Influence of Fear of Falling Severity Measured by Falls Efficacy Scale-International on Gait and Balance Performance After Chronic Stroke

Objectives: Fear of falling (FOF) is a common complication after stroke affecting gait and balance performance in individuals with a history of stroke. The current study aimed at determining the influence of the level of FOF on gait and balance performance after chronic stroke. Methods: A total of 76 persons with chronic stroke (including 41 women), who had no cognitive impairment and could walk at least 10 meters without walking aids, participated in this cross-sectional observational study. The participants walked at their preferred speed to calculate gait asymmetry ratios for stance time, swing time, and step length. The Asymmetry Index determined standing balance asymmetry measures of medial-lateral and anterior-posterior (AP) center of pressure (COP) velocity. The Falls Efficacy Scale-International (FES-I) evaluated the severity of FOF. Thirty-one participants had no FOF, 25 had low FOF, and 20 had high FOF. A multivariate analysis of variance test was used to compare standing balance and gait parameters among 3 groups. The Pearson correlation test was also used to define the relationships between FES-I and gait and standing balance asymmetry measures in individuals with FOF. Results: The mean ± SD age of the participants was 57.53 ± 9.28 years. The mean ± SD time since stroke onset was 17.29 ± 3.6 months. The participants with a high FOF had a significantly more asymmetrical swing time and step length and higher AP COP asymmetry compared to those without FOF (P = 0.02, P = 0.007, P = 0.03, respectively). Increased FES-I was related to increased swing time (r = 0.65, P = 0.001), step asymmetry (r = 0.45, P = 0.002), and AP COP asymmetry (r = 0.44, P = 0.003). Discussion: A high level of FOF affects gait and balance asymmetry after chronic stroke. Future research to develop therapeutic programs should consider the effects of FOF.