Influence of Therapeutic Adherence, Patient-Therapist Alliance, and Patient-Centred Rehabilitation Approach in Subacute Stroke Rehabilitation: Protocol for a Prospective Observational Study.

Introduction. Adherence to guidelines and recommendations during rehabilitation is frequently demonstrated to be poor in stroke patients, which may impede their progress. Although several clinical risk factors have been explored to explain this phenomenon, personal factors remain underexamined in the literature. The present study aims to investigate the impact of therapeutic adherence, therapeutic alliance, and patient-centred perception on rehabilitation outcomes in stroke patients. Methods and analysis. An observational study comprising two phases will be conducted at a neurorehabilitation hospital in Madrid, Spain. In the first phase, the content of the Scale of Adherence to Treatment of Physiotherapy (AdT-Physio) and the Therapeutic Alliance in Physiotherapy Questionnaire (CAF-P) will be adapted for the stroke population using the Delphi method to achieve consensus among at least 15 experts nationwide. Following this, a pilot study will be conducted to evaluate the comprehensibility of the adapted questionnaires. In the second phase, a content validation and correlation study of these questionnaires will be conducted through a prospective longitudinal observational study with multiple measurement points. Stroke patients aged over 18 years, in the subacute stage, and undergoing neurorehabilitation programmes will be included. Sociodemographic and clinical data will be collected at baseline, while physical capacities (assessed through trunk control, balance, and gait performance scales) will be evaluated throughout the rehabilitation process and at discharge. The target sample size is set at n=59, accounting for a 20% dropout rate. A comprehensive psychometric analysis will be performed, including the examination of convergent and criterion validity through correlations with relevant measures. Reliability will be assessed using Cronbach's alpha and test-retest correlation coefficients, and mean differences will be analysed using analysis of variance (ANOVA). Ethics and dissemination. The present study has been granted ethical approval by the Ethics Committee of the Hospital Universitario Clínico San Carlos (Madrid, Spain), with the reference number 23/438. Prior to participation, all subjects will be required to provide written informed consent. The findings will be disseminated through publication in a peer-reviewed scientific journal.