Predictive utility of self-efficacy in early stroke rehabilitation

Rachel M Vaughn; Rachana Gangwani; Jasper I Mark; Kelly Fletcher; John M Baratta; Jessica M Cassidy

doi:10.1080/10749357.2024.2403806

Predictive utility of self-efficacy in early stroke rehabilitation

Top Stroke Rehabil. 2024 Sep 18:1-9. doi: 10.1080/10749357.2024.2403806. Online ahead of print.

Authors

Rachel M Vaughn¹, Rachana Gangwani^{1

2}, Jasper I Mark^{1

2}, Kelly Fletcher³, John M Baratta^{3

4}, Jessica M Cassidy¹

Affiliations

¹ Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
² Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ UNC Health, Chapel Hill, NC, USA.
⁴ Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 39292651
DOI: 10.1080/10749357.2024.2403806

Abstract

Introduction: A biopsychosocial approach entailing person-centered factors provides valuable insight to post-stroke rehabilitation potential. The consideration of an individual's belief in their capabilities, known as self-efficacy, may prove especially informative in the inpatient rehabilitation setting where motor learning often occurs.

Objective: To assess the predictive utility of self-efficacy in functional independence status change during inpatient rehabilitation.

Methods: Individuals with stroke admitted to an inpatient rehabilitation facility (IRF) completed an assessment battery near IRF admission and discharge involving motor assessments, participant-reported self-efficacy (Stroke Self-Efficacy Questionnaire), and functional independence status evaluation (sum of self-care and mobility Quality Indicators (QI) from the IRF-Patient Assessment Instrument). Linear regression was performed to determine the predictive performance of self-efficacy on QI change during IRF stay while accounting for age, time post-stroke, and IRF length of stay. Regression procedures were repeated for separate subgroups based on initial motor impairment level.

Results: Thirty individuals with stroke (14 females, age = 67.0 ± 9.80 years, 10.4 ± 3.46 days post-stroke) were enrolled. Self-efficacy at IRF admission explained a significant percentage of variance in QI Change for the cohort (R² = 30.7%, p = .001) and for the moderate to severe motor impairment subgroup (n = 12; R² = 49.9%, p = .010). After accounting for confounders, self-efficacy remained a significant predictor for the cohort (n = 30) model.

Discussion: Findings generated from this work support the predictive utility of self-efficacy in early post-stroke motor recovery. The inclusion of self-efficacy in a multi-faceted evaluation framework may therefore optimize rehabilitation outcomes by providing therapists with additional knowledge to better tailor an individual's care.

Keywords: Self-efficacy; functional independence; quality indicators; recovery; rehabilitation; stroke.