Purpose: The purpose of this study was to identity factors affecting patient adherence and to develop an explanatory model for patient adherence in patients with spinal cord injury. 8 Variables that were based on the previous research and a review of literature were used to construct hypothetical model. Social support, economic status, perceived barrier, patient provider relationship and rehabilitation related knowledge were the exogenous variables, depression, self-efficacy and patient adherence were the endogenous variables. Methods: Data form 117 patients with SCI were analysed to test the hypothetical model, using SAS and LISREL 8.53 program. Results: The overall fitness of the model was good (GFI=.991, AGFI=.915, NNFI=1.299, NFI=.953, p=.632) Depression, powerlessness, economic status were the strong factors influencing patient adherence. Powerlessness was significant factors for self-efficacy. Conclusion: To improve of patient adherence should focus on nursing intervention for depression, powerlessness and economic status.