Abstract
Objective
To determine whether self-efficacy (SE) mediates or moderates the relationship between
motor ability at pretest and functional use of the affected arm at posttest in task-related
training for stroke.
Design
Retrospective, observational cohort study.
Setting
Outpatient rehabilitation settings.
Participants
Eighty patients with chronic stroke (N=80).
Interventions
The training was delivered to the participants for 60-90 min/session, 3-5 sessions/wk
for 4-6 weeks. The training involved specific robot-assisted, mirror, or combined
therapy, followed by functional task practice for approximately 30 minutes in each
session.
Main Outcome Measures
The outcome measure was the perceived amount of functional arm use and quality of
movement evaluated by the Motor Activity Log (MAL) at posttest. The predictor was
scores on the Fugl-Meyer Assessment (FMA)–Upper Extremity subscale at pretest. The
tested mediator and moderator were scores on the Stroke Self-Efficacy Questionnaire
(SSEQ) at pretest and posttest.
Results
The SSEQ scores at pretest and posttest moderated the predictive relationship of pretest
FMA to posttest MAL. The interaction between pretest FMA and SSEQ accounted for an
additional 3.14%-5.37% of the variance in the posttest MAL. The predictive relationship
between FMA and MAL was its greatest when the SSEQ was high, with a less amplified
positive relationship at low levels of SSEQ.
Conclusions
The results suggest the evaluation of SE at pretest for a better prediction of an
individual patient's functional arm use after an intervention and recommend aiming
at SE during training to make the most of motor ability transferred to functional
use. Future research may compare the effectiveness of task-related training with and
without SE building to verify the findings of this study.
Keywords
List of abbreviations:
AOU (amount of use), FMA (Fugl-Meyer Assessment), MAL (Motor Activity Log), SE (self-efficacy), SSEQ (Stroke Self-Efficacy Questionnaire), UE (upper extremity)To read this article in full you will need to make a payment
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References
- Self-perceived utilization of the paretic arm in chronic stroke requires high upper limb functional ability.Arch Phys Med Rehabil. 2014; 95: 918-924
- Predictors of clinically important changes in actual and perceived functional arm use of the affected upper limb after rehabilitative therapy in chronic stroke.Arch Phys Med Rehabil. 2020; 101: 442-449
- Predicting daily use of the affected upper extremity 1 year after stroke.J Stroke Cerebrovasc Dis. 2015; 24: 274-283
- Optimizing performance through intrinsic motivation and attention for learning: the OPTIMAL theory of motor learning.Psychon Bull Rev. 2016; 23: 1382-1414
- Does task-specific training improve upper limb performance in daily life poststroke?.Neurorehabil Neural Repair. 2017; 31: 290-300
- Self-efficacy: toward a unifying theory of behavioral change.Psychol Rev. 1977; 84: 191-215
- Role of self-efficacy in rehabilitation outcome among chronic low back pain patients.J Couns Psychol. 1993; 40: 335
- Self-efficacy and reach performance in individuals with mild motor impairment due to stroke.Neurorehabil Neural Repair. 2019; 33: 319-328
- Robotic assistance for training finger movement using a Hebbian model: a randomized controlled trial.Neurorehabil Neural Repair. 2017; 31: 769-780
- Self-efficacy mediates the relationship between balance/walking performance, activity, and participation after stroke.Top Stroke Rehabil. 2016; 23: 77-83
- Relationship between walking capacity, biopsychosocial factors, self-efficacy, and walking activity in persons poststroke.J Neurol Phys Ther. 2016; 40: 232-238
- Upper limb performance in daily life improves over the first 12 weeks poststroke.Neurorehabil Neural Repair. 2019; 33: 836-847
- Testing mediational models with longitudinal data: questions and tips in the use of structural equation modeling.J Abnorm Psychol. 2003; 112: 558-577
- Mediation analysis with longitudinal data.in: Newsom JT Jones RN Hofer SM Longitudinal data analysis: a practical guide for researchers in aging, health, and social sciences. Routledge, New York2012: 181-216
- The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance.Scand J Rehabil Med. 1975; 7: 13-31
- Technique to improve chronic motor deficit after stroke.Arch Phys Med Rehabil. 1993; 74: 347-354
- The Stroke Self-Efficacy Questionnaire: measuring individual confidence in functional performance after stroke.J Clin Nurs. 2008; 17: 244-252
- Foundations of clinical research: applications to practice.3rd ed. Pearson Education, Upper Saddle River2009
- Introduction to mediation, moderation, and conditional process analysis: a regression-based approach.2nd ed. Guilford Publications, New York; London2018
- Belief, confidence, and motivation to use the paretic upper limb in daily life over the first 24 weeks after stroke.J Neurol Phys Ther. 2019; 43: 197-203
- Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial.Stroke. 1999; 30: 2369-2375
- Prediction of recovery of motor function after stroke.Lancet Neurol. 2010; 9: 1228-1232
- Use it and improve it or lose it: interactions between arm function and use in humans post-stroke.PLoS Comput Biol. 2012; 8e1002343
- Determining levels of upper extremity movement impairment by applying a cluster analysis to the Fugl-Meyer Assessment of the upper extremity in chronic stroke.Arch Phys Med Rehabil. 2017; 98: 456-462
- A functional threshold for long-term use of hand and arm function can be determined: predictions from a computational model and supporting data from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) Trial.Phys Ther. 2009; 89: 1327-1336
Article info
Publication history
Published online: April 08, 2021
Accepted:
March 13,
2021
Received in revised form:
February 11,
2021
Received:
June 9,
2020
Footnotes
Supported by Chang Gung Memorial Hospital (grant nos. CMRPD1I0032, BMRP553), Healthy Aging Research Center, Chang Gung University from the Featured Areas Research Center Program within the Framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan (grant no. EMRPD1L0411), the Ministry of Science and Technology (grant no. MOST108-2314-B-182-040 -MY3) in Taiwan, and the National Health Research Institutes (grant no. NHRI-EX109-10604PI) in Taiwan.
Disclosures: none.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
