Association between fear of falling and falls following acute and chronic stroke: a systematic review with meta-analysis.
Tamis W Pin, Stanley J Winser, Wayne L S Chan and 5 others
PMID 38226564WHAT IT FOUND
People with acute stroke who answer yes to "are you afraid of falling?" have a higher risk of falls.
In chronic stroke, a simple yes/no question misses the link, so use a confidence scale like the FES or ABC to spot the risk.
Key findings
01In acute stroke, participants who reported fear of falling had a significantly higher risk of falls compared to those who did not.
02In chronic stroke, a single yes/no question about fear of falling did not show a significant association with falls.
03In chronic stroke, people who fell had significantly lower scores on formal balance confidence scales (FES and ABC) than those who did not fall.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The quality of evidence is low to very low, largely because most included studies were observational rather than randomized trials. Many studies had high rates of participants lost to follow-up, which can skew results. The review could not confirm cause and effect because most studies were cross-sectional or did not track changes over time rigorously. Fear of falling was measured in different ways across studies (single question vs. FES vs. ABC), which complicates direct comparison. Only English-language studies were included, which may miss relevant research from other regions.
Declared interests
The authors declared no conflicts of interest. The study was supported by an internal university research grant that paid for personnel and materials, but the funder did not influence the study design, analysis, or writing.
The easy way to misread this
Do not assume that a patient in the chronic stage of stroke who says they are not afraid of falling is at low risk. The single yes/no question failed to detect the link between fear and falls in this group. Use a standardized scale like the FES or ABC to assess balance confidence accurately in chronic patients.