Motivation in stroke patients for rehabilitation scale

Authors

Purpose

In the landscape of neurorehabilitation, accurately assessing a patient's drive to engage in therapy is paramount, yet notoriously difficult. Previous instruments have either relied heavily on observational proxies—where a physically exhausted patient might be unfairly labeled as 'unmotivated'—or borrowed theoretical frameworks from sports psychology that do not neatly map onto the trauma of a stroke. The MORE scale was engineered to solve this precise measurement problem.

By utilizing a patient-reported framework, it bypasses observational bias and directly taps into the individual's internal psychological state. For clinicians, this means having a validated metric to identify patients who may need targeted psychological support, ultimately optimizing rehabilitation outcomes and ensuring that therapeutic interventions are appropriately tailored to the patient's motivational readiness.

Construct

The theoretical foundation of the MORE scale is rooted in the lived experiences of stroke survivors, conceptualizing motivation as a dynamic interplay between internal and external forces. During the item development phase, the construct was mapped across several distinct domains: personal factors (such as goal setting, resilience, and processing success or failure) and social-relationship factors (including interactions with healthcare professionals, family, and peers).

Interestingly, while the theoretical blueprint was highly multidimensional, the psychometric validation revealed a unidimensional structure. This suggests that for stroke patients undergoing intensive rehabilitation, these diverse personal and social influences coalesce into a single, unified psychological drive. Rather than experiencing distinct 'types' of motivation, patients appear to experience a generalized motivational state that is fueled by these various inputs.

Validity

The validation framework for this instrument was comprehensive, employing both classical test theory and item response theory (IRT). The IRT analysis demonstrated excellent parameter estimates, with item discrimination slopes ranging from 0.811 to 2.142, indicating that the items are highly effective at differentiating between patients with varying levels of motivation. Furthermore, the difficulty parameters (-3.203 to 0.522) suggest the scale captures a wide spectrum of the latent trait.

In terms of construct validity, the researchers established strong discriminant evidence by demonstrating moderate negative correlations with the Apathy Scale (rho = -0.536) and the Self-rating Depression Scale (rho = -0.347). This is a crucial psychometric triumph, as it proves the scale measures a distinct motivational construct rather than merely capturing the absence of clinical depression or apathy. Convergent validity was also confirmed via a strong positive relationship with a Visual Analogue Scale measuring subjective motivation (rho = 0.536).

Convergent & Discriminant Validation Correlations

Reference Instrument	Correlation Coefficient (r)
Visual Analogue Scale (VAS) for subjective motivation	rho=0.536
Apathy Scale (AS)	rho=-0.536
Self-rating Depression Scale (SDS)	rho=-0.347

Reliability

Internal consistency for the instrument is exceptionally high, yielding a Cronbach's alpha of 0.948. While such a robust alpha underscores excellent inter-item reliability and confirms the unidimensional nature of the scale, psychometricians should note that values this high can sometimes indicate item redundancy or a ceiling effect. The authors astutely point out that administering the scale during the early, intensive phases of rehabilitation might capture artificially inflated expectations, contributing to this ceiling effect.

Temporal stability was evaluated using a one-month test-retest interval, resulting in a moderate correlation (rho = 0.612). In the context of rehabilitation psychology, this moderate stability is theoretically appropriate; motivation is a state-like construct expected to fluctuate in response to recovery progress, setbacks, and environmental changes over a month of intensive therapy.

Factor Analysis

The structural integrity of the scale was rigorously tested using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Given the diverse qualitative origins of the item pool—spanning personal resilience, social support, and goal setting—the research team initially hypothesized a multi-factor model.

However, the empirical data did not support this multidimensionality. Both the EFA and CFA converged on a robust one-factor solution. This psychometric finding is highly revealing: it indicates that while the sources of motivation may be multifaceted, the psychological manifestation of that motivation operates as a singular latent variable in this clinical population. Consequently, the scale is scored as a single composite measure, streamlining its clinical utility while still allowing practitioners to review individual item responses for qualitative clinical insights.

Instrument

Test Type	Self-report questionnaire
Format	17 items, 7-point Likert scale (1 = Strongly disagree to 7 = Strongly agree)
Scoring	Total score calculated by summing all items. Higher scores indicate higher motivation for rehabilitation.
Language	Japanese
Population	Medical patients, Clinical patients
Age Group	Adults, Older adults
Administration	Self-administered

Motivation in stroke patients for rehabilitation scale Items

Sample

The initial Delphi panel included 61 medical staff and 22 stroke patients. The validation sample consisted of 201 first-time stroke patients admitted to a convalescent rehabilitation hospital.