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Belief, Confidence, and Motivation to Use the Paretic Upper Limb in Daily Life Over the First 24 Weeks After Stroke

Waddell, Kimberly J. PhD; Tabak, Rachel G. PhD; Strube, Michael J PhD; Haire-Joshu, Debra PhD; Lang, Catherine E. PhD

Journal of Neurologic Physical Therapy: October 2019 - Volume 43 - Issue 4 - p 197–203
doi: 10.1097/NPT.0000000000000287
Research Articles

Background and Purpose: The recovery patterns of upper limb (UL) impairment after stroke are established. Psychosocial factors such as belief that paretic UL recovery is possible, confidence, and motivation to use the paretic UL in everyday tasks are unexplored early after stroke. The purpose of this exploratory study was to characterize belief, confidence, and motivation to use the paretic UL in daily life, and self-perceived barriers to UL recovery over the first 24 weeks after stroke.

Methods: This was a longitudinal cohort study (N = 30) with 8 assessment sessions over the first 24 weeks after stroke. Belief, confidence, and motivation to use the paretic UL and self-perceived barriers were quantified via survey and analyzed using descriptive statistics. Change in the number of self-perceived barriers between weeks 2 and 24 was tested using a paired-samples t test. The relationship between UL capacity, depressive symptomatology, cognition, and each psychosocial factor was examined using Spearman rank-order correlation analyses.

Results: Twenty-two participants completed all study assessments. Belief, confidence, and motivation were high across the 24 weeks, with little variation. There was no difference between the average number of barriers from weeks 2 to 24. There was no relationship between the clinical measures and psychosocial factors at week 2, 12, or 24.

Discussion and Conclusions: High levels of belief, confidence, and motivation appear consistent over the first 6 months after stroke. The lack of correlations between psychosocial factors and clinical measures suggests belief, confidence, and motivation may not be vulnerable to functional status early after stroke.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at:

Program in Physical Therapy (K.J.W., C.E.L.), Brown School (R.G.T., D.H.J.), Psychological and Brain Sciences (M.JS.), and Program in Occupational Therapy and Department of Neurology (C.E.L.), Washington University, St Louis, Missouri.

Correspondence: Catherine E. Lang, PhD, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Ave, St Louis, MO 63108 (

This study was funded by National Institutes of Health R01HD068290 and TL1 TR002344.

Preliminary results were reported at the American Society for Neurorehabilitation annual meeting on November 1, 2018.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

© 2019 Academy of Neurologic Physical Therapy, APTA