Abstract
Kinesiophobia after pediatric fracture surgery can hinder early functional exercise and delay recovery. This quasi-experimental, non-synchronous controlled study evaluated a fear-avoidance-model (FAM)-guided game-based rehabilitation program in 151 school-aged children with elbow fractures admitted to a tertiary Grade-A children's hospital in Anhui Province, China, between April 2025 and March 2026. Using sequential historical-control allocation, 75 children admitted from April to September 2025 received routine nursing care and rehabilitation guidance, whereas 76 children admitted from October 2025 to March 2026 received routine care plus FAM-guided game-based rehabilitation. Kinesiophobia, pain, anxiety, and self-efficacy were assessed using the Tampa Scale for Kinesiophobia (TSK-17), Wong-Baker FACES Pain Rating Scale, State Anxiety Inventory (SAI), and General Self-Efficacy Scale (GSES) at admission, postoperative day 1, and discharge. Repeated-measures analysis of variance showed significant group × time interactions for all outcomes (TSK-17: P 2 = 0.729; pain: P = 0.00324, partial η2 = 0.039; anxiety: P 2 = 0.756; self-efficacy: P 2 = 0.558). The intervention group had lower kinesiophobia, pain, and anxiety scores and higher self-efficacy scores than the control group on postoperative day 1 and at discharge (all P < 0.05). At discharge, the between-group difference in TSK-17 score was 10.63 points (95% CI, 10.17-11.08), exceeding the prespecified minimal clinically important difference of 5 points. These findings indicate that FAM-guided game-based rehabilitation was associated with more favorable early postoperative kinesiophobia, pain, anxiety, and self-efficacy outcomes in school-aged children after elbow fracture surgery.