The Association Between Ischemic Stroke Patients’ Illness Perception and Adherence to Rehabilitation Exercises: An Analysis of a Moderated Chain Mediation Model

Abstract

Background: To investigate the relationship between stroke patients’ illness perception and rehabilitation exercise adherence, while also exploring the potential mediating influences of frailty and family care, as well as the moderating impact of nutrition. Methods: A total of 307 ischemic stroke patients underwent surveys utilizing the Illness Perception Questionnaire, the Frailty Assessment Scale, the Family APGAR Index, the Rehabilitation Adherence Assessment Scale, and the Mini Nutritional Assessment-Short Form. Pearson correlation analysis was used to examine the associations among the scores of various scales. Following data standardization, mediation and moderation effects were tested using PROCESS v4.1 Models 6 and 83, with the Bootstrap method employed to assess the robustness of these effects. Results: Illness perception was negatively correlated with rehabilitation exercise adherence (r=−0.532, P<0.01). Both frailty (β=−0.17, 95% CI [−0.26, −0.079]) and family care (β=−0.101, 95% CI [−0.156, −0.052]) had significant independent mediating effects between illness perception and rehabilitation exercise adherence, and the chain mediation effect was also significant (β=−0.087, 95% CI [−0.14, −0.045]), accounting for 68.45% of the total effect. Nutrition moderated the relationship between illness perception and frailty (β=−0.176, P<0.001), with the positive influence of illness perception on frailty weakening as the level of nutrition increased. Conclusion: Illness perception is negatively associated with rehabilitation exercise adherence, exacerbating frailty and reducing family care. The impact of illness perception on escalating frailty is primarily manifested through inadequate nutritional status. Therefore, healthcare providers are required to help stroke patients establish correct illness cognitions, prevent the occurrence of frailty, encourage family members to provide sufficient family care, and pay attention to patients’ nutritional status to promote better recovery.