The moderating roles of self-efficacy and depression in dual-task walking in multiple sclerosis: A test of self-awareness theory

Charles Van Liew, Mark Gudesblatt, Thomas J. Covey, Jeffrey Wilken, Daniel Golan, Myassar Zarif, Barbara Bumstead, Marijean Buhse, Edward Ofori, Daniel Peterson

Research output: Contribution to journalArticlepeer-review


Objective: Multiple sclerosis (MS) is a debilitating neurological disease associated with a variety of psychological, cognitive, and motoric symptoms. Walking is among the most important functions compromised by MS. Dual-task walking (DTW), an everyday activity in which people walk and engage in a concurrent, discrete task, has been assessed in MS, but little is known about how it relates to other MS symptoms. Self-awareness theory suggests that DTW may be a function of the interactions among psychological, cognitive, and motor processes. Method: Cognitive testing, self-report assessments for depression and falls self-efficacy (FSE), and walk evaluations [DTW and single-task walk (STW)] were assessed in seventy-three people with MS in a clinical care setting. Specifically, we assessed whether psychological factors (depression and FSE) that alter subjective evaluations regarding one's abilities would moderate the relationships between physical and cognitive abilities and DTW performance. Results: DTW speed is related to diverse physical and cognitive predictors. In support of self-awareness theory, FSE moderated the relationship between STW and DTW speeds such that lower FSE attenuated the strength of the relationship between them. DTW costs - the change in speed normalized by STW speed - did not relate to cognitive and motor predictors. DTW costs did relate to depressive symptoms, and depressive symptoms moderated the effect of information processing on DTW costs. Conclusions: Findings indicate that an interplay of physical ability and psychological factors - like depression and FSE - may enhance understanding of walking performance under complex, real-world, DTW contexts.

Original languageEnglish (US)
Pages (from-to)274-282
Number of pages9
JournalJournal of the International Neuropsychological Society
Issue number3
StatePublished - Mar 25 2023


  • Cognition
  • Depression
  • Dual-task walking
  • Multiple sclerosis
  • Self-efficacy

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Psychology
  • Clinical Neurology
  • Psychiatry and Mental health


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