Despite the importance of activity for rehabilitating patients with rheumatic and musculoskeletal diseases (RMDs), the activity levels remain suboptimal in many patients. This is partly due to kinesiophobia and avoidance behaviors triggered by concerns about pain or joint damage. This systematic review aimed to synthesize the available evidence to identify factors associated with kinesiophobia in patients with RMDs.

We searched 11 databases (PubMed, Web of Science, CINAHL, Cochrane Library, EMBASE, PsycINFO, Scopus, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP, SinoMed) from the time of database inception to October 11, 2025. Eligible studies were English/Chinese articles reporting factors associated with kinesiophobia in patients with RMDs. Letters, editorials, conference abstracts/presentations, and duplicate records were excluded. Study selection, quality assessment, and data extraction were independently conducted by two reviewers. The biopsychosocial model guided factor classification.

A total of 17 studies (7,356 participants) were included, comprising one longitudinal study and 16 cross-sectional studies. Sixteen studies were rated as high quality. Guided by the biopsychosocial model, poor physical function, negative psychological states, low self-efficacy, and inadequate social support were identified as main correlates of kinesiophobia in patients with RMDs.

Kinesiophobia is prevalent in patients with RMDs, with its correlates aligning with the biopsychosocial model. Targeted multidimensional interventions (optimizing physical function, psychological regulation, and social support) may mitigate kinesiophobia and improve rehabilitation outcomes.