Can rehabilitation adherence among stroke patients be measured using a single item?

Wen Yu Kuo, Chen Yin Chen, Min Chi Chen, Chin Man Wang, Yu Li Lin, Jeng Wang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

2 Scopus citations


AIMS AND OBJECTIVES: To assess the concurrent validity between logbooks and a single-item rehabilitation adherence measurement for patients with stroke. Agreement between caregivers and patients and between caregivers and physical therapists regarding a single-item measurement was investigated, and its predictive validity was explored.

BACKGROUND: Adherence to therapy is a primary determinant of treatment success. There are no standard instruments for measuring rehabilitation adherence available for stroke patients.

DESIGN: Prospective longitudinal study.

METHODS: Seventy-five patients with stroke were recruited, measured four times and followed for 6 months. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to ensure comprehensive reporting. Adherence was documented in logbooks, and single-item measurements were compared. Predictive validity was explored by assessing associations between adherence levels, self-care ability and health-related quality of life. The Spearman's correlation coefficients, weighted kappa, and generalised estimating equations statistics were used to explore the concurrent validity, measurement agreement, and predictive validity, respectively.

RESULTS: Logbook records had a fair correlation (r s = .23, p = .04) with the single-item rehabilitation adherence measurements. There was moderate agreement (kappa = 0.42, p < .001) between caregiver and patient assessments and fair agreement (kappa = 0.29, p = .017) between caregiver and physical therapist assessments of patients' rehabilitation adherence levels. Perfect rehabilitation adherence, based on the logbook and single-item measurements, predicted better scores for self-care ability and quality of life than imperfect rehabilitation adherence during 6 months after inclusion.

CONCLUSIONS: There was fair concurrent validity between logbooks and single-item rehabilitation adherence measurements and moderate and fair adherence measure agreement between caregivers and patients and caregivers and physical therapists, respectively. Logbooks and single-item rehabilitation adherence measurements had adequate predictive validity.

RELEVANCE TO CLINICAL PRACTICE: Single-item rehabilitation adherence measurement is a workable and straightforward method to assess stroke patients' rehabilitation adherence in busy clinical care settings. Caregivers can represent stroke patients regarding their reported rehabilitation adherence.

PATIENT OR PUBLIC CONTRIBUTION: Patients were diagnosed with stroke in the study hospital. Rehabilitation physicians transferred patients to a research nurse who then screened them for the inclusion criteria and invited them and their family caregivers to participate in this study if they met the requirements. We also recruited seven physical therapists responsible for the physical therapy of the study participants. After participants signed informed consent, the research nurse encouraged participants to respond to research questions face to face, including rehabilitation adherence data, daily physical function, and quality of life. Each participant was measured four times at baseline and at 1, 3, and 6 months after inclusion in this study. Physical therapists had to score their patients' rehabilitation adherence levels before discharge.


Original languageEnglish
Pages (from-to)950-962
Number of pages13
JournalJournal of Clinical Nursing
Issue number5-6
StatePublished - 03 2023

Bibliographical note

© 2022 John Wiley & Sons Ltd.


  • adherence
  • concurrent validity
  • nursing
  • predictive validity
  • rehabilitation
  • stroke
  • Stroke
  • Prospective Studies
  • Stroke Rehabilitation/methods
  • Humans
  • Quality of Life
  • Longitudinal Studies


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