Relationships Among Environmental Variables, Physical Capacity, Balance Self-Efficacy, and Real-World Walking Activity Post-Stroke.

IF 3.7 2区 医学 Q1 CLINICAL NEUROLOGY
Neurorehabilitation and Neural Repair Pub Date : 2022-08-01 Epub Date: 2022-08-04 DOI:10.1177/15459683221115409
Allison Miller, Ryan T Pohlig, Darcy S Reisman
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引用次数: 5

Abstract

Background: Social and physical environmental factors affect real-world walking activity in individuals with stroke. However, environmental factors are often non-modifiable, presenting a challenge for clinicians working with individuals with stroke whose real-world walking is limited due to environmental barriers.

Objective: The purpose of this work was to test a model hypothesizing the relationships among environmental factors (specifically, living situation and area deprivation), modifiable factors, and real-world walking activity to understand opportunities for intervention. We hypothesized that balance self-efficacy would mediate the relationship between the environment and real-world walking and that physical capacity would moderate this mediation.

Methods: This was a cross-sectional study of 282 individuals with chronic (≥6 months) stroke. We tested the indirect effect to determine if mediation was present. Multiple group structural equation modeling was used to test if physical capacity moderated this mediation. A χ2 difference test was used to compare the moderation model against the null (no moderation) model.

Results: Balance self-efficacy mediated the relationship between area deprivation and real-world walking (indirect effect: β = -0.04, P = .04). Both the moderation and null models fit the data equally well statistically (χ2(5) = 6.9, P = .23). We therefore accepted the simpler (null) model and concluded that the mediation was not moderated.

Conclusions: Targeting balance self-efficacy may be an effective approach to improving real-world walking in persons with stroke who experience barriers within the physical environment. A stroke survivor's physical capacity may not impact this approach. Future work should consider utilizing more specific measures of the social and physical environment to better understand their influences on real-world walking activity in individuals with stroke. However, the results of this work provide excellent targets for future longitudinal studies targeting real-world walking activity in stroke.

环境变量、身体能力、平衡自我效能和中风后真实世界步行活动的关系。
背景:社会和物理环境因素影响中风患者的真实步行活动。然而,环境因素通常是不可改变的,这对临床医生来说是一个挑战,因为中风患者的实际行走受到环境障碍的限制。目的:本研究的目的是检验一个假设环境因素(特别是生活状况和面积剥夺)、可改变因素和现实世界步行活动之间关系的模型,以了解干预的机会。我们假设平衡自我效能会调节环境和现实世界行走之间的关系,而身体能力会调节这种调节。方法:对282例慢性(≥6个月)脑卒中患者进行横断面研究。我们测试了间接效应,以确定是否存在中介作用。采用多组结构方程模型检验身体能力是否调节了这种中介作用。采用χ2差异检验比较调节模型与零(无调节)模型。结果:平衡自我效能感介导了区域剥夺与真实世界行走的关系(间接效应:β = -0.04, P = 0.04)。适度模型和零模型在统计上都能很好地拟合数据(χ2(5) = 6.9, P = 0.23)。因此,我们接受了更简单的(零)模型,并得出结论:中介没有被调节。结论:以平衡自我效能为目标可能是一种有效的方法,可以改善在物理环境中遇到障碍的中风患者的现实行走能力。中风幸存者的身体能力可能不会影响这种方法。未来的工作应考虑利用更具体的社会和物理环境测量,以更好地了解它们对中风患者现实生活中步行活动的影响。然而,这项工作的结果为未来针对中风患者真实世界步行活动的纵向研究提供了很好的目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.30
自引率
4.80%
发文量
52
审稿时长
6-12 weeks
期刊介绍: Neurorehabilitation & Neural Repair (NNR) offers innovative and reliable reports relevant to functional recovery from neural injury and long term neurologic care. The journal''s unique focus is evidence-based basic and clinical practice and research. NNR deals with the management and fundamental mechanisms of functional recovery from conditions such as stroke, multiple sclerosis, Alzheimer''s disease, brain and spinal cord injuries, and peripheral nerve injuries.
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