Objective To explore the dilemmas in self-decision making for home-based rehabilitation among stroke patients based on self-determination theory, and to provide references for developing self-decision support programs for stroke patients.Methods A descriptive qualitative research method was used.From November 2023 to May 2024, 16 stroke patients were selected for semi-structured interviews, and thematic analysis was used to analyze the data.Results A total of three themes and twelve sub-themes were refined:autonomy needs dilemma (decision hesitation under knowledge barriers, decision laziness caused by insufficient sense of competence, decision conflict under family intervention, negative decision-making due to immediate satisfaction tendency), competence needs dilemma (self-doubt caused by poor decision outcomes, decision avoidance due to negative experiences and high da-mage perception, decision complexity under co-morbidity, decision confusion due to information barriers), and belongingness needs dilemma (decision pressure aggravated by lack of family support, decision reference dilemma due to insufficient adaptation of peer experience, decision constraints due to accessibility barriers of rehabilitation services, decision value depreciation caused by social prejudice).Conclusion Stroke patients face complex dilemmas in self-decision making for home-based rehabilitation exercise.Medical staff should adopt interdisciplinary, full-cycle personalized decision support strategies base on digital platforms to achieve scientific and precise home-based exercise rehabilitation, and improve long-term rehabilitation outcomes.