Impact of Fall-Related Anxiety on Post-Stroke Balance and Functional Performance: A Review

Abstract

Background: Fear of falling is a frequent psychological consequence after stroke and may limit balance recovery, mobility, and functional independence. Objective: To synthesize contemporary evidence on the association between fall-related anxiety (fear of falling, reduced falls self-efficacy, or low balance confidence) and post-stroke balance and functional performance in adult stroke survivors. Methods: A systematic review without meta-analysis was conducted using PubMed and Google Scholar to identify studies published between January 2020 and February 2025. Eligible primary studies assessed fear of falling or balance confidence using validated instruments and reported outcomes related to balance, mobility, gait, functional performance, participation, or falls. Findings were synthesized using structured narrative methods due to heterogeneity in designs and outcome measures. Results: Across included studies, fear of falling was consistently associated with impaired balance and reduced functional mobility, and was linked to lower limb weakness, frailty, sensory deficits, prior falls, and assistive device use. Several studies also reported significant associations between fear of falling and recurrent falls, and longitudinal evidence suggested early fear may persist and predict later fear trajectories. Conclusion: Fear of falling is consistently associated with worse balance, mobility, and functional outcomes after stroke and may contribute to ongoing fall vulnerability, particularly among frail and physically impaired survivors. Rehabilitation programs should incorporate routine screening and integrated interventions addressing both physical impairments and fear-related avoidance