Self-efficacy Mediates the Relationship between Balance/Walking Performance, Activity, and Participation after Stroke

BACKGROUND: Many outcome measures (OM) that assess individuals' ability or beliefs in their ability to perform tasks exist to evaluate activity and participation after stroke; however, the relationship between various OM and activity/participation is unclear. OBJECTIVE: The purpose of this study was to explore the relationships between different OM and activity and participation in people after stroke. METHODS: Fifty-nine subjects post stroke participated in an assessment including self-selected walking speed, 6 minute walk test, Timed "Up and Go" test, Berg Balance Scale, Functional Gait Assessment, Walk 12, and Activity-specific Balance Confidence Scale. Step Watch Activity Monitoring (SAM) was used as a measure of activity and Stroke Impact Scale-Participation (SIS-P) as a measure of participation. Exploratory Factor Analysis was performed including all measures except SAM and SIS-P. Two factors were extracted and termed performance based (PB) and self-efficacy (SE). A path analysis assessed the role of SE as a mediator in the relationships of PB and SAM/SIS-P. RESULTS: In the path analysis, PB significantly predicts SE (p < 0.001, b = 0.44), but not SAM or SIS-P (p > 0.05, b = 0.25, and b = 0.11, respectively). SE significantly predicts both SAM and SIS-P (p < 0.001, b = 0.46, and b = 0.59, respectively). The indirect effects of PB on SAM and SIS-P were significant (p < 0.001; b = 0.20, and b = 0.26, respectively). CONCLUSION: These results suggest that SE mediates the relationship between PB and activity and participation after stroke, reinforcing that improving activity and participation is more complicated than only targeting performance. Clinicians should administer SE and PB measures to determine the most accurate view of patients after stroke and seek to improve SE through interventions.