Date Presented 4/18/2015
Fear of falling (FoF) has not been studied in chronic stroke. In our sample, average time since stroke was more than 4 yr, and 66% of study participants identified a FoF. FoF was associated with worse balance, activity, participation, anxiety, and stroke severity. Occupational therapists (OTs) must address FoF after stroke.
SIGNIFICANCE: Only 14% of the 800,000 individuals who sustain a stroke annually achieve a full recovery after 1 yr. The remaining individuals require occupational therapy and sustain some level of cognitive, emotional, and physical disability, including fear of falling (FoF), balance impairment, activity intolerance, anxiety, and depression. Understanding these important variables will influence the delivery and impact of occupational therapy.
INNOVATION: Currently, FoF and how it relates to balance, anxiety, depression, activity, participation, and stroke severity have been explored in people with acute stroke. However, the prevalence of FoF and its associations with these important variables are unknown for people with chronic stroke.
APPROACH: More individuals are surviving strokes and are living with significant consequences, some of which can lead to the development of FoF. FoF has not been studied in chronic stroke. Therefore, our objectives were to identify the prevalence of FoF in a sample of people with chronic stroke and to compare multiple variables between people with and without FoF.
METHOD: We used secondary data analysis of data from a cross-sectional parent study, and the was a university-based research laboratory. Inclusion criteria for participants included the following: referred to occupational or physical therapy 6 mo ago for physical deficits as a result of a stroke, completed all stroke-related rehabilitation, had residual functional disability, scored 4 out of 6 on the six-item Mini-Mental State Examination, and were between the ages of 50 and 85 yr. Participants were recruited from stroke support groups, ongoing research studies, and outpatient rehabilitation centers.
FoF was assessed with a modified FoF questionnaire (dichotomous yes/no). We included multiple outcome measures: Berg Balance Scale (balance); Generalized Anxiety Disorder—7 (anxiety); Patient Health Questionnaire—9 (depression); International Classification of Functioning, Disability and Health (ICF) measures of participation and activities (activity and participation); and the modified Rankin scale (stroke severity).
We assessed normality of data using p plots and Shapiro–Wilk tests. The frequency and percentage of people with FoF in the sample were calculated. We compared variables of interest (balance, anxiety, depression, activity, and participation) between people with and without FoF using independent t tests (or nonparametric equivalent Mann–Whitney U tests). Stroke severity was a dichotomous variable; chi-square analysis was used to compare stroke severity between people with and without FoF. Bonferroni correction was used to correct for multiple comparisons and to avoid false positive correlations between variables (α = .05) by the number of variables of interest (p = .05/5, α = .01).
RESULTS: A total of 77 subjects participated in the study. Average time since stroke was 53 + 44.34 mo. In this sample, 51 participants (66%) reported a FoF. After Bonferroni correction, people with FoF had significantly decreased balance (p < .001) and activity and participation (p = .006), increased anxiety (p = .007), and worse stroke severity (p = .001) when compared with people without FoF.
CONCLUSION: FoF is a prevalent concern in the chronic stroke population. The presence of FoF was associated with worse scoring in multiple outcome measures. Occupational therapists should address these issues in practice and could potentially influence outcomes if interventions address FoF. Further research is needed to develop effective occupational therapy interventions for this population.
