To investigate the application of the Transtheoretical Model of Behavior Change (TTM)-based approach in early-stage stroke rehabilitation training. Methods: A total of 96 stroke patients with hemiplegia admitted to our hospital from March 2023 to December 2024 were selected. Patients were randomly assigned to a control group (n=48) and an observation group (n=48) using a randomization list, and both groups underwent a 3-month intervention. The control group received conventional rehabilitation exercises, while the observation group received early stroke rehabilitation guidance based on the TTM. The implementation rate of early motor rehabilitation, limb motor function (Fugl-Meyer Assessment [FMA] scores), post-stroke quality of life (Stroke-Specific Quality of Life [SS-QOL] scores), and psychological resilience (Connor-Davidson Resilience Scale [CD-RISC] scores) were compared between the two groups. Results: The implementation rate of early motor rehabilitation was significantly higher in the observation group than in the control group (48 vs. 41, P=0.019). After the intervention, the observation group showed significantly greater improvements in upper limb FMA scores (52.15±5.82 vs. 48.50±5.74, P=0.003), lower limb FMA scores (25.85±3.52 vs. 23.48±3.49, P= 0.001), SS-QOL scores (78.33±10.93 vs. 73.27±6.24, P=0.006), and CD-RISC scores (79.29±9.16 vs. 65.78± 8.82, P<0.001) compared to the control group. Conclusion: TTM-based early stroke motor rehabilitation enhances the implementation rate of early motor rehabilitation in stroke patients with hemiplegia, improves psychological resilience, increases rehabilitation compliance and initiative, promotes the formation of long-term rehabilitation behaviors, and enhances the effectiveness of stroke motor rehabilitation and quality of life, demonstrating significant clinical efficacy.