Balance and Balance Self-Efficacy Are Associated With Activity and Participation After Stroke: A Cross-Sectional Study in People With Chronic Stroke

Schmid AA, Van.Puymbroeck M, Altenburger PA, Dierks TA, Miller KK, Damush TM, Williams LS. Balance and balance self-efficacy are associated with activity and participation after stroke: a cross-sectional study in people with chronic stroke. Arch Phys Med Rehabil 2012;93:1101-7. Objectives: To (1) examine the relationships between multiple poststroke mobility variables (gait speed, walking capacity, balance, balance self-efficacy, and falls self-efficacy) and activity and participation; and (2) determine which poststroke mobility variables are independently associated with activity and participation. Design: This is the primary analysis of a prospective cross-sectional study completed to understand the impact of mobility on activity and participation in people with chronic stroke. Setting: University-based research laboratory, hospitals, and stroke support groups. Participants: People (N=77) with stroke greater than 6 months ago were included in the study if they were referred to occupational or physical therapy for physical deficits as a result of the stroke, completed all stroke related inpatient rehabilitation, had residual functional disability, scored a >= 4 out of 6 on the short, 6-item Mini-Mental State Examination, and were between the ages of 50 and 85. Interventions: Not applicable, this is a cross-sectional data collection of 1 timepoint. Main Outcome Measures: We measured activity and participation with the validated International Classification of Functioning, Disability and Health Measure of Participation and Activities. Other variables included gait speed (10-meter walk), walking capacity (6-minute walk), balance (Berg Balance Scale), balance self-efficacy (Activities Specific Balance Confidence Scale), and falls self-efficacy (Modified Falls Efficacy Scale). Results: Only balance self-efficacy was found to be independently associated with poststroke activity (beta=-.430, P<.022, 95% confidence interval [CI], -.247 to -.021) and participation (beta=.439, P<.032, 95% CI, -.210 to -.010). Conclusions: Among people with chronic stroke, balance self-efficacy, not physical aspects of gait, was independently associated with activity and participation. While gait training continues to be important, this study indicates a need to further evaluate and address the psychological factors of balance and falls self-efficacy to obtain the best stroke recovery.