Background
Reduced balance confidence is associated with impairments in features of balance and
gait in individuals with subacute stroke. However, an understanding of these relationships
in individuals at the chronic stage of stroke recovery is lacking. This study aimed
to quantify the relationships between balance confidence and specific features of
balance and gait in individuals with chronic stroke.
Methods
Participants completed a balance confidence questionnaire and clinical balance assessment
(quiet standing, walking, and reactive stepping) at 6 months postdischarge from inpatient
stroke rehabilitation. Regression analyses were performed using balance confidence
as a predictor variable, and quiet standing, walking, and reactive stepping outcome
measures as the dependent variables.
Results
Walking velocity was positively correlated with balance confidence, whereas mediolateral
center of pressure excursion (quiet standing) and double support time, step width
variability, and step time variability (walking) were negatively correlated with balance
confidence.
Conclusions
This study provides insight into the relationships between balance confidence and
balance and gait measures in individuals with chronic stroke, suggesting that individuals
with low balance confidence exhibited impaired control of quiet standing as well as
walking characteristics associated with cautious gait strategies. Future work should
identify the direction of these relationships to inform community-based stroke rehabilitation
programs for individuals with chronic stroke, and determine the potential utility
of incorporating interventions to improve balance confidence into these programs.
Key Words
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References
- Incidence and consequences of falls due to stroke: a systematic inquiry.BMJ. 1995; 311: 83-86
- Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke.Stroke. 2002; 33: 542-547
- The Activities-Specific Balance Confidence (ABC) Scale.J Gerontol A Biol Sci Med Sci. 1995; 50A: M28-M34
- Using the International Classification of Functioning, Disability and Health as a framework to examine the association between falls and clinical assessment tools in people with stroke.Phys Ther. 2009; 89: 816-825
- Fall-related self-efficacy, not balance and mobility performance, is related to accidental falls in chronic stroke survivors with low bone mineral density.Osteoporos Int. 2008; 19: 919-927
- Is impaired control of reactive stepping related to falls during inpatient stroke rehabilitation?.Neurorehabil Neural Repair. 2013; 27: 526-533
- Psychological indicators of balance confidence: relationship to actual and perceived abilities.J Gerontol. 1996; 51: M37-M43
- Self-efficacy, state anxiety, and cortisol responses to treadmill running.Percept Mot Skills. 2001; 92: 1129-1138
- Does fear of falling influence spatial and temporal gait parameters in elderly persons beyond changes associated with normal aging?.J Gerontol. 2005; 60A: 1163-1167
- Fear of falling, balance, and gait velocity in patients with stroke.Physiother Theory Pract. 2005; 21: 113-120
- Relationships between fear of falling, balance confidence, and control of balance, gait, and reactive stepping in individuals with sub-acute stroke.Gait Posture. 2016; 43: 154-159
- Do measures of reactive balance control predict falls in people with stroke returning to the community?.Physiotherapy. 2015; 101: 373-380
- A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population.J Gerontol. 1994; 49: M72-M84
- Stressing the postural response: a quantitative method for testing balance.J Am Geriatr Soc. 1986; 34: 845-850
- Quantitative gait markers and incident fall risk in older adults.J Gerontol. 2009; 64A: 896-901
- Neuropsychological, balance, and mobility risk factors for falls in people with multiple sclerosis: a prospective cohort study.Arch Phys Med Rehabil. 2014; 95: 480-486
- The impact of falls on motor and cognitive recovery after discharge from in-patient stroke rehabilitation.J Stroke Cerebrovasc Dis. 2016; 25: 1613-1621
- Measurements of acute cerebral infarction: a clinical examination.Stroke. 1989; 20: 864-870
- Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment.Stroke. 1993; 24: 58-63
- Measurement properties of the Activities-Specific Balance Confidence Scale among individuals with stroke.Disabil Rehabil. 2005; 27: 156-163
- Preferred placement of the feet during quiet stance: development of a standardized foot placement for balance testing.Clin Biomech (Bristol, Avon). 1997; 12: 66-70
- Relationship between asymmetry of quiet standing balance control and walking post-stroke.Gait Posture. 2014; 39: 177-181
- Clinical implementation of a reactive balance control assessment in a sub-acute stroke patient population using a “lean-and-release” methodology.Gait Posture. 2015; 41: 529-534
- A simple sequentially rejective multiple test procedure.Scand J Stat. 1979; 6: 65-70
- Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: a systematic review of the literature.Eur Spine J. 2011; 20: 358-368
- Center-of-pressure total trajectory length is a complementary measure to maximum excursion to better differentiate multidirectional standing limits of stability between individuals with incomplete spinal cord injury and able-bodied individuals.J Neuroeng Rehabil. 2014; 11: 8
- Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults.Gait Posture. 2013; 38: 120-124
- Gait changes in older adults: predictors of falls or indicators of fear?.J Am Geriatr Soc. 1997; 45: 313-320
- Walking patterns in healthy old men.J Gerontol. 1969; 24: 169-178
- Gait variability: methods, modeling and meaning.J Neuroeng Rehabil. 2005; 2: 19
- Human balance and posture control during standing and walking.Gait Posture. 1995; 3: 193-214
- Falls in individuals with stroke.J Rehabil Res Dev. 2008; 45: 1195-1213
- The effect of interventions on balance self-efficacy in the stroke population: a systematic review and meta-analysis.Clin Rehabil. 2015; 29: 1168-1177
- Measurement of fall-related psychological constructs among independent-living older adults: a review of the research literature.Aging Ment Health. 2008; 12: 684-699
- Determinants and consequences for standing balance of spontaneous weight-bearing on the paretic side among individuals with chronic stroke.Gait Posture. 2013; 38: 428-432
- Between-limb synchronization for control of standing balance in individuals with stroke.Clin Biomech (Bristol, Avon). 2011; 26: 312-317
- Impaired reactive stepping among patients ready for discharge from inpatient stroke rehabilitation.Phys Ther. 2014; 94: 1755-1764
Article info
Publication history
Published online: December 07, 2016
Accepted:
July 11,
2016
Received in revised form:
June 29,
2016
Received:
May 10,
2016
Footnotes
Funding: This project has been generously funded by a grant from the Ontario Ministry of Health and Long-Term Care, administered and supported by the Ontario Stroke Network (OSN1101-000117). Equipment and space were funded with grants from the Canada Foundation for Innovation, Ontario Innovation Trust, and the Ministry of Research and Innovation. AS-I is supported by a Trainee Award from the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery and an Interdisciplinary Fellowship from the Canadian Frailty Network. AM holds a New Investigator Award from the Canadian Institutes of Health Research (MSH-141983). The funding sources did not have any role in the experimental process or in the preparation of the manuscript, and the views expressed do not necessarily reflect those of the funders.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.07.022
Copyright
© 2017 Published by Elsevier Inc. on behalf of National Stroke Association.
