Abstract
Measuring self-efficacy during rehabilitation provides an important insight into understanding recovery post stroke. A Rasch analysis of the Stroke Self-efficacy Questionnaire (SSEQ) was undertaken to establish its use as a clinically meaningful and scientifically rigorous measure. One hundred and eighteen stroke patients completed the SSEQ with the help of an interviewer. Participants were recruited from local acute stroke units and community stroke rehabilitation teams. Data were analysed with confirmatory factor analysis conducted using AMOS and Rasch analysis conducted using RUMM2030 software. Confirmatory factor analysis and Rasch analyses demonstrated the presence of two separate scales that measure stroke survivors' self-efficacy with: i) self-management and ii) functional activities. Guided by Rasch analyses, the response categories of these two scales were collapsed from an 11-point to a 4-point scale. Modified scales met the expectations of the Rasch model. Items satisfied the Rasch requirements (overall and individual item fit, local response independence, differential item functioning, unidimensionality). Furthermore, the two subscales showed evidence of good construct validity. The new SSEQ has good psychometric properties and is a clinically useful assessment of self-efficacy after stroke. The scale measures stroke survivors' self-efficacy with self-management and activities as two unidimensional constructs. It is recommended for use in clinical and research interventions, and in evaluating stroke self-management interventions.
Highlights
Stroke survivors with disabilities need to make adjustments to their lives, often by learning new behaviours and modifying lifestyles
In the case of DIF, we found that those living alone tended to endorse the item ‘Use both your hands for eating your food’ compared to those living with a spouse or partner, perhaps suggesting that people who live alone develop greater resourcefulness and self-efficacy than those who have support from carers
By collapsing categories with disordered thresholds, redundant categories are eliminated and each category represents a distinct level of ability [36, 37]
Summary
Stroke survivors with disabilities need to make adjustments to their lives, often by learning new behaviours and modifying lifestyles. The acquisition of such skills is contingent on factors such as the quality and intensity of rehabilitation [1] and a person’s psychological state [2]. By accurately measuring self-efficacy, any mismatches between anticipated and ultimate level of function can be highlighted. This knowledge can benefit clinical practice and the design and development of clinical trials in stroke rehabilitation
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