title: Longitudinal analysis of balance confidence in individuals with stroke using a multilevel model for change.
abstract: BACKGROUND
  Confidence about balance may be an important factor affecting self-efficacy for daily activities after stroke.
  
  
  OBJECTIVE
  The authors investigated whether confidence changes and the parameters that may predict changes in self-perceived balance within the first year of community reintegration.
  
  
  METHODS
  In this prospective study, 98 hemiparetic participants who could walk at least 10 m independently were assessed 1, 3, 6, and 12 months postdischarge from rehabilitation by the Berg Balance Scale, Timed Up and Go, 6-minute walking distance, and depression and anxiety scales. The 98 age-/sex-matched controls were assessed at enrollment and the same intervals. Multilevel modeling was used to determine if assessed covariates predicted changes in balance confidence by the Activities-Specific Balance Confidence Scale.
  
  
  RESULTS
  Stroke subjects had lower initial balance confidence than controls and showed a statistically significant increase in confidence over 1 year at each assessment. Poor balance and high state anxiety were associated with lower balance confidence. Significant interactions were observed between greater depression, along with more impaired walking capacity and balance tests, in predicting lower change trajectories in confidence. Falls predicted a reduced rate of improvement.
  
  
  CONCLUSIONS
  Balance confidence after stroke remained lower than controls over the first year. Physical therapies and supportive interventions designed to treat confidence should be initiated at discharge from inpatient rehabilitation.
authors.affiliation: Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Yiu
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Janice J
authors.initials: JJ
authors.lastname: Eng
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D055361:Multilevel Analysis; D004856:Postural Balance / Q000502:physiology*; D020377:Self Efficacy; D020521:Stroke / Q000150:complications* / Q000523:psychology*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016138:Walking / Q000502:physiology