An Explanatory Model for Rehabilitation Adherence in Patients With Stroke Based on the Capability, Opportunity, Motivation and Behaviour Model

AIMS: To develop a rehabilitation adherence model for patients with stroke based on the Capability, Opportunity, Motivation and Behaviour (COM-B) model; verify the model; and identify the direct and indirect effects of each variable on rehabilitation adherence. DESIGN: This was a cross-sectional, correlational study using structural equation modelling. METHODS: Participants were 212 patients aged 23-89 (69.8% men) visiting the neurology outpatient clinic of a tertiary hospital in Seoul, Republic of Korea, between 3 months and 1 year after stroke onset. Data were collected from September 25, 2023 to September 22, 2025. RESULTS: The model fit indices were adequate. Functional status as a physical ability has a significant direct effect on rehabilitation adherence. Resilience as a psychological ability has a significant indirect effect on rehabilitation adherence through rehabilitation motivation. Socioeconomic status as physical opportunity had a significant direct effect on rehabilitation adherence. Social support, as a social opportunity, has a significant indirect effect on rehabilitation adherence through motivation. Rehabilitation motivation had significant direct and total effects on rehabilitation adherence. Finally, squared multiple correlation values showed that functional status, resilience, socioeconomic status, social support and rehabilitation motivation accounted for 27.4% of the total variance in rehabilitation adherence. CONCLUSION: The Capability, Opportunity, Motivation and Behaviour model is a promising predictor of rehabilitation adherence in patients with stroke. Considering functional status, resilience, socioeconomic status, social support and rehabilitation motivation together may help understand rehabilitation adherence. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: It is necessary to consider functional and socioeconomic status to accurately evaluate rehabilitation adherence among patients with stroke. In addition, interventions enhancing resilience, social support and rehabilitation motivation may contribute to improving rehabilitation adherence in this population. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.