The Path Of Rehabilitation Exercise Self-Management Behavior Of Stroke Patients Based On The Extended Model Of Planned Behavior Theory

ObjectiveTo develop a questionnaire to measure the self-management of rehabilitation exercise in stroke patients and test its reliability and validity.To develop a questionnaire to measure the implementation intention of rehabilitation exercise behavior in stroke patients and test its reliability and validity.To understand the current situation of rehabilitation exercise self-management behavior of stroke patients.To form the extended model based on the Theory of Planned Behavior,and increase the variables of implementation intention,self-efficacy and social support.To explore the influence path of rehabilitation exercise self-management behavior of stroke patients based on the extended model of Planned Behavior Theory.Methods1.The rehabilitation exercise self-management questionnaire for stroke patients was developed through domestic and foreign literature searches,Delphi method and small sample tests.232 stroke patients were selected from October to December 2019.The questionnaire is tested by item analysis,reliability and validity test,and confirmatory factor analysis.2.The rehabilitation exercise implementation intention questionnaire for stroke patients was developed through literature review,Delphi method and small sample tests.From October to December 2019,234 stroke patients were selected.The questionnaire is tested by item analysis,reliability and validity test,and confirmatory factor analysis.3.273 stroke patients selected by convenience sampling and from January to August2020.The investigation of rehabilitation exercise self-management,attitude,subjective norm,perceived behavioral control,implementation intention,self-efficacy and social support for stroke patients using general information questionnaire,Rehabilitation exercise self-management questionnaire for stroke patients,Planned Behavior Theory Scale,Rehabilitation exercise implementation intention questionnaire for stroke patients,Stroke Self-Efficacy Questionnaire and the Social Support Scale.The data were analyzed using SPSS 22.0 and AMOS 22.0 software.The count data was described by frequency and percentage,the measurement data are described by means and standard deviations.The general demographic data of rehabilitation exercise self-management behavior of stroke patients were compared by independent sample t test or one-way ANOVA.Pearson correlation analysis was used to analyze the relationship between attitude,subjective norm,perceived behavioral control,behavior intention,implementation intention,self-efficacy,social support and self-management behavior of rehabilitation exercise in stroke patients.Structural equation model was used to analyze the influence path of rehabilitation exercise attitude,subjective norm,perceived behavior control,behavior intention,implementation intention,self-efficacy and social support on self-management behavior of stroke patients.Results1.The reliability and validity of the rehabilitation exercise self-management questionnaire for stroke patients:a total of 3 factors were extracted from the questionnaire,the three factors were named as objective and method management,content management,monitoring and evaluation management,and the cumulative variance contribution rate was 88.412%,the Cronbach’sαcoefficient of the total questionnaire was 0.974,and the Cronbach’sαcoefficients of each factor were 0.961,0.974,0.976;The test-retest reliability of the total questionnaire was 0.921,the test-retest reliability of each factor was 0.853,0.864,0.839;the total content validity of the questionnaire was 0.969;the confirmatory factor analysis model fitted well:x~2/df=1.755,RMSEA=0.053,GFI=0.914,NFI=0.963,IFI=0.984,TLI=0.980,CFI=0.983.2.The reliability and validity of the rehabilitation exercise implementation intention questionnaire for stroke patients:a total of 2 factors were extracted from the questionnaire,the two factors are named action planning and coping planning,and the cumulative variance contribution rate was 85.973%,the Cronbach’sαcoefficient of the total questionnaire was 0.980,and the Cronbach’sαcoefficients of each factor were 0.982,0.979;the test-retest reliability of the total questionnaire was 0.884,the test-retest reliability of each factor was 0.885,0.856;the total content validity of the questionnaire was 0.947;the criterion-related validity was 0.713;the confirmatory factor analysis model fitted well:c~2/df=1.960,RMSEA=0.059,GFI=0.886,NFI=0.959,IFI=0.979,TLI=0.976,CFI=0.979.3.The self-management behavior score of rehabilitation exercise in stroke patients was(63.40±16.06)points.The differences of rehabilitation exercise self-management behavior of stroke patients in gender,age,educational level,residence,current working status and personal monthly income were statistically significant(P<0.05).The attitude of rehabilitation exercise,subjective norm,perceived behavioral control,behavior intention,implementation intention,self-efficacy,social support and rehabilitation exercise self-management behavior were all positively correlated(P<0.05).4.Structural equation model showed that rehabilitation exercise attitude,subjective norm,perceived behavioral control,behavior intention,implementation intention,self-efficacy,and social support of stroke patients can explain 74%of the variance variables of self-management behaviors of stroke patients.The direct effect value of rehabilitation behavior intention on rehabilitation exercise self-management behavior was0.278.The effect value of behavioral intention on rehabilitation exercise self-management behavior reached 0.674 after the variables of implementation intention,self-efficacy and social support were added.The indirect effect value of behavioral intention on rehabilitation exercise self-management behavior through implementation intention,self-efficacy and social support was 0.396.The effect values of rehabilitation exercise attitude and subjective norm on self-management behavior through behavior intention were 0.073 and 0.279.Perceived behavioral control can not only affect the self-management behavior of rehabilitation exercise through behavior intention,but also have a direct effect on the self-management behavior of rehabilitation exercise.The direct effect value was 0.139,the indirect effect value was 0.319,and the total effect value was0.458.Conclusions1.The rehabilitation exercise self-management questionnaire for stroke patients has good reliability and validity,and is used to evaluate the self-management behavior of rehabilitation exercise for stroke patients.2.The rehabilitation exercise behavior implementation intention questionnaire for stroke patients has good reliability and validity,and can be used to assess the implementation intention of rehabilitation exercise behavior in stroke patient.3.The rehabilitation exercise self-management behavior of stroke patients is at a moderate level.Gender,age,educational level,residence,current working status and personal monthly income were the influencing factors of stroke rehabilitation exercise self-management behavior.4.The rehabilitation exercise behavior intention of stroke patients can directly affect self-management behavior of rehabilitation exercise,and can also affect the self-management behavior of rehabilitation exercise through implementation intention,self-efficacy and social support.Perceived behavioral control can directly affect rehabilitation exercise self-management behavior.The rehabilitation exercise attitude,subjective norm and perceived behavioral control can indirectly affect rehabilitation exercise self-management behavior by influencing behavioral intention.