Self-management and self-efficacy in stroke survivors: validation of the Italian version of the stroke self-efficacy questionnaire

BACKGROUND: Self-efficacy is an important mediator of the adaptation process after stroke. However, few studies have attempted to measure self-efficacy in a stroke population. The most recently developed scale is the Stroke Self-Efficacy Questionnaire that measures self-efficacy ratings in specific domains of functioning relevant for a stroke survivor. AIM: The aim of this study was to validate the Italian version of Stroke Self-efficacy Questionnaire in stroke survivors. DESIGN: Cross-sectional study. SETTING: Three Physical Medicine and Rehabilitation Units located in public hospitals. POPULATION: 149 adult patients recruited after their first stroke. METHODS: Patients were assessed using the Self-efficacy in stroke survivors questionnaire, the Modified Barthel Index, the Geriatric Depression Scale and the Short Form Health Survey. RESULTS: Patients (38.3% female, mean age 69.3 years) completed the Self-efficacy in stroke survivors questionnaire with the help of an interviewer. Using confirmatory factor analysis two factors were identified (activity and self-management). The factor score 'activity' was significantly associated with the Modified Barthel Index and with the physical component of the Short Form Health Survey, but uncorrelated with the mental component of the Short Form Health Survey and with the Geriatric Depression Scale , supporting the convergent/discriminant validity of the instrument. The 'self-management' factor was weakly associated with the Modified Barthel Index, the physical and mental components of the Short Form Health Survey and uncorrelated with the Geriatric Depression Scale, suggesting that it measures a different construct. When we categorized patients according to their walking status, we found that the walking group had significantly higher scores on the activity factor than the non-walking group, while no significant differences were found concerning the self-management factor. CONCLUSIONS: The findings supported the validity of the Italian version of the Stroke Self-efficacy questionnaire. It measures two dimensions of self-efficacy, activity and self-management, strongly related to independence and recovery after stroke and therefore it represents a useful tool to assess self-efficacy. CLINICAL REHABILITATION IMPACT: The Italian version of the Stroke Self-efficacy questionnaire is a valid and reliable measure of self-efficacy. Clinicians can use this instrument to target rehabilitation interventions according to patients' individual confidence in their functional and self-management capacity and in order to set realistic goals.