Does falls efficacy influence the relationship between forward and backward walking speed after stroke

Objective Forward walking speed (FWS) is known to be an important predictor of mobility, falls, and falls-related efficacy post-stroke. However, backward walking speed (BWS) is emerging as an assessment tool to reveal mobility deficits in people post-stroke that may not be apparent with FWS alone. Since backward walking is more challenging than forward walking, falls efficacy may play a role in the relationship between one's preferred FWS and BWS. We tested the hypothesis that people with lower falls efficacy would have a stronger positive relationship between FWS and BWS than those with higher falls efficacy. Methods Forty-five individuals (12.9 ± 5.6 months post-stroke), participated in this observational study. We assessed FWS with the 10 meter walk test and BWS with the 3 meter backward walk test. The Modified Falls-Efficacy Scale (mFES) quantified falls efficacy. A moderated regression analysis examined the hypothesis. Results FWS was positively associated with BWS (R2 = 0.26, p 6.6) had no relationship between their walking speed in the two directions. Conclusions FWS is positively related to BWS post-stroke, but this relationship is influenced by one's perceived falls efficacy. Our results suggest that BWS can be predicted from FWS in people with lower falls efficacy, but as falls efficacy increases, BWS becomes a separate and unassociated construct from FWS. Impact statement This study provides unique evidence that the degree of falls efficacy significantly influences the relationship between FWS and BWS post-stroke. Physical therapists should examine both FWS and BWS in people with higher falls efficacy, but further investigation is warranted for those with lower falls efficacy.