UBC Theses and Dissertations
Natural history of balance confidence : its significance and relationship with social participation in inidividuals with stroke Yiu, Jeanne Yeung Chun
Background: Balance confidence may be an important factor affecting the recovery and rehabilitation of individuals with stroke. Little is known about how balance confidence changes over time and whether a relationship exists between balance confidence and critical outcomes such as social participation in individuals with stroke. No study has investigated the influence of balance confidence on social participation while controlling for important covariates. If balance confidence is an important predictor of social participation, treating reduced balance confidence may enhance an individual’s social participation. Purpose: 1) To compare how balance confidence changed over 1 year in individuals with stroke and controls 2) To determine if stroke status was an important predictor of balance confidence and explore stroke specific factors affecting balance confidence 3) To compare how social participation changed over 1 year in individuals with stroke and controls 4) To determine if balance confidence was an important predictor of social participation Methods: In this longitudinal study, 98 individuals with stroke and 98 age- and sex-matched controls were evaluated at baseline (discharge from in-patient rehabilitation for stroke subjects) 3, 6 and 12 months post baseline. Subjects were recruited from 5 communities in British Columbia. Multilevel modeling and multiple regression analyses were used to answer our research questions. Results: Balance confidence scores improved slightly over 1 year in individuals with stroke however while the change was statistically important it was not considered clinically meaningful. Balance confidence remained significantly lower in these individuals compared to controls (p<0.001). Stroke status was the most important predictor of balance confidence even after controlling for covariates (p<0.001) and stoke status interacted with symptoms of depression and walking capacity when predicting balance confidence. The level of social participation did not change over 1 year in either group but it was statistically lower in individuals with stroke (p<0.001). Balance confidence interacted with balance performance (p=0.023) in predicting social participation. Conclusions: Reduced balance confidence is a persistent and serious problem in individuals with stroke. Having better balance confidence may enhance an individual’s social participation. Clinicians working in stroke rehabilitation should incorporate assessment and treatment for reduced balance confidence into their rehabilitation regime.
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