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 Jun;93(6):1101-7. doi: 10.1016/j.apmr.2012.01.020. Epub 2012 Apr 11.


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 (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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acceleration
  • Accidental Falls / prevention & control
  • Activities of Daily Living*
  • Chronic Disease
  • Cross-Sectional Studies
  • Disability Evaluation
  • Female
  • Follow-Up Studies
  • Gait Disorders, Neurologic / physiopathology
  • Gait Disorders, Neurologic / rehabilitation*
  • Humans
  • Linear Models
  • Male
  • Mobility Limitation
  • Multivariate Analysis
  • Patient Participation
  • Postural Balance / physiology*
  • Prospective Studies
  • Recovery of Function / physiology
  • Self Efficacy*
  • Severity of Illness Index
  • Stroke / diagnosis
  • Stroke Rehabilitation*
  • Treatment Outcome
  • Walking / physiology*