Main Article Content

Neelofar Rizwan
Arooj Fatima
Maimoona Akhlaq Ahmed
Sana Tauqeer


OBJECTIVE: To compare fear of fall (lack of self-confidence to maintain balance during normal activity) with and without fall history among sub-acute stroke patients in Lahore, Pakistan.
METHODS: This cross-sectional study was conducted from October 2018 till January 2019 in different hospitals of Lahore, Pakistan. Sixty-six patients in age group of 40-75 years and having sub-acute stroke (stroke duration between 2-6 months) were included in the study after taking their consent. Fall Efficacy Scale-International (FES-I) questionnaire was used.
RESULTS: Out of 66 subjects, 41 (62.1%) were males. Majority (n=39; 59.1%) of patients were between 50-70 years of age and 16 (24.2%) were >70 years old. Fifty (75.8%) patients had hemorrhagic stroke. Most (52/66, 78.8%) of the patients were independent/ambulatory. Thirty-six (54.5%) patients used assistive devices. Patients with history of fall were 37 (56.1%) while fear of fall was recorded in 28 (42.4%) patients. Maximum (17/37; 45.9%) patients fell in washroom, 12/37 (32.4%) in bedroom, 5/37 (12.5 %) fell outside at road or pavement and 3/37 (8.1%) patients fell from stairs. Overall mean FES-I score was 29.08±5.29. Mean FES-I score in patients with history of fall was 30.38±5.55 as compared to 27.41 ±4.50 in patients with no fall history (p<0.05).
CONCLUSION: In our study, fear of fall score is significantly higher in sub-acute stroke patients with history of fall than in patients without history of fall.

Article Details

How to Cite
Rizwan, N., A. Fatima, M. Akhlaq Ahmed, and S. Tauqeer. “FEAR OF FALL AMONG SUB-ACUTE STROKE PATIENTS IN LAHORE, PAKISTAN”. KHYBER MEDICAL UNIVERSITY JOURNAL, Vol. 12, no. 1, Mar. 2020, pp. 15-8, doi:10.35845/kmuj.2020.19054.
Original Articles


1. Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014;45(8):2532-53. DOI: 10.1161/STR.0000000000000022.
2. Joseph C, Rhoda A. Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape. Afr Health Sci 2013;13(3):646-54.
3. Lord SE, McPherson K, McNaughton HK, Rochester L, Weatherall M. Community ambulation after stroke: how important and obtainable is it and what measures appear predictive? Arch Phys Med Rehabil 2004;85(2):234-9.
4. Barlow J. Self-efficacy in the context of rehabilitation. Int Encyclopedia Rehabil 2013.
5. Hellström K, Lindmark B, Fugl-Meyer A. The Falls-Efficacy Scale, Swedish version: does it reflect clinically meaningful changes after stroke? Disabil Rehabil 2002;24(9):471-81.
6. Hellstrom K, Lindmark B, Wahlberg B, Fugl-Meyer AR. Self-efficacy in relation to impairments and activities of daily living disability in elderly patients with stroke: a prospective investigation. J Rehabil Med 2003;35(5):202-7.
7. Batchelor FA, Mackintosh SF, Said CM, Hill KD. Falls after stroke. Int J Stroke 2012;7(6):482-90. DOI: 10.1111/j.1747-4949.2012.00796.x.
8. Weerdesteijn V, Niet MD, Van Duijnhoven H, Geurts AC. Falls in individuals with stroke. J Rehabil Res Dev 2008;45(8):1195-213
9. Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol 2001;52(1):1-26. DOI: 10.1146/annurev.psych.52.1.1.
10. Cho K, Yu J, Rhee H. Risk factors related to falling in stroke patients: a cross-sectional study. J Phys Ther Sci 2015;27(6):1751-3. DOI: 10.1589/jpts.27.1751.
11. Dewan N, MacDermid JC. Fall Efficacy Scale-International (FES-I). J Physiother 2014 Mar;60(1):60. DOI: 10.1016/j.jphys.2013.12.014.
12. Perell KL, Nelson A, Goldman RL, Luther SL, Prieto-Lewis N, Rubenstein LZ. Fall risk assessment measures: an analytic review. J Gerontol A Biol Sci Med Sci 2001;56(12):M761-6.
13. Li F, Fisher KJ, Harmer P, McAuley E. Delineating the impact of Tai Chi training on physical function among the elderly. Am J Prev Med 2002;23(2):92-7.
14. Pakistan Stroke Society. Information about Stroke. [Cited on October 02, 2018]. Available from URL: http://www.pakstroke.com/
15. Schmid AA, Arnold SE, Jones VA, Ritter MJ, Sapp SA, Van Puymbroeck M. Fear of falling in people with chronic stroke. Am J Occup Ther 2015;69(3):6903350020. DOI: 10.5014/ajot.2015.016253.
16. Lamb SE, Ferrucci L, Volapto S, Fried L, Guralnik JM. Risk factors for falling in home-dwelling older women with stroke: the Women’s Health and Aging Study. Stroke 2003;34(2):494-501.
17. Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Arch Phys Med Rehabil 2006;87(12):1583-9. DOI: 10.1016/j.apmr.2006.09.004.
18. Yates JS, Lai SM, Duncan PW, Studenski S. Falls in community-dwelling stroke survivors: an accumulated impairments model. J Rehabil Res Dev 2002;39(3):385-94.
19. Belgen B, Beninato M, Sullivan PE, Narielwalla K. The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil 2006;87(4):554-61. DOI: 10.1016/j.apmr.2005.12.027.
20. Persson CU, Kjellberg S, Lernfelt B, Westerlind E, Cruce M, Hansson PO. Risk of falling in a stroke unit after acute stroke: The Fall Study of Gothenburg (FallsGOT). Clin Rehabil 2018;32(3):398-409. DOI: 10.1177/0269215517728325.
21. Schinkel-Ivy A, Inness EL, Mansfield A. Relationships between fear of falling, balance confidence, and control of balance, gait, and reactive stepping in individuals with sub-acute stroke. Gait posture 2016;43:154-9. DOI: 10.1016/j.gaitpost.2015.09.015.
22. Panel on Prevention of Falls in Older Persons AGS, Society BG. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 2011;59(1):148-57. DOI: 10.1111/j.1532-5415.2010.03234.x.
23. Cumming RG, Salkeld G, Thomas M, Szonyi G. Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Biol Sci Med Sci 2000;55(5):M299-305.
24. Batchelor FA, Hill KD, Mackintosh SF, Said CM, Whitehead CH. Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial. Arch Phys Med Rehabil 2012;93(9):1648-55. DOI: 10.1016/j.apmr.2012.03.031.
25. Tsai S-F, Yin J-H, Tung T-H, Shimada TJD, rehabilitation. Falls efficacy among stroke survivors living in the community. Disabil Rehabil 2011;33(19-20):1785-90. DOI: 10.3109/09638288.2010.546938.
26. Goh H-T, Nadarajah M, Hamzah NB, Varadan P, Tan MP. Falls and fear of falling after stroke: a case-control study. Phys Med Rehabil (PM R) 2016;8(12):1173-80. DOI: 10.1016/j.pmrj.2016.05.012.
27. Afridi A, Maqbool S, Malik AN. Relationship between fear, fall & balance in community dwelling older adults relationship between fear, fall & balance in community dwelling older adults. Pak J Neurol Sci 2015; 10(2):3.