title: Balance and balance self-efficacy are associated with activity and participation after stroke: a cross-sectional study in people with chronic stroke.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  University-based research laboratory, hospitals, and stroke support groups.
  
  
  METHODS
  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.
  
  
  METHODS
  Not applicable, this is a cross-sectional data collection of 1 timepoint.
  
  
  METHODS
  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 (β=-.430, P<.022, 95% confidence interval [CI], -.247 to -.021) and participation (β=-.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.
authors.affiliation: Roudebush Veterans Administration Medical Center, Health Services Research and Development Center on Implementing Evidence-Based Practice, Indianapolis, IN 46202, USA. arlene.schmid@va.gov
authors.forename: Arlene A
authors.initials: AA
authors.lastname: Schmid
authors.forename: Marieke
authors.initials: M
authors.lastname: Van Puymbroeck
authors.forename: Peter A
authors.initials: PA
authors.lastname: Altenburger
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Dierks
authors.forename: Kristine K
authors.initials: KK
authors.lastname: Miller
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Damush
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
mesh_terms: D000054:Acceleration; D000058:Accidental Falls / Q000517:prevention & control; D000203:Activities of Daily Living; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D016014:Linear Models; D008297:Male; D051346:Mobility Limitation; D015999:Multivariate Analysis; D010358:Patient Participation; D004856:Postural Balance / Q000502:physiology*; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D020377:Self Efficacy; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*