Objective Based on the theory of self-determination, the influencing factors and pathways of rehabilitation motivation in middle-aged and elderly stroke patients were discussed, so as to provide reference for formulating intervention programs to improve patients′ rehabilitation motivation. Methods A total of 608 middle-aged and elderly stroke patients were selected as the research objects, and the survey was conducted using sociodemographic data and disease data, the Motivation in Stroke Patients for Rehabilitation Scale(MORE), Apathy Evaluation Scale-Informant(AES-I), Simplified Chinese Version of the Perceived Enactment of Autonomy Scale, Stroke Self-Efficacy Questionnaire(SSEQ), Perceived Social Support Scale(PSSS) and National Institute of Health Stroke Scale(NIHSS). Results The score of rehabilitation motivation in middle-aged and elderly stroke patients was (86.16±14.10). Stratified regression analysis showed that after controlling for general data variables, the degree of neurological deficit and apathy could explain 8.4% of the total variation of rehabilitation motivation in middle-aged and elderly stroke patients, and after further incorporating autonomy perception, rehabilitation self-efficacy and perceived social support, these three variables could explain 15.5% of the total variation in rehabilitation motivation (all P<0.05). Pathway analysis showed that the direct effects of apathy symptoms was -0.232, and auto-nomous perception, rehabilitation self-efficacy, and perceived social support played a mediating role in the relationship between apathy symptoms and rehabilitation motivation, and the mediating effect accounted for 60.137% of the total effect. The degree of neurological deficit indirectly affected rehabilitation motivation only through autonomy perception, rehabilitation self-efficacy, and perceived social support (all P<0.05). Conclusion The level of rehabilitation motivation of middle-aged and elderly stroke patients is at a medium level, which is affected by the intersection of various factors, clinical medical staff can develop personalized intervention measures based on the impact pathways of various factors on the rehabilitation motivation of middle-aged and elderly stroke patients and in combination with the individual characteristics of the patients, thereby enhancing their rehabilitation motivation.