Fear of Falling in Patients With Chronic Stroke

Effects of Combining Cognitive Behavioural Therapy With Task-oriented Balance Training for Reducing Fear of Falling in People With Chronic Stroke: A Randomized Controlled Trial

The aim of the study is to evaluate whether combining cognitive-behavioral therapy (CBT) with task-oriented balance training (TOBT) is more effective than general health education (GHE) together with TOBT in promoting fear of falling and reducing activity avoidance behavior.

The null hypothesis of this study will be that no significant difference in the efficacy of the two treatments (CBT + TOBT; GHE + TOBT) in promoting fear of falling and reducing fear avoidance behavior, and thus no significant difference in improving balance ability, reducing fall risks, improving health-related quality of life and community reintegration of people with stroke.

Inclusion criteria: Subjects will be included if they

• are between 55 and 85 years of age;
• have been diagnosed with a first unilateral ischemic brain injury or intracerebral hemorrhage by magnetic resonance imaging or computed tomography within the previous 1 to 6 years;
• have been discharged from all rehabilitation services at least 6 months before program begins;
• are able to work independently at least 10 meters with or without an assistive device;
• have low balance self-efficacy (The Activities-specific Balance Confidence scale score of <80);
• are able to score > 7 out of 10 on the Chinese version of Abbreviated Mental Test; and
• are able to follow instructions and provide written informed consent.

Exclusion criteria: Subjects will be excluded if they

• have any additional medical, cardiovascular, orthopaedic, or psychiatric or psychological condition that would hinder proper treatment or assessment;
• have receptive dysphasia;
• have significant lower peripheral neuropathy; or
• are involved in a drug studies or other clinical trial.