artery disease (CAD). METHODS: This cross-sectional study enrolled 60 individuals aged ≥50 years with preserved left ventricular systolic function, including 30 patients with standard left-sided cardiac pacemakers and 30 individuals with CAD. Kinesiophobia was assessed using the validated Turkish version of the Tampa Scale for Kinesiophobia-Heart (TSK-Heart). Shoulder ROM, HGS, and upper limb function [quick disabilities of the arm, shoulder, and hand (QuickDASH)] were evaluated using standardized clinical protocols. Analysis of covariance was used for between-group comparisons. RESULTS: The TSK-Heart scores were similar between the pacemaker and CAD groups, with no statistically significant difference (P = .061). Internal rotation of the left shoulder was significantly more limited in the pacemaker group (P = .031, Cohen's d = 0.58). No significant differences were observed in other shoulder ROM parameters, QuickDASH scores, or HGS between the groups. CONCLUSION: Kinesiophobia levels were similarly elevated in patients with pacemakers and those with CAD, suggesting that fear of movement is a generalized phenomenon across chronic cardiac populations rather than a device-specific issue. The selective internal rotation limitation observed exclusively in pacemaker recipients highlights the importance of targeted musculoskeletal assessment during clinical follow-up. Recognition of such functional impairments, alongside awareness of elevated kinesiophobia, is critical for comprehensive patient management.