OBJECTIVES: 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. DESIGN: Secondary analysis of a two-center, observer-blinded, randomized, controlled trial. SETTING: General community. PARTICIPANTS: Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke. INTERVENTION: Task-oriented interventions targetingwalking or upper extremity (UE) function were provided three times a week for 6 weeks. MEASUREMENTS: 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. CONCLUSION: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.
RCT Entities:
OBJECTIVES: 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. DESIGN: Secondary analysis of a two-center, observer-blinded, randomized, controlled trial. SETTING: General community. PARTICIPANTS: Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke. INTERVENTION: Task-oriented interventions targeting walking or upper extremity (UE) function were provided three times a week for 6 weeks. MEASUREMENTS: 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. CONCLUSION: 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.
Authors: Brodie M Sakakibara; William C Miller; Melanie Souza; Viara Nikolova; Krista L Best Journal: Arch Phys Med Rehabil Date: 2013-02-04 Impact factor: 3.966
Authors: Anthony Jerant; Brent Hanson; Richard L Kravitz; Daniel J Tancredi; Emily Hanes; Sanjeet Grewal; Rimaben Cabrera; Peter Franks Journal: Patient Educ Couns Date: 2016-08-22
Authors: Anthony Jerant; Richard L Kravitz; Daniel Tancredi; Debora A Paterniti; Lynda White; Lynn Baker-Nauman; Dionne Evans-Dean; Chloe Villarreal; Lori Ried; Andrew Hudnut; Peter Franks Journal: J Gen Intern Med Date: 2016-03-08 Impact factor: 5.128
Authors: Judith E Deutsch; Mary Jane Myslinski; Michal Kafri; Richard Ranky; Mark Sivak; Constantinos Mavroidis; Jeffrey A Lewis Journal: J Neurol Phys Ther Date: 2013-09 Impact factor: 3.649