Can balance and balance self-efficacy predict levels of community ambulation in individuals with chronic stroke?

Abstract

Background: Community ambulation is a key goal for a majority of stroke survivors (Lord et al., 2004). Restriction in communitywalking is a consequence ofmulti-system impairments following stroke. Community ambulation has been evaluated with measures particularly focusing on gait speed and endurance. However, an individual’s perception about his/her ability to maintain balance can play an important role for participation in the community. Purpose:Several researchers have concludedgait speed to be a valid predictor of community ambulation (Perry et al., 1995; Hill et al., 1997). An observational study conducted by Lord et al (2004), concluded that gait speed is not sufficient as a single measure of community ambulation and should be augmented by self-report and the use of measures of social integration and community participation. Recently, Robinson et al (2011) in a case–control study investigated the role physical impairments in participation in the communitywalking after stroke. They found that underlying physical impairments explained very little of the variance in participation related to community walking and further recommended a need to investigate the role of self efficacy in community walking. This study aims to identify the role of subjective and objective balancemeasures in predicting levels of community ambulation in individuals with chronic stroke. Participants: 28 ambulatory adults with chronic stroke. Methods: Participants were recruited by convenient sampling from Neuro-rehabilitation OPD and categorized into Functional Ambulatory Category (FAC) levels. Balance was evaluated using Berg Balance Scale. To assess subjects self perceived level of confidence, Balance Confidence Scale (BCS) (a 22-item scale for assessing balance confidence in Indian community dwelling older adults) was administered. Detailed history and other demographic data were collected. Analysis: Correlation statistics (Pearson’s correlation coefficient) & Regression analysis was applied. Results: In a sample of 28, 18 were males and 10 were females. Mean age was 46.7 and mean post-stroke duration was 26.3 months. BBS correlated strongly (r= 0.841) with Functional Ambulatory Category (FAC) (p= 0.01). Balance Confidence score had a strong positive correlation (r= 0.766) with Functional Ambulatory Category (FAC) with significance of p= 0.01. Regression analysis revealed predictability of BBS for FAC is 71% and for Balance Confidence score, it is 59%. Components like ‘crossing the roads’, going to public places had highest correlation with FAC scores (r= 0.837 and 0.781, respectively). Conclusion(s): Subjective (balance self efficacy on BCS) & objective measurements (BBS) correlated positively with community ambulation. Confidence in activities like crossing the road (r= 0.837) plays a major role for walking in the community. Implications: Psychological aspects such as self efficacy for balance need to be addressed when designing rehabilitation protocols for individuals with chronic stroke. Further research into the areas of environmental factors affecting level of confidence and physical impairments for balance would contribute to our understanding of community ambulation in individuals with Chronic Stroke.