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 post-stroke. Methods Individuals greater than 3 months post-stroke (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 was collected via a StepWatch Activity Monitor (SAM). 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 (ΔR2 = 0.15, p<0.001) and the interaction between the FGA*ABC (ΔR2 = 0.047, p<0.001) significantly increased the variability explained. 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/Conclusion While 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 low balance self-efficacy may augment walking capacity and translate to improved walking activity post-stroke.

Predicting Home and Community Walking Activity Poststroke

“…2 However, it is a complex behavior involving individual, environmental, and contextual factors 37 that make it challenging to measure. 38 In addition to walking capacity, balance, motor function, and other factors such as self-efficacy 28,39 and psychosocial factors 40 likely play a role in community mobility, which we did not take into account in our model. Another limitation of our study is that it was a secondary analysis of data collected from 2 different studies with different purposes.…”

Implementation of Wearable Sensing Technology for Movement: Pushing Forward into the Routine Physical Rehabilitation Care Field

“…Published data on gait speed, an index of walking capacity, and steps per day, an index of walking performance, illustrate this problem. Gait speed, measured in the clinic, generally accounted for 30–45% of the variance in steps/day, leaving up to 70% of the variance in daily stepping unexplained [ 16 , 17 ]. For example, individuals in a recent study with self-selected gait speeds around 0.8 m/s ranged from about 750 steps/day to over 6000 steps/day (see Figure 2 B of [ 18 ]).…”

Relationships between gait variability and ambulatory activity post stroke

“…A number of factors have been associated with post-stroke ambulatory activity, including walking ability and balance confidence, 1,[6][7][8][9] but so far, no single factor can adequately predict amount of ambulatory activity. 9,10 Gait speed is a common measure of walking ability that is related to post-stroke ambulatory activity.…”