Challenges in selecting relevant outcomes when evaluating the effectiveness of rehabilitation inteventions for persons with stroke

The effectiveness of rehabilitation interventions has traditionally been measured using tests of physical capacity. The rehabilitation process, however, comprises many ingredients that set up a cascade of effects that impact beyond simple physical capacity. In this thesis, the vehicle of a clinical trial conducted to evaluate the efficacy of a walking intervention for persons with chronic stroke was used to illustrate the array of outcomes that are impacted upon by a rehabilitation intervention. First, the walking intervention was proven effective in enhancing two traditional capacity outcomes: functional walking capacity and walking speed. The intervention primarily benefited functional walking capacity, measured as the distance a person can walk in six minutes, indicating the task-specificity of training effects. Persons with a baseline walking deficit of moderate severity responded to the walking intervention to a greater extent than persons with mild or severe impairment. Following, the role of a less traditional construct---self-efficacy for balance activities---as an outcome of stroke rehabilitation was evaluated. Self-efficacy reflects perceived ability and it is measured not by direct testing but rather by self-report. It was hypothesized that the walking intervention would benefit balance self-efficacy in addition to functional walking capacity given that mastering a task is expected to enhance self-efficacy for that task. Thesis findings supported this hypothesis and suggested that the level of depressive symptoms may modify effects. Self-efficacy was also expected to influence physical functioning as much as physical capacity and this hypothesis was verified. Self-efficacy was also an independent predictor of perceived health status. Additional associations were observed between balance self-efficacy and age, gender, depression and functional capacity. Before recommending the evaluation of balance self-efficacy in rehabilitatio