A longitudinal study on the developmental trajectory and interaction between learned helplessness and adherence with rehabilitation exercises in hemiplegic patients following a stroke

Objective The aim of this study was to examine the developmental trajectories of learned helplessness (LH) and rehabilitation exercise adherence (EAQ) in stroke patients with hemiplegia and their longitudinal associations, thereby providing a basis for improving rehabilitation exercise adherence. Method From March 2022 to December 2024, 259 patients from the Department of Neurology at the Sixth People’s Hospital of Nantong were conveniently sampled. General information questionnaires, the Learned Helplessness Scale, and the Exercise Adherence Questionnaire were utilized to assess LH and EAQ at baseline (T0), at 3 months (T1), and at 6 months (T2). The data were analyzed using the Parallel Growth Curve Model (PGCM) and the Cross-Lagged Panel Model (CLPM), with the robust maximum likelihood estimation method employed to manage missing data. Results In stroke patients with hemiplegia, LH showed a linear decline over time (baseline: 65.32 ± 12.45 points; slope: −6.04 points per 3 months; p < 0.01), whereas EAQ exhibited quadratic growth (baseline: 32.15 points; linear slope: 4.89 points per 3 months; quadratic term: 0.15; p < 0.05). Baseline LH was negatively associated with the initial level of EAQ ( β = −0.53, p < 0.001) and with its subsequent growth rate ( β = −0.31, p = 0.012). In addition, the growth rate of EAQ was negatively associated with the rate of decline in LH ( β = −0.27, p = 0.017). The CLPM revealed that T0-LH was negatively associated with T1-EAQ ( β = −0.38, p < 0.001), and T1-EAQ was negatively associated with T2-LH ( β = −0.24, p = 0.003). Conclusion LH and EAQ were found to be longitudinally interrelated. Early LH was negatively associated with subsequent improvement in EAQ, while later gains in EAQ were positively associated with the decline in LH. These findings suggest that the combination of cognitive restructuring and adherence ladder goal management during the first 3 months of rehabilitation may hold potential as an intervention strategy, although its efficacy remains to be confirmed in future intervention research.