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Exercise rehabilitation adherence and associated factors in patients aged ≥75 years with hemorrhagic stroke: a
1The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Background:
Patients aged ≥75 years with hemorrhagic stroke are at high risk of functional impairment and poor recovery. Exercise rehabilitation is essential for restoring physical function, but adherence to exercise rehabilitation may be associated with multiple factors in this population. This study aimed to investigate exercise rehabilitation adherence and its associated factors among patients aged ≥75 years with hemorrhagic stroke using an explanatory sequential mixed-methods approach.
Methods:
A total of 254 patients aged ≥75 years with hemorrhagic stroke were recruited by convenience sampling between July 2024 and May 2025. Data were collected using a general information questionnaire, the Stroke Functional Exercise Adherence Scale, the Stroke Self-Efficacy Questionnaire, and the Mishel Uncertainty in Illness Scale. Univariate analysis and multinomial logistic regression were conducted to identify factors associated with adherence. Subsequently, 13 patients were purposively selected for semi-structured interviews to explore the experiences underlying the quantitative findings. Qualitative data were analyzed using Colaizzi's seven-step method.
Results:
The mean adherence score was 37.97 ± 10.57. Overall, 20.87, 29.53, and 49.60% of participants demonstrated low, moderate, and high adherence, respectively. Multinomial logistic regression showed that higher rehabilitation self-efficacy was associated with lower odds of low adherence. In contrast, greater illness uncertainty and disease duration ≤6 months were associated with higher odds of low adherence. Greater illness uncertainty, male sex, and disease duration ≤6 months were also associated with moderate adherence. Qualitative analysis identified three themes underlying adherence: cognition and attitudes toward exercise rehabilitation, psychological and emotional disturbances, and external support.
Conclusion:
Exercise rehabilitation adherence varied among patients aged ≥75 years with hemorrhagic stroke and was associated with disease duration, rehabilitation self-efficacy, illness uncertainty, and sex. The qualitative findings further indicated that patients' cognition and attitudes, psychological and emotional experiences, and external support shaped their engagement in rehabilitation. These findings highlight the potential value of tailored interventions addressing these multidimensional factors to support engagement in exercise rehabilitation among this vulnerable population.