Validation of an adapted falls efficacy scale in older rehabilitation patients

Büla CJ, Martin E, Rochat S, Piot-Ziegler C. Validation of an adapted Falls Efficacy Scale in older rehabilitation patients.

Objective

To determine the psychometric properties of an adapted version of the Falls Efficacy Scale (FES) in older rehabilitation patients.

Design

Cross-sectional survey.

Setting

Postacute rehabilitation facility in Switzerland.

Participants

Seventy elderly persons aged 65 years and older receiving postacute, inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

FES questions asked about subject’s confidence (range, 0 [none]-10 [full]) in performing 12 activities of daily living (ADLs) without falling. Construct validity was assessed using correlation with measures of physical (basic ADLs [BADLs]), cognitive (Mini-Mental State Examination [MMSE]), affective (15-item Geriatric Depression Scale [GDS]), and mobility (Performance Oriented Mobility Assessment [POMA]) performance. Predictive validity was assessed using the length of rehabilitation stay as the outcome. To determine test-retest reliability, FES administration was repeated in a random subsample (n=20) within 72 hours.

Results

FES scores ranged from 10 to 120 (mean, 88.7±26.5). Internal consistency was optimal (Cronbach α=.90), and item-to-total correlations were all significant, ranging from .56 (toilet use) to .82 (reaching into closets). Test-retest reliability was high (intraclass correlation coefficient, .97; 95% confidence interval, .95−.99; P<.001). Subjects reporting a fall in the previous year had lower FES scores than nonfallers (85.0±25.2 vs 94.4±27.9, P=.054). The FES correlated with POMA (Spearman ρ=.40, P<.001), MMSE (ρ=.37, P=.001), BADL (ρ=.43, P<.001), and GDS (ρ=−.53, P<.001) scores. These relationships remained significant in multivariable analysis for BADLs and GDS, confirming FES construct validity. There was a significant inverse relationship between FES score and the length of rehabilitation stay, independent of sociodemographic, functional, cognitive, and fall status.

Conclusions

This adapted FES is reliable and valid in older patients undergoing postacute rehabilitation. The independent association between poor falls efficacy and increased length of stay has not been previously described and needs further investigations.     

Evidence of the psychometric qualities of a simplified version of the Activities-specific Balance Confidence scale for community-dwelling seniors

OBJECTIVE: To evaluate the validity, reliability, and item hierarchy of a modified version of the Activities-specific Balance Confidence (ABC) scale using an item-response theory framework and integrating modifications aimed at increasing user-friendliness and promoting better congruence of the scale with public health falls prevention strategies. DESIGN: Cross-sectional study. SETTING: Community-based. PARTICIPANTS: Two hundred community-dwelling seniors involved in an effectiveness study of a falls prevention program. Participants were recruited by community-based organizations. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Balance confidence. RESULTS: The modified ABC scale (called ABC-Simplified [ABC-S] scale) has high internal consistency (reliability index, .86) and good convergent validity (statistically significant associations with perceived balance; performances on the one-leg stance, tandem stance, tandem walking, functional reach, and lateral reach [on the right side] tests; fear of falling; and occurrence of falls in the previous 12 mo). Analyses also showed differing degrees of difficulty across items, allowing for a determination of the scale's item hierarchy. CONCLUSIONS: The ABC-S scale is a valid and reliable measure for the assessment of balance confidence among community-dwelling seniors. The fact that this measure was validated with high-functioning seniors makes it particularly well-suited for identifying community-dwelling seniors who are beginning to lose confidence in their balance and who could benefit from community falls prevention programs.     

Balance Confidence and Falls in Nondemented Essential Tremor Patients: The Role of Cognition

Objectives

To examine (1) the effect of cognitive ability on balance confidence and falls, (2) the relationship of balance confidence and falls with quantitative measures of gait, and (3) measures that predict falls, in people with essential tremor (ET).

Design

Cross-sectional study.

Setting

General community.

Participants

People with ET (n=132) and control subjects (n=48). People with ET were divided into 2 groups based on the median score on the Modified Mini-Mental State Examination: those with lower cognitive test scores (ET-LCS) and those with higher cognitive test scores (ET-HCS).

Interventions

Not applicable.

Main Outcome Measures

Six-item Activities of Balance Confidence (ABC-6) Scale and falls in the previous year.

Results

Participants with ET-LCS had lower ABC-6 scores and a greater number of falls than those with ET-HCS (P<.05 for all measures) or control subjects (P<.01 for all measures). Quantitative gait measures were significantly correlated with ABC-6 score and falls. Gait speed (P<.007) and ABC-6 score (P<.02) were significant predictors of falls. Receiver operating characteristic curve analysis revealed that gait speed <0.9m/s and ABC-6 score <51% were associated with moderate sensitivity and specificity in identifying fallers.

Conclusions

People with ET-LCS have impaired gait and report lower balance confidence and a higher number of falls than their counterparts (ET-HCS) and than control subjects. We have identified assessments that are easily administered (gait speed, ABC-6 Scale) and are associated with falls in ET.     

Quantitative assessment of the stops walking while talking test in the elderly

OBJECTIVE: To examine whether trunk sway and walking speed differ between elderly "stoppers" and "nonstoppers" during a shorter version of the stops walking while talking (SWWT) test-an observational assessment of impaired dual-task performance-and during a normal walking trial. DESIGN: The original SWWT test was administered on the way to the test room (over a distance of 150m). Then, subjects were asked to walk 2 trials of 8m while wearing a trunk sway measuring device strapped firmly to their lower back. For the first 8-m trial, no questions were asked (control trial). During the second 8-m trial, subjects were asked an easy question (What is your age?) after walking 2m. SETTING: Long-stay geriatric care unit in Switzerland. PARTICIPANTS: Seventeen institutionalized elderly (16 women, 1 man; mean age, 86.3y; range, 79-93y). Subjects had to be able to walk at least 150m and to understand simple questions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The amplitude of trunk sway angle and angular velocity in the forward-backward (pitch) and side-to-side (roll) directions and the duration of each trial were compared between the two 8-m walking trials with and without a question among subjects who did and did not come to a complete stop. RESULTS: In the original SWWT test, 4 persons stopped walking while talking, compared with 8 persons who stopped in the short (8-m) walking trial when a question was asked. Persons who stopped during the 8-m trial when a question was asked had significantly longer walking durations (by 19s) and larger trunk roll angular displacements (by 5.5 degrees ) during trials, both with and without a question. For both stoppers and nonstoppers, duration was longer during the trial when a question was asked. CONCLUSION: A fixed and brief walking distance, coupled with a single sudden question, provided an effective method of identifying subjects who stop walking while talking. These subjects are those who have slower walking speeds and more unstable trunk control in the roll plane even under normal walking conditions. Our findings support the predictive capabilities of a brief SWWT test for the unstable and fall-prone elderly, as well as the usefulness of objective trunk sway measures to identify gait instabilities.     

Reliability and Internal Consistency of the Activities-Specific Balance Confidence Scale

ABSTRACT

The Activities-specific Balance Confidence Scale (ABC) was developed to assess balance confidence. While several researchers have used the ABC to measure balance confidence, its psychometric properties are reported by only a few studies. The purpose of this study was to evaluate the ABC's test–retest reliability and internal consistency among a sample of community dwelling older adults. Forty-four subjects aged 65 and older who lived independently in a senior living community participated in the study. Each participant completed the ABC on two separate test days, 6 months apart. Test–retest reliability revealed an intraclass correlation coefficient of 0.879 (95% CI, 0.779–0.934). Internal consistency measured by cronbach's α was 0.973 for both baseline and six-month data. The ABC demonstrated good test–retest reliability and strong internal consistency among a sample of community dwelling older adults; however, internal consistency may be exceedingly high, indicating item redundancy.     

Assessing subjective fall concerns in residential living seniors: development of the activities-specific fall caution scale

OBJECTIVES: To examine subjective fall concerns of seniors in residential care and to develop a tool applicable to both nursing home and assisted living settings. DESIGN: Used focus groups with residents and staff for construct examination and item generation; surveyed staff and interviewed residents for item verification; and conducted psychometric testing using Rasch analysis for scale refinement. SETTING: Seventeen residential care facilities in Ontario, Canada. PARTICIPANTS: Convenience samples totaling 57 staff and 234 residents. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Activities-specific Fall Caution (AFC) Scale, developed inductively with residents and staff, with items pertaining to residential living (eg, moving around a room full of people, furniture, or walkers). RESULTS: Resident terms (being cautious or careful) and qualifications (whether alone and proximity of gait aids) guided tool development. Rasch analysis showed that the final 13-item AFC Scale was hierarchic and unidimensional, with good person (.86) and item (.95) reliability. CONCLUSIONS: The AFC scale is a promising new tool for assessing subjective fall concerns in residential care residents. This tool can be administered via interview in about 10 minutes to most residents with Mini-Mental State Examination scores of 12 or greater, using practice questions to determine understanding and a 4-point color response card similar to a traffic light to facilitate responding.     

The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program

Sze P-C, Cheung W-H, Lam P-S, Lo HS-D, Leung K-S, Chan T. The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program.

Objective

To investigate the efficacy of a falls prevention clinic and a community step-down program in reducing the number of falls among community-dwelling elderly at high risk of fall.

Design

Prospective cohort.

Setting

Community.

Participants

Community-dwelling elderly (N=200) were screened for risk of fall; 60 were identified as being at high risk and were referred to the intervention program.

Intervention

Twelve sessions of a once-a-week falls prevention clinic, including fall evaluation, balance training, home hazard management program, and medical referrals, were provided in the first 3 months. The community step-down program, including falls prevention education, a weekly exercise class, and 2 home visitations, was provided in the following 9 months.

Main Outcome Measures

Fall rate, injurious fall, and its associated medical consultation were recorded during the intervention period and the year before intervention. Balance tests included the Berg Balance Scale (BBS), Sensory Organization Test, and limits of stability test; fear of falling, as evaluated using the Activities-specific Balance Confidence (ABC) scale, was measured at baseline and after the training in the falls prevention clinic.

Results

Significant reductions in fall rate (74%), injurious falls (43%), and fall-associated medical consultation (47%) were noted. Significant improvement in balance scores (BBS, P<.001; endpoint excursion in limits of stability test, P=.004) and fear of falling (ABC scale, P=.001) was shown.

Conclusions

The programs in the falls prevention clinic were effective in reducing the number of falls and injurious falls. The community step-down programs were crucial in maintaining the intervention effects of the falls prevention clinic.     

Lateral Balance Factors Predict Future Falls in Community-Living Older Adults

Hilliard MJ, Martinez KM, Janssen I, Edwards B, Mille M-L, Zhang Y, Rogers MW. Lateral balance factors predict future falls in community-living older adults.

Objective

To prospectively determine the capacity of measures of mediolateral (ML) protective stepping performance, maximum hip abduction torque, and trunk mobility, in order to predict the risk of falls among community-living older people.

Design

Cross-sectional study.

Setting

A balance and falls research laboratory.

Participants

Medically screened and functionally independent community-living older adult volunteers (N=51).

Interventions

Not applicable.

Main Outcome Measures

Measures included: (1) protective stepping responses: percentage of trials with multiple balance recovery steps and sidestep/crossover step recovery patterns, and first step length following motor-driven waist-pull perturbations of ML standing balance; (2) hip abduction strength and axial mobility: (3) peak isokinetic hip abduction joint torque and trunk functional axial rotation (FAR) range of motion; and (4) fall incidence: monthly mail-in reporting of fall occurrences with follow-up contact for 1 year post-testing. One- and 2-variable logistic regression analysis models determined which single and combined measures optimally predicted fall status.

Results

The single variable model with the strongest predictive value for falls was the use of multiple steps in all trials (100% multiple steps) (odds ratio, 6.2; P=.005). Two-variable models, including 100% multiple steps and either hip abduction torque or FAR variables, significantly improved fall prediction over 100% multiple steps alone. The hip abduction and FAR logistic regression optimally predicted fall status.

Conclusions

The findings identify new predictor variables for risk of falling that underscore the importance of dynamic balance recovery performance through ML stepping in relation to neuromusculoskeletal factors contributing to lateral balance stability. The results also highlight focused risk factors for falling that are amenable to clinical interventions for enhancing lateral balance function and preventing falls.     

Clinical identification of multiple fall risk early after unilateral transtibial amputation

OBJECTIVE: To examine if previously reported clinical tests of stepping and functional mobility could discriminate between multiple-falling and nonmultiple-falling people with unilateral transtibial amputations. DESIGN: Nonrandomized prospective cohort. SETTING: Rehabilitation hospital and general community. PARTICIPANTS: Forty-seven subjects initially recruited and tested at discharge. Forty subjects were retested at 6 months postdischarge and grouped as either multiple fallers (n=13) or nonmultiple fallers (n=27). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Four Square Step Test (FSST), Timed Up & Go (TUG) test, 180 degrees turn test, and the Locomotor Capabilities Index (LCI) advanced score. RESULTS: Significant differences (P<.01) were found between the 2 groups for all of the main outcome measures. The test scores associated with an increased risk of having multiple falls were as follows: TUG test of 19 seconds or more (sensitivity, 85%; specificity, 74%), turn time of 3.7 seconds or more (sensitivity, 85%; specificity, 78%), turn steps 6 steps or more (sensitivity, 100%; specificity, 74%), FSST of 24 seconds or more (sensitivity, 92%; specificity, 93%), and LCI advanced score of 15 or less (sensitivity, 43%; specificity, 91%). CONCLUSIONS: In this study, multiple-falling people with transtibial amputations displayed impaired mobility on the outcome measures reported. These measures offer valuable clinical tests of different and functionally relevant activities and provide good identification of multiple-falls risk.     

Rating scale analysis of the Berg Balance Scale

Kornetti DL, Fritz SL, Chiu Y-P, Light KE, Velozo CA. Rating scale analysis of the Berg Balance Scale. Arch Phys Med Rehabil 2004;85:1128-35.

Objectives

To examine, using Rasch analysis, the rating scale performance of the Berg Balance Scale (BBS) and to describe the 45/56 cutoff score in functional terms.

Design

Retrospective chart review of BBS scores. Rasch rating scale analysis was performed on these data.

Setting

Outpatient Veterans Affairs medical center.

Participants

One hundred (99 men, 1 woman) community-dwelling veterans referred for balance deficits (age range, 64-88y).

Interventions

Not applicable.

Main outcome measure

The BBS.

Results

Condensing item-rating categories allowed the elimination of underutilized categories and constructed categories that better separated people of differing abilities. Rating pivot points were developed for each item to represent a transition between passing and failing. Following pivot-point development and rating scale rescoring, person and item measures became more evenly distributed across the BBS and resulted in changes in item difficulty order. In our sample, functional indicators of a score of at least 45/56 were a rating of passing the item “tandem stance,” as well as passing 2 of the following 3 items: “alternating foot,” “standing on one leg,” and “look behind.”

Conclusions

Our findings provide direction for improving the rating scale structure for each of the items and establish a connection between the BBS cutoff score of 45/56 and functional ability.     

Subcortical vascular lesions predict falls at 12 months in elderly patients discharged from a rehabilitation ward

Guerini F, Frisoni GB, Marrè A, Turco R, Bellelli G, Trabucchi M. Subcortical vascular lesions predict falls at 12 months in elderly patients discharged from a rehabilitation ward.

Objective

To test whether subcortical vascular lesions are associated with falls in elderly patients with gait disorder discharged from a rehabilitation ward.

Design

Secondary 12-month follow-up analysis of an observational survey focusing on the prevalence of subcortical vascular lesions in a population of elderly patients discharged from rehabilitation hospitals.

Setting

A rehabilitation and aged care unit.

Participants

Consecutively admitted elderly patients (N=214) with gait disorder.

Interventions

Not applicable.

Main Outcome Measures

On admission, all patients underwent comprehensive geriatric assessment including sociodemographics, cognitive and depressive symptoms, nutritional status, physical health, and functional status. Subcortical vascular lesions were assessed on computed tomography films with a validated rating scale. All patients received a standardized rehabilitative program. Twelve months after discharge, all patients were interviewed by telephone, mainly focusing on the occurrence of falls during the follow-up period. Potential predictors of falls were assessed in univariate and multivariate analyses.

Results

Univariate predictors of falls were age, sex, Mini-Mental State Examination, Barthel Index on admission, and subcortical vascular lesions. In multivariate analyses, subcortical vascular lesions were the only significant predictor of risk of falling; patients with moderate and severe subcortical vascular lesions scores had a greater risk of falling (odds ratio [OR]=3.0; 95% confidence interval [CI], 1.3–7.1; P=.012; OR=3.9; 95% CI, 1.6–9.2; P=.002, respectively) than those with no subcortical vascular lesions.

Conclusions

Subcortical vascular lesions are associated with falls at 12 months in elderly patients with gait disorder discharged from a rehabilitative ward. Future research is needed to confirm our results.     

Detection of gait instability using the center of mass and center of pressure inclination angles

OBJECTIVE: To define a parameter that quantifies balance control during gait and better identifies elderly people who are at a higher risk of falling. DESIGN: Controlled study. SETTING: University research laboratory. PARTICIPANTS: Twelve elderly patients (mean age, 76.9+/-6y) with complaints of imbalance during walking, or with a history of falls, and 12 matched healthy elderly adults. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Temporal-distance gait parameters (gait velocity, stride length, step width); and sagittal and frontal center of mass (COM) and center of pressure (COP) inclination angles. RESULTS: Elderly patients demonstrated a significantly greater medial, but a significantly smaller anterior, inclination angle than their matched controls during both unobstructed and obstructed gait. The medial COM-COP inclination angle was not affected by the gait velocity in the healthy elderly. When the 2 groups were compared at a similar gait velocity ( approximately 1m/s), the elderly patients still had a significantly greater medial COM-COP inclination angle than did the controls. CONCLUSIONS: Instantaneous COM-COP inclination angles during walking provide information about the ability to control COM position in relation to the corresponding COP. The medial COM-COP inclination angle may be a sensitive measure of gait stability in the elderly.     

Exergaming With Additional Postural Demands Improves Balance and Gait in Patients With Multiple Sclerosis as Much as Conventional Balance Training and Leads to High Adherence to Home-Based Balance Training

Objective

To assess the effectiveness of and adherence to an exergame balance training program with additional postural demands in patients with multiple sclerosis (MS).

Design

Matched controlled trial, assessment of balance before and after different balance training programs, and adherence to home-based balance exercise in the 6 months after the training.

Setting

A neurorehabilitation facility and center for MS.

Participants

Patients with balance problems (N=70) matched into 1 of the training groups according to age as well as balance and gait performance in 4 tests. Nine patients dropped out of the study because of scheduling problems. The mean age of the 61 remaining participants was 47±9 years, and their Expanded Disability Status Scale score was 3±1.

Interventions

Three weeks of (1) conventional balance training (control), (2) exergame training (playing exergames on an unstable platform), or (3) single-task (ST) exercises on the unstable platform.

Main Outcome Measures

Test scores in balance tests and gait analyses under ST and dual-task (DT) situations. Furthermore, in the 6 months after the rehabilitation training, the frequency and type of balance training were assessed by using questionnaires.

Results

All 3 groups showed significantly improved balance and gait scores. Only the exergame training group showed significantly higher improvements in the DT condition of the gait test than in the ST condition. Adherence to home-based balance training differed significantly between groups (highest adherence in the exergame training group).

Conclusions

Playing exergames on an unstable surface seems to be an effective way to improve balance and gait in patients with MS, especially in DT situations. The integration of exergames seems to have a positive effect on adherence and is thus potentially beneficial for the long-term effectiveness of rehabilitation programs.     

Delphi-Based Assessment of Fall-Related Risk Factors in Acute Rehabilitation Settings According to the International Classification of Functioning,Disability and Health

Objective

To apply the International Classification of Functioning, Disability and Health (ICF) model to fall prevention by developing an ICF core set for fall risks in acute rehabilitation settings.

Design

Fall risk factors were identified based on a systematic review of the literature and linked to ICF categories. A consensus process was conducted using a Delphi-based evaluation technique.

Setting

University-based hospital.

Participants

Multidisciplinary participants (N=20) from different institutions.

Interventions

Not applicable.

Main Outcome Measures

A 5-point Likert-type scale was used to weigh the importance of each risk category. The level of agreement for each consensus was assessed based on Spearman rho and semi-interquartile range indices. Categories with a mean score ≥4 in the third round of evaluation were included in this ICF core set.

Results

The core set comprised 34 fall risk categories that were distributed as follows: 18 categories on body functions, 2 on body structures, 8 on activities and participation, 4 on environmental factors, and 2 categories on personal factors.

Conclusions

An ICF core set for falls in acute rehabilitation settings was developed in this study. Further validation is required.     

Validation of the Activities-Specific Balance Confidence Scale With 5-Option Response Format in Slovene Lower-Limb Prosthetic Users

ObjectiveTo examine the psychometric properties of the Activities-specific Balance Confidence (ABC) scale administered in the Slovene version with a simplified 5-option response format (ABC-5/SLO) using Rasch analysis.DesignMethodological research on data gathered in a cross-sectional study.SettingOutpatient university rehabilitation clinic.ParticipantsA convenience sample of adults with unilateral lower-limb amputation (N=138; 75% men) longer than 6 months who regularly wear a prosthesis.InterventionNot applicable.Main Outcome MeasuresWe evaluated functioning of rating scale categories, internal construct validity, reliability indices, and dimensionality using the ABC-5/SLO (0=no confidence to 4=complete confidence).ResultsThe ABC-5/SLO rating scale fulfilled the category functioning criteria. All items fit the underlying scale construct (balance confidence) except item 8 (“walk outside the house to a car parked in the driveway”), which was overfitting. The person abilities-item difficulty matching (targeting) was good. The person separation reliability was .92, and the item separation reliability was .99. Analysis of the standardized Rasch residuals showed the scale’s unidimensionality and absence of high item dependency (residual correlations, <.30). The correlation between the ABC-5/SLO and the Prosthetic Mobility Questionnaire (Rasch measures) was high (ρ=.84), as expected. Minor signs of item redundancy were found.ConclusionsThe simplified ABC-5/SLO scale is a valid and reliable measure of balance confidence for individuals with lower-limb amputation. It is possible to transform the ordinal summed raw scores of the ABC-5/SLO into interval-level measurements using a nomogram.     

Effect of a 12-Week Yoga Intervention on Fear of Falling and Balance in Older Adults: A Pilot Study

Schmid AA, Van Puymbroeck M, Koceja DM. Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study.

Objective

To determine whether fear of falling (FoF) and balance improved after a 12-week yoga intervention among older adults.

Design

A 12-week yoga intervention single-armed pilot study.

Setting

A retirement community in a medium-sized university town in the Midwest.

Participants

A convenience sample of adults (N=14) over the age of 65 years who all endorsed an FoF.

Intervention

Each participant took part in a biweekly 12-week yoga intervention. The yoga sessions included both physical postures and breathing exercises. Postures were completed in sitting and standing positions.

Main Outcome Measures

We measured FoF with the Illinois FoF Measure and balance with the Berg Balance Scale. Upper- and lower-body flexibility were measured with the back scratch test and chair sit and reach test, respectively.

Results

FoF decreased by 6%, static balance increased by 4% (P=.045), and lower-body flexibility increased by 34%.

Conclusions

The results indicate that yoga may be a promising intervention to manage FoF and improve balance, thereby reducing fall risk for older adults. Rehabilitation therapists may wish to explore yoga as a modality for balance and falls programming; however, future research is needed to confirm the use of yoga in such programming.     

The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke

OBJECTIVES: To describe the frequency of falls; to relate capacity-based and self-efficacy measures to fall history; and to determine to what extent capacity-based and self-efficacy measures are explained by subject characteristics and stroke impairments. DESIGN: Cross-sectional. SETTING: Community. PARTICIPANTS: Convenience sample of 50 people with chronic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fall history, Falls Efficacy Scale-Swedish Version, fear of falling, and the mood subscore of the Stroke Impact Scale. Balance, strength, and functional mobility were measured using the Berg Balance Scale, timed sit to stand, and Timed Up & Go, respectively. RESULTS: Falls were reported by 40% (n=20) of subjects; 22% (n=11) reported multiple falls. Subjects with fall history had more fear of falling (relative risk [RR], 2.4; 95% confidence interval [CI], 1.1-4.9), had less falls-related self-efficacy (P=.04), and more depressive symptoms (P=.02) than nonfallers. Subjects with multiple fall history had poorer balance (P=.02), more fear of falling (RR=5.6; 95% CI, 1.3-23), and used a greater number of medications (P=.04) than non- and 1-time fallers. Strength partially explained balance, mobility, and falls-related self-efficacy. CONCLUSIONS: Balance and falls-related self-efficacy are associated with fall history and should be addressed in people with chronic stroke.