Three latent profiles of stress adaptation and their gradient association with kinesiophobia in elderly patients with chronic obstructive pulmonary disease: a cross-sectional study

Chronic obstructive pulmonary disease (COPD) patients endure prolonged physical and psychological stress, which predisposes them to varying levels of kinesiophobia. Stress adaptation serves as a critical psychological resource for maintaining the stability of physical and mental functions. Previous studies have predominantly treated it as a single continuous variable, overlooking the heterogeneity of adaptation patterns within the population, and lacking comparisons of the relationships between different stress adaptation types and kinesiophobia. This study aims to identify the latent classes of stress adaptation in elderly COPD patients, analyze their influencing factors, and compare the differential associations between distinct stress adaptation types and kinesiophobia levels, thereby providing a theoretical basis for stratified interventions.

A cross-sectional study was conducted using convenience sampling. A total of 253 elderly inpatients with COPD admitted to Department of Respiratory Medicine of Hefei First People's Hospital between April and June 2026. General information questionnaire, Stress Adaptation Scale (SAS), Tampa Scale for Kinesiophobia (TSK), and Social Support Rating Scale (SSRS) were applied for survey. Latent profile analysis (LPA) was performed to identify latent classes of stress adaptation. Univariate and multinomial logistic regression analyses were employed to explore the influencing factors of latent profiles and to compare the differences in kinesiophobia levels across classes.

The median SAS score was 35.00 (30.00, 40.00) among the 253 elderly COPD patients. LPA identified 3 latent classes of stress adaptation: low-adaptation with difficult and suppressed recovery (Class 1, C1, n=80, 31.62%), moderate-adaptation with delayed comprehension and recovery (Class 2, C2, n=106, 41.90%), and high-adaptation with flexible and resilient benefits (Class 3, C3, n=67, 26.48%). The model demonstrated good fit (AIC=4644.510, BIC=4792.912, aBIC=4659.764, entropy=0.954, LMRT and BLRT both P<0.001). Multinomial logistic regression analysis revealed that, with C1 as the reference, aged 60-69 years (C2 vs C1: OR=7.295; C3 vs C1: OR=14.594, both P<0.05) and urban residence (C2 vs C1: OR=3.885; C3 vs C1: OR=5.330, both P<0.05) were common independent protective factors for C2 and C3, conversely indicating that older age and rural residence were independent risk factors for C1. With C1 as reference, disease duration <5 years (OR=6.878, 95%CI: 1.193 to 39.646, P=0.031) and higher social support score (OR=1.784, 95%CI: 1.403 to 2.268, P<0.001) were independent protective factors for C3. With C3 as reference, education level of junior high school (OR=23.478, 95%CI: 6.079 to 90.674, P<0.001) and primary school or below (OR=7.395, 95%CI: 1.900 to 28.776, P=0.004), as well as partial self-care ability (OR=7.205, 95%CI: 1.223 to 42.464, P=0.029) were independent risk factors for C2. The TSK scores for C1, C2 and C3 were 43.00 (40.00, 46.00), 40.00 (35.75, 42.00) and 35.00 (33.00, 37.00), respectively, with statistically significant differences (H=75.817, P<0.001). The detection rates of kinesiophobia (TSK score >37) were 83.8%, 63.2% and 17.9% for C1, C2 and C3, respectively, showing a significant between-group difference (χ²=67.024, P<0.001) and a progressive decline with increasing stress adaptation.

Stress adaptation in elderly COPD patients is generally at a moderate level with marked heterogeneity. Age, residence, disease duration, self-care ability, education level, and social support are independent influencing factors for stress adaptation classes, and significant gradient differences are observed in kinesiophobia levels and detection rates across the 3 classes. These findings suggest that clinical interventions should be implemented based on stress adaptation classes: for C1 patients, symptom management and psychological counseling should be strengthened to reduce kinesiophobia; for C2 patients, deep reflection and growth-oriented comprehension should be facilitated with attention to kinesiophobia alleviation; and for C3 patients, peer support should be leveraged, while their low kinesiophobia level should be maintained.