The Motivation in stroke patients for rehabilitation scale<\/strong> (commonly designated as the MORE scale<\/strong>) represents a landmark development within contemporary rehabilitation psychology<\/a> and neurorehabilitation psychometrics. Designed to quantitatively measure the motivational intensity and psychological commitment of adult stroke survivors undergoing active convalescent therapy, the instrument resolves persistent methodological shortcomings inherent in conventional assessment strategies. Historically, the evaluation of post-stroke rehabilitation drive has been constrained either by clinician-rated observational instruments\u2014which routinely conflate physical fatigue, motor paresis, or neuro-motor impairment with a genuine absence of psychological engagement\u2014or by generic self-report batteries adapted from athletic or occupational spheres that fail to reflect the existential crisis, functional bereavement, and neurocognitive sequelae characteristic of cerebrovascular accidents. Developed rigorously according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN)<\/a> taxonomy and recommendations, the MORE scale establishes a standardized, patient-reported outcome measure (PROM) grounded directly in the lived phenomenology of stroke survivors through mixed-method Delphi consensus and clinical psychometric validation.<\/p>\n The scale encompasses 17 self-report items<\/strong> scored on an authentic 7-point Likert scale<\/strong> ranging from 1 (Strongly disagree<\/em>) to 7 (Strongly agree<\/em>), generating a cumulative score between 17 and 119, with higher scores reflecting elevated levels of therapeutic motivation. Psychometrically, the instrument was calibrated using both classical test theory<\/a> (CTT) and multidimensional\/unidimensional item response theory<\/a> (specifically, Samejima\u2019s Graded Response Model). Although the initial item generation paradigm mapped across diverse ecological facets\u2014including internal goal orientation, personal resilience, emotional processing of functional feedback, and interpersonal alliances with rehabilitation therapists and family\u2014empirical exploratory and confirmatory factor analyses identified an unambiguous, robust unidimensional latent structure<\/strong>. Internal consistency is exceptionally high (Cronbach\u2019s α = 0.948), and temporal stability evaluated across a one-month test-retest interval demonstrates moderate longitudinal reproducibility (Spearman's ρ = 0.612), reflecting the dynamic, state-like responsiveness of recovery drive. The MORE scale displays divergent validity against clinical apathy (Apathy Scale ρ = -0.536) and depressive symptomatology (Zung Self-rating Depression Scale ρ = -0.347), and robust convergent validity with subjective motivational visual analogue scales (ρ = 0.536), rendering it a vital diagnostic and clinical research instrument in post-acute neurorehabilitation<\/span>.<\/p>\n stroke rehabilitation, motivation, patient-reported outcome measure, psychometrics, COSMIN, item response theory, cerebrovascular accident, neurorehabilitation, convalescent care, graded response model<\/p>\n The scale was developed and empirically validated by a multidisciplinary research consortium in Japan specializing in physical and rehabilitation medicine, occupational therapy, and psychometric science:<\/p>\n Within inpatient neurorehabilitation, therapeutic engagement represents one of the single most influential determinants of long-term functional recovery, neuroplastic reorganization, and community reintegration following a cerebrovascular accident (CVA). Stroke rehabilitation necessitates prolonged, intensive, and physically taxing efforts distributed across multiple therapeutic modalities, including physical therapy, occupational therapy, and speech-language pathology. Despite empirical consensus linking high motivational engagement with superior functional independence measure gains, measuring motivation has long posed severe diagnostic and epistemological challenges for clinical teams.<\/p>\n Prior to the introduction of the MORE scale, clinicians predominantly assessed patient motivation using clinician-administered observation ratings, such as the Pittsburgh Rehabilitation Participation Scale (PRPS), or ad-hoc behavioral checklists. Such observational approaches possess profound systematic vulnerabilities: they inherently confound functional motor impairment, neuromuscular hemiplegia, post-stroke expressive aphasia, cognitive fatigue, and clinical apathy with a deliberate or subjective deficit in psychological drive. A patient who suffers from severe physical exhaustion or apraxia may be misclassified by clinical staff as unmotivated, whereas a compliant but profoundly passive patient may be inaccurately evaluated as possessing high intrinsic drive. Conversely, borrowing psychometric batteries originally developed within sport psychology<\/a>\u2014such as adaptations of the Sport Motivation Scale (SMS)\u2014or traumatic brain injury tools lacking validation for ischemic and hemorrhagic stroke populations fails to account for the unique psychological devastation, sudden bodily transformation, and functional dependency intrinsic to stroke survivorship.<\/p>\n The primary clinical purpose of the MORE scale is to establish an authentic, self-administered patient-reported outcome measure<\/a> that directly accesses the survivor's internal phenomenological state, bypassing clinician observational bias. In applied clinical environments, the MORE scale equips physical therapists, occupational therapists, rehabilitation physicians, and clinical neuropsychologists with an objective, standardized metric to detect motivational deficits early in the convalescent phase. Identifying patients with diminished rehabilitation drive enables care teams to deploy tailored psychological, environmental, and behavioral interventions\u2014such as shared goal-setting protocols, self-efficacy training, collaborative therapeutic alliances, or pharmacological reviews for secondary apathy. In research paradigms, the scale serves as a standardized endpoint metric to evaluate the efficacy of motivational interviewing, virtual reality systems, robotic neurorehabilitation therapies, and patient-centered rehabilitation models on sustained patient engagement.<\/p>\n The latent construct quantified by the MORE scale is defined as rehabilitation motivation<\/em>: the conscious, goal-directed psychological activation, persistence, and subjective determination of a stroke survivor to participate fully in therapeutic training aimed at functional restitution and psychosocial adaptation.<\/p>\n During the qualitative conceptualization phase, the construct was systematically structured through Delphi consensus panels encompassing stroke survivors and experienced multidisciplinary rehabilitation professionals. This initial mapping parsed the ecological drivers of rehabilitation drive into several interacting experiential dimensions:<\/p>\n Crucially, while the qualitative construct blueprint was conceived as multifaceted across personal and relational spheres, empirical structural analysis demonstrated that among stroke survivors in active inpatient rehabilitation, these diverse personal, social, and functional drivers integrate into a singular, cohesive psychological entity. Rather than operating as compartmentalized or competing motivational modules, personal aspirations, family obligations, and therapeutic alliances synthesize into an undifferentiated latent motivational force that directly fuels rehabilitation engagement.<\/p>\n The MORE scale is theoretically anchored at the intersection of Self-Determination Theory (SDT)<\/a>, Bandura\u2019s Self-Efficacy Theory<\/a>, and modern neurorehabilitation models of goal-directed action.<\/p>\n Formulated by Edward L. Deci and Richard M. Ryan, Self-Determination Theory posits that sustained human agency and psychological flourishing depend upon the satisfaction of three fundamental psychological needs: autonomy<\/em>, competence<\/em>, and relatedness<\/em>. In the traumatic context of an acute stroke, all three basic needs are abruptly compromised:<\/p>\n Albert Bandura's Social Cognitive Theory underscores that motivation is fundamentally mediated by perceived self-efficacy\u2014an individual's belief in their capability to execute courses of action required to attain designated performances. Within the MORE scale, self-efficacy is explicitly assessed through the survivor\u2019s subjective conviction that their active physical participation makes an authentic difference in long-term functional recovery. This sense of personal agency serves as an essential psychological buffer against learned helplessness, which frequently develops when stroke patients perceive their physical impairments as irreversible.<\/p>\n Neurorehabilitation literature has historically grappled with the conceptual overlap between diminished motivation, post-stroke depression (PSD), and organic post-stroke apathy resulting from frontal-subcortical circuit disruption (as characterized by Robert S. Marin and Sergio E. Starkstein). The theoretical premise underpinning the MORE scale posits that rehabilitation motivation is not simply the mirror inverse of apathy or depression. While apathy represents a broad deficit in self-initiated, goal-directed behavior spanning cognitive, behavioral, and emotional domains, rehabilitation motivation reflects context-specific, prospective volition directed specifically at functional restoration, somatic exercise, and identity reconstruction.<\/p>\n The validation methodology of the MORE scale was conducted in full alignment with the international COSMIN guidelines, combining Classical Test Theory with modern Item Response Theory to rigorously evaluate its psychometric properties.<\/p>\n The researchers fitted Samejima\u2019s Graded Response Model (GRM), an advanced polytomous IRT framework suited for ordered categorical responses. The empirical parameter estimates demonstrated exceptional diagnostic performance across all 17 scale items:<\/p>\n Construct validity was evaluated against validated standardized psychometric reference instruments in a clinical sample of 201 convalescent stroke survivors:<\/p>\n2. Keywords<\/h2>\n
3. Authors<\/h2>\n
\n
4. Purpose<\/h2>\n
5. Psychological Construct<\/h2>\n
\n
6. Theoretical Framework<\/h2>\n
Self-Determination Theory in Neurorehabilitation<\/h3>\n
\n
Social Cognitive Theory and Mastery Expectations<\/h3>\n
Distinction from Apathy and Post-Stroke Depression Models<\/h3>\n
7. Validity<\/h2>\n
Item Response Theory (IRT) Validation<\/h3>\n
\n
Convergent and Discriminant Validity Evidence<\/h3>\n