Development, Reliability and Validity of Engagement in Exercise Rehabilitation Scale for Patients with Stroke

Background: Exercise rehabilitation is a crucial component of stroke recovery, particularly for patients transitioning to home or community settings. However, there is currently a lack of self-reported scales designed to measure the level of engagement in exercise rehabilitation among patients with stroke. Objective: To develop and validate psychometric properties of the Engagement in Exercise Rehabilitation Scale for patients with stroke. Methods: The initial item pool was extracted from a literature review and a semi-structured interview with patients with stroke. The development and refinement of the items underwent expert consultation and cognitive interviews with patients with stroke. The items primarily covered patients' perceptions, emotional attitudes, and specific engagement behaviors regarding exercise rehabilitation in home or community settings. A total of 260 patients with stroke were selected to test the reliability and validity. The psychometric proprieties test included construct validity, content validity, criterion-related validity, exploratory factor analysis, internal consistency reliability, test-retest reliability, and split-half reliability. Results: The final version of the Engagement in Exercise Rehabilitation Scale comprised 20 items. The scale's content validity index was determined to be 0.976, while the item-content validity indices ranged from 0.833 to 1.000. Results from exploratory factor analysis indicated that this scale is unidimensional, with a cumulative variance contribution rate of 79.3%. The test-retest reliability of the scale was found to be 0.879, its split-half reliability was measured at 0.980, and its Cronbach's α coefficient was calculated to be 0.986. Conclusion: The Engagement in Exercise Rehabilitation Scale for patients with stroke demonstrates accepted reliability and validity. The accuracy and generalizability of this scale necessitate further validation through additional large-sample studies involving diverse populations across multiple centers.