Measuring confidence after stroke

Horne, Jane (2016) Measuring confidence after stroke. PhD thesis, University of Nottingham.

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Improving confidence following stroke has been cited as a research priority (Pollock et al 2012). It is difficult to measure a change in confidence levels without valid and reliable measures. This research aims to develop and conduct a psychometric evaluation of a self-reported, confidence after stroke measure [CaSM].


Items were generated from themes highlighted in the literature review, and from a qualitative interview study, exploring the meaning of confidence. The CaSM was piloted with expert groups to establish face and content validity. The CaSM was administered to a sample of stroke and healthy elderly people recruited from the community. Completed postal questionnaires were analysed for reliability (internal consistency and test-retest), construct validity (factor analysis) and convergent validity. A visual analogue scale, to correlate therapists opinion with CaSM scores was used to assess concurrent validity. Sensitivity to change was assessed by comparing change scores at three time points after a confidence intervention. Case vignettes were used with stroke clinical experts to detect a minimal clinically meaningful change score.


Stroke (n=101) and healthy elderly participants (n=101) were recruited. Using item reduction techniques, a 53 item scale was reduced to 27 items. Factor Analysis was used to derive a three factor solution, Self-Confidence, Positive Attitude and Social Confidence, which explained 52% of variance. There was good evidence for internal consistency (α=0.94) and good temporal stability (rs=0.85 p=0.001). There was a small positive correlation between the two variables when assessing concurrent validity (rs=0.18, n=31, p<0.34), and did not demonstrate statistical significance. Four points on the CaSM was recommended by clinical experts as being a clinically important change score.


The 27 item CaSM [Appendix 1] was shown to be a valid and reliable measure. The CaSM was designed to be used to identify people with low confidence after stroke in order to facilitate appropriate treatment. The CaSM could be used in research, as a patient reported outcome measure to evaluate strategies to improve confidence after a stroke. Assessment of the CaSM’s ability to detect sensitivity to change needs further assessment.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Logan, P.A.
Lincoln, N.B.
Keywords: Stroke rehabilitation, Confidence
Subjects: W Medicine and related subjects (NLM Classification) > WL Nervous system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 31465
Depositing User: Horne, Jane
Date Deposited: 19 Jul 2016 06:40
Last Modified: 13 Oct 2017 04:14

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