The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial.
OBJECTIVE
To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific, influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity.


METHODS
Secondary analysis of a two-center, observer-blinded, randomized, controlled trial.


METHODS
General community.


METHODS
Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke.


METHODS
Task-oriented interventions targeting walking or upper extremity (UE) function were provided three times a week for 6 weeks.


METHODS
Activities-specific Balance Confidence Scale, Six-Minute Walk Test, 5-m walk, Berg Balance Scale, and Timed "Up and Go" administered at baseline and postintervention.


RESULTS
The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the UE intervention. Treatment effects were largest in persons with low self-efficacy at baseline and for activities relating to tasks practiced. In the walking group, change in balance self-efficacy correlated with change in functional walking capacity (correlation coefficient=0.45, 95% confidence interval=0.16-0.68). Results of multivariable modeling suggested effect modification by the baseline level of depressive symptoms and a prognostic influence of age, sex, comorbidity, time poststroke, and functional mobility on change in self-efficacy.


CONCLUSIONS
Task-oriented walking retraining enhances balance self-efficacy in community-dwelling individuals with chronic stroke. Benefits may be partially the result of improvement in walking capacity. The influence of baseline level of self-efficacy, depressive symptoms, and prognostic variables on treatment effects are of clinical importance and must be verified in future studies.
Salbach
Nancy M
NM
Department of Epidemiology and Biostatistics and Occupational Health, McGill University Montreal, Quebec, Canada. nancy.salbach@utoronto.ca
Mayo
Nancy E
NE
Robichaud-Ekstrand
Sylvie
S
Hanley
James A
JA
Richards
Carol L
CL
Wood-Dauphinee
Sharon
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D004856:Postural Balance; D020377:Self Efficacy; D016037:Single-Blind Method; D000071939:Stroke Rehabilitation; D016138:Walking