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已发表论文
缺血性脑卒中患者疾病感知与康复锻炼依从性的关联：一种调节链式中介模型的分析
Authors Long Q , Lee Y , Liu Y, Li Y, Shi Z, Cui L
Received 22 June 2025
Accepted for publication 9 October 2025
Published 21 October 2025 Volume 2025:19 Pages 3211—3223
DOI https://doi.org/10.2147/PPA.S544741
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Qizhi (Cathy) Yao
Qingwen Long,1,2 Yujun Lee,2 Yina Liu,2 Yongli Li,2 Zijuan Shi,2 Lijun Cui3
1Nursing Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China; 2Nursing Department, North Sichuan Medical College, Nanchong, People’s Republic of China; 3Transfusion Medicine Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
Correspondence: Lijun Cui, Transfusion Medicine Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China, Email 3184723182@qq.com
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.
Keywords: stroke, illness perception, frailty, family care, rehabilitation exercise adherence
1Nursing Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China; 2Nursing Department, North Sichuan Medical College, Nanchong, People’s Republic of China; 3Transfusion Medicine Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
Correspondence: Lijun Cui, Transfusion Medicine Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China, Email 3184723182@qq.com
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.
Keywords: stroke, illness perception, frailty, family care, rehabilitation exercise adherence