Relationship Between Walking Capacity, Biopsychosocial Factors, Self-efficacy, and Walking Activity in Persons Poststroke

Abstract

Background/purpose: Many factors appear to be related to physical activity after stroke, yet it is unclear how these factors interact and which ones might be the best predictors. Therefore, the purpose of this study was twofold: (1) to examine the relationship between walking capacity and walking activity, and (2) to investigate how biopsychosocial factors and self-efficacy relate to walking activity, above and beyond walking capacity impairment poststroke.

Methods: Individuals greater than 3 months poststroke (n = 55) completed the Yesavage Geriatric Depression Scale (GDS), Fatigue Severity Scale (FSS), Modified Cumulative Illness Rating (MCIR) Scale, Walk 12, Activities-Specific Balance Confidence (ABC) Scale, Functional Gait Assessment (FGA), and oxygen consumption testing. Walking activity data were collected via a StepWatch Activity Monitor. Predictors were grouped into 3 constructs: (1) walking capacity: oxygen consumption and FGA; (2) biopsychosocial: GDS, FSS, and MCIR; (3) self-efficacy: Walk 12 and ABC. Moderated sequential regression models were used to examine what factors best predicted walking activity.

Results: Walking capacity explained 35.9% (P < 0.001) of the variance in walking activity. Self-efficacy (ΔR = 0.15, P < 0.001) and the interaction between the FGA×ABC (ΔR = 0.047, P < 0.001) significantly increased the variability explained. The FGA (β = 0.37, P = 0.01), MCIR (β = -0.26, P = 0.01), and Walk 12 (β = -0.45, P = 0.00) were each individually significantly associated with walking activity.

Discussion and conclusion: Although measures of walking capacity and self-efficacy significantly contributed to "real-world" walking activity, balance self-efficacy moderated the relationship between walking capacity and walking activity. Improving balance self-efficacy may augment walking capacity and translate to improved walking activity poststroke.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A139).

Figure 1

Results of the moderated regression analysis. FGA: Functional Gait Assessment; ABC: Activities Specific Balance Confidence Scale. Light grey lines represent data from subjects who scored ABC scores 1 standard deviation above the mean (high), black lines represent mean ABC scores and dark grey lines represent ABC scores 1 standard deviation below the mean (low). Each symbol represents the mean (middle symbol) ± 1 standard deviation (first and third symbol) of the group data for the FGA. The ABC score appears to moderate the relationship between the FGA and ABC. Subjects with a high ABC score demonstrate a weak relationship between the FGA and SPD. In contrast, participants with a low ABC score exhibit a strong positive relationship between the FGA and SPD.