Abstract: Objective: To analyze the developmental trajectory subtypes of fear of falling and their influencing factors in patients after spinal fracture surgery, and to develop individualized nursing strategies for each subtype, with the aim of improving prognosis. Methods: A total of 360 patients with spinal fractures who underwent surgical treatment at a tertiary grade A hospital in Nanchang from March 2023 to March 2025 were enrolled. Fear of falling was assessed using the short version of the Falls Efficacy Scale International on the day of discharge and at 1, 3, and 6 months after discharge. A latent variable mixed growth model was applied to identify and name the optimal number of trajectory subtypes. At discharge, general clinical data were collected simultaneously, and the Fried Frailty Phenotype, the Berg Balance Scale (BBS), the Orthopedic Patient Functional Exercise Adherence Scale, and Social Support Rating Scale (SSRS) were administered for assessment. Univariate and multivariate analyses were performed to identify factors influencing the assignment to each trajectory subtype. Results: A total of 331 patients completed all follow-ups in this study. The developmental trajectories of fear of falling were identified as four subtypes: low fear-stable (82 cases, 24.77%), moderate fear-slowly rising (64 cases, 19.34%), moderate fear-rapidly decreasing (121 cases, 36.56%), and high fear-stable (64 cases, 19.34%). Age, number of fractured vertebrae, the presence or absence of postoperative complications, the presence or absence of comorbid chronic diseases, the presence or absence of history of falls in the past 6 months, BBS score, functional exercise adherence score, and SSRS score were all influencing factors for the assignment to fear of falling trajectory subtypes (all P<0.05). Conclusion: There are four developmental trajectories of fear of falling in patients after spinal fracture surgery. Clinical nursing interventions should be tailored to the influencing factors specific to each trajectory subtype, so as to effectively reduce the level of fear of falling, and promote postoperative functional rehabilitation.

Key words: spinal fracture; fear of falling; trajectory; influencing factors; latent variable mixed growth model