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The Effect of a Task-Oriented Walking Intervention on Improving Balance Self-Efficacy Poststroke: A Randomized, Controlled Trial

Authors

  • Nancy M. Salbach MSc, PT,

    1. From the *Department of Epidemiology and Biostatistics and Occupational Health, School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, CanadaDivision of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec, Canada§Faculty of Nursing, University of Montreal, Montreal, Quebec, CanadaRehabilitation Department, Laval University and Interdisciplinary Research Center for Rehabilitation and Social Integration, Rehabilitation Institute of Quebec, Quebec, Quebec, Canada.
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  • Nancy E. Mayo PhD, PT,

    1. From the *Department of Epidemiology and Biostatistics and Occupational Health, School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, CanadaDivision of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec, Canada§Faculty of Nursing, University of Montreal, Montreal, Quebec, CanadaRehabilitation Department, Laval University and Interdisciplinary Research Center for Rehabilitation and Social Integration, Rehabilitation Institute of Quebec, Quebec, Quebec, Canada.
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  • Sylvie Robichaud-Ekstrand PhD, RN,

    1. From the *Department of Epidemiology and Biostatistics and Occupational Health, School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, CanadaDivision of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec, Canada§Faculty of Nursing, University of Montreal, Montreal, Quebec, CanadaRehabilitation Department, Laval University and Interdisciplinary Research Center for Rehabilitation and Social Integration, Rehabilitation Institute of Quebec, Quebec, Quebec, Canada.
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  • James A. Hanley PhD,

    1. From the *Department of Epidemiology and Biostatistics and Occupational Health, School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, CanadaDivision of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec, Canada§Faculty of Nursing, University of Montreal, Montreal, Quebec, CanadaRehabilitation Department, Laval University and Interdisciplinary Research Center for Rehabilitation and Social Integration, Rehabilitation Institute of Quebec, Quebec, Quebec, Canada.
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  • Carol L. Richards PhD, PT,

    1. From the *Department of Epidemiology and Biostatistics and Occupational Health, School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, CanadaDivision of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec, Canada§Faculty of Nursing, University of Montreal, Montreal, Quebec, CanadaRehabilitation Department, Laval University and Interdisciplinary Research Center for Rehabilitation and Social Integration, Rehabilitation Institute of Quebec, Quebec, Quebec, Canada.
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  • Sharon Wood-Dauphinee PhD, PT

    1. From the *Department of Epidemiology and Biostatistics and Occupational Health, School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, CanadaDivision of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec, Canada§Faculty of Nursing, University of Montreal, Montreal, Quebec, CanadaRehabilitation Department, Laval University and Interdisciplinary Research Center for Rehabilitation and Social Integration, Rehabilitation Institute of Quebec, Quebec, Quebec, Canada.
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  • Nancy M. Salbach received a fellowship from the Canadian Institutes of Health Research to conduct this study. Operating funds were provided by the Quebec Réseau provincial de recherche en adaptation-réadaptation, the Heart and Stroke Foundation of Canada, and the Canadian Stroke Network.

Address correspondence to Nancy Salbach, Department of Physical Therapy, University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Toronto, Ontario M5G 1V7. E-mail: nancy.salbach@utoronto.ca

Abstract

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.

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