Does Falls Efficacy Influence the Relationship Between Forward and Backward Walking Speed After Stroke?

Area of Science:

• Neurology
• Rehabilitation Medicine
• Biomechanical Engineering

Background:

• Forward walking speed (FWS) is a key indicator of mobility and fall risk poststroke.
• Backward walking speed (BWS) is an emerging metric revealing mobility deficits not evident with FWS alone.
• Falls efficacy may mediate the relationship between FWS and BWS due to backward walking's challenge.

Purpose of the Study:

• To test the hypothesis that lower falls efficacy is associated with a stronger positive relationship between FWS and BWS poststroke.
• To investigate the moderating role of falls efficacy on the FWS-BWS relationship.

Main Methods:

• Observational study of 45 individuals poststroke (12.9 ± 5.6 months).
• Assessed FWS (10-meter walk test) and BWS (3-meter backward walk test).
• Quantified falls efficacy using the modified Falls-Efficacy Scale (mFES) and analyzed using moderated regression.

Main Results:

• FWS was positively associated with BWS (R² = 0.26).
• The FWS × mFES interaction term explained an additional 7.6% of variance in BWS.
• Individuals with lower falls efficacy (mFES ≤ 6.6) showed a significant positive FWS-BWS relationship, unlike those with higher efficacy.

Conclusions:

• The relationship between FWS and BWS poststroke is significantly moderated by perceived falls efficacy.
• BWS is predictable from FWS in individuals with lower falls efficacy.
• As falls efficacy increases, BWS becomes less associated with FWS, suggesting distinct underlying mechanisms.