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

Sun Zhiyan; Pan Aihong; Zhang Yun; Zhou Xun; Zheng Menghan; Zhao Yunfeng

doi:10.16016/j.2097-0927.202607002

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

Clinical Medicine | 更新时间：2026-10-01

- Three latent profiles of stress adaptation and their gradient association with kinesiophobia in elderly patients with chronic obstructive pulmonary disease: a cross-sectional study
- Journal of Army Medical University Vol. 48, Issue 18, Pages: 2645-2655(2026)
- 作者机构：
  
  1.安徽中医药大学护理学院，安徽合肥
  2.合肥市第一人民医院办公室，安徽合肥
  3.皖南医科大学研究生院，安徽芜湖
  4.徐州医科大学附属口腔医院，江苏徐州
- 作者简介：
  
  Pan Aihong，E-mail：281851862@qq.com
- 基金信息：
  
  the Scientific Research Project of Anhui Provincial Health Commission(AHWJ2023A20195);the Health Applied Medical Research Project of Hefei(HWK2025YB004)
- DOI：10.16016/j.2097-0927.202607002
  CLC： R395;R563.9;R592
- Received：01 July 2026，
  
  Revised：2026-07-30，
  
  Accepted：06 August 2026，
  
  Published：30 September 2026
- 稿件说明：
移动端阅览
孙芷妍，潘爱红，张昀，等.老年慢阻肺患者压力适应三类分型且与运动恐惧水平呈梯度差异：一项横断面研究［J］.陆军军医大学学报，2026，48（18）：2645-2655.DOI：10.16016/j.2097-0927.202607002.

Sun Z Y，Pan A H，Zhang Y，et al.Three latent profiles of stress adaptation and their gradient association with kinesiophobia in elderly patients with chronic obstructive pulmonary disease： a cross-sectional study［J］.J Army Med Univ，2026，48（18）：2645-2655.DOI：10.16016/j.2097-0927.202607002.
孙芷妍，潘爱红，张昀，等.老年慢阻肺患者压力适应三类分型且与运动恐惧水平呈梯度差异：一项横断面研究［J］.陆军军医大学学报，2026，48（18）：2645-2655.DOI：10.16016/j.2097-0927.202607002. DOI：

Sun Z Y，Pan A H，Zhang Y，et al.Three latent profiles of stress adaptation and their gradient association with kinesiophobia in elderly patients with chronic obstructive pulmonary disease： a cross-sectional study［J］.J Army Med Univ，2026，48（18）：2645-2655.DOI：10.16016/j.2097-0927.202607002. DOI：

摘要

目的

慢性阻塞性肺疾病（COPD）患者长期承受身心压力，易诱发不同程度的运动恐惧。压力适应是维持身心功能稳定的重要心理资源，既往研究多将其视为单一连续变量，忽视了群体内适应模式的异质性，且缺乏不同压力适应类型与运动恐惧关系的比较。本研究旨在识别老年COPD患者压力适应的潜在剖面类别，分析影响因素，并比较不同压力适应类型与运动恐惧水平的关联差异，为分层干预提供理论依据。

方法

采用横断面研究设计方案，以便利抽样法于2026年4—6月抽取合肥市第一人民医院呼吸内科253例老年COPD住院患者，使用一般资料调查表、压力适应量表（stress adaptation scale，SAS）、坦帕运动恐惧量表（tampa scale for kinesiophobia， TSK）和社会支持评定量表（social support rating scale， SSRS）进行调查。潜在剖面分析识别压力适应的类别，单因素分析及多元Logistic回归分析不同潜在剖面的影响因素及各类别运动恐惧水平的差异。

结果

253例老年COPD患者压力适应量表得分为35.00（30.00，40.00）分。潜在剖面分析将患者压力适应分为3个类别：低适应-恢复艰难压抑型（C1，80例，31.62%）、中适应-领悟复原迟缓型（C2，106例，41.90%）、高适应-灵活回弹获益型（C3，67例，26.48%）。模型拟合良好（AIC=4 644.510，BIC=4 792.912，aBIC=4 659.764，熵值=0.954，LMRT及BLRT均

0.001）。多分类Logistic回归分析显示：以C1为参照，年龄60~69岁（C2

C1：

=7.295；C3

C1：

=14.594，均

0.05）和居住地为城镇（C2

C1：

=3.885；C3

C1：

=5.330，均

0.05）是C2和C3的共同独立保护因素；以C1为参照，患病时长

5年（

=6.878，95%

：1.193~39.646，

=0.031）及社会支持得分较高（

=1.784，95%

：1.403~2.268，

0.001）是C3的独立保护因素；以C3为参照，文化程度为初中（

OR=

23.478，95%

：6.079~90.674，

0.001）、小学及以下（

=7.395，95%

：1.900~28.776，

=0.004）及自理能力为部分自理（

=7.205，95%

：1.223~42.464，

=0.029）是C2的独立危险因素。C1、C2和C3组的运动恐惧得分分别为：43.00（40.00，46.00）、40.00（35.75，42.00）和35.00（33.00，37.00）分，差异有统计学意义（

=75.817，

0.001）；运动恐惧检出率（TSK

37分）分别为83.8%、63.2%和17.9%，差异有统计学意义（

=67.024，

0.001），呈现随压力适应水平升高而逐级下降的趋势。

结论

老年COPD患者压力适应可分为：低适应-恢复艰难压抑型、中适应-领悟复原迟缓型和高适应-灵活回弹获益型3类。年龄、居住城镇或农村、患病时长、自理能力、文化程度及社会支持是压力适应类别的独立影响因素；不同类型的运动恐惧水平和检出率存在显著梯度差异。应依据压力适应分型实施分层临床干预策略：C1患者应强化症状管理与心理疏导，降低其运动恐惧；C2患者应引导其深度反思与成长领悟，并关注其运动恐惧的缓解；C3患者可发挥其同伴支持作用，并维持其低运动恐惧水平。

Abstract

Objective

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.

Methods

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.

Results

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

https://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=120685497&type=

https://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=120685496&type=

1.86266661

2.62466669

=80

31.62%)

moderate‑adaptation with delayed comprehension and recovery (Class 2

https://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=120685497&type=

https://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=120685496&type=

1.86266661

2.62466669

=106

41.90%)

and high‑adaptation with flexible and resilient benefits (Class 3

https://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=120685497&type=

https://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=120685496&type=

1.86266661

2.62466669

=67

26.48%). The model demonstrated good fit (AIC=4 644.510

BIC=4 792.912

aBIC=4 659.764

entropy=0.954

LMRT and BLRT both

0.001). Multinomial logistic regression analysis revealed that

with C1 as the reference

aged 60-69 years (C2

C1:

=7.295; C3

C1:

=14.594

both

0.05) and urban residence (C2

C1:

=3.885; C3

C1:

=5.330

both

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 (

=6.878

95%

: 1.193 to 39.646

=0.031) and higher social support score (

=1.784

95%

: 1.403 to 2.268

0.001) were independent protective factors for C3. With C3 as reference

education level of junior high school (

=23.478

95%

: 6.079 to 90.674

0.001) and primary school or below (

=7.395

95%

: 1.900 to 28.776

=0.004)

as well as partial self‑care ability (

=7.205

95%

: 1.223 to 42.464

=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 (

=75.817

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 (

²=67.024

0.001) and a progressive decline with increasing stress adaptation.

Conclusion

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.

关键词

Keywords

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