Decreasing Fear of Falling in Chronic Stroke Survivors through Cognitive Behavior Therapy and Task-Oriented Training

Tai Wa Liu, Gabriel Y.F. Ng, Raymond C.K. Chung, Shamay S.M. Ng (Corresponding Author)

Research output: Journal article publicationJournal articleAcademic researchpeer-review

7 Citations (Scopus)


Background and Purpose - Research has shown that balance training is effective for reducing the fear of falling in individuals with a history of stroke. In this study, we evaluated (1) whether cognitive behavior therapy could augment the beneficial effects of task-oriented balance training (TOBT) in reducing the fear of falling in chronic stroke survivors and (2) whether it could, in turn, reduce fear-avoidance behavior and improve related health outcomes. Methods - Eighty-nine cognitively intact subjects with mildly impaired balance ability were randomized into the following 2 groups that underwent 90-minutes interventions 2 days per week for 8 weeks: (1) cognitive behavior therapy + TOBT or (2) general health education + TOBT (control). The primary outcome was the fear of falling, and the secondary outcomes were fear-avoidance behavior, balance, fall risk, independent daily living, community integration, and health-related quality of life. The outcomes were assessed at baseline, after 4 and 8 weeks of intervention, and 3 and 12 months after completing the intervention. Results - Eighty-two subjects completed the intervention and follow-up assessments. From postintervention to 12 months after completing the intervention, the cognitive behavior therapy + TOBT participants reported greater reduction in the fear of falling and fear-avoidance behavior and greater improvements in balance and independent daily living than the general health education + TOBT participants. Conclusions - Cognitive behavior therapy should be considered as an adjuvant therapy to standard physiotherapy for cognitively intact individuals with a history of stroke. Clinical Trial Registration - URL: Unique identifier: NCT02937532.

Original languageEnglish
Pages (from-to)148-154
Number of pages7
Issue number1
Publication statusPublished - 7 Dec 2018


  • avoidance learning
  • cognitive therapy
  • fear
  • quality of life
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

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