activities and decreased muscle strength and balance, leading to further declines in ADLs,

increased falls incidence and fear of falling, and completing the circle with additional

declines in activities [114]. Li et al. discussed the existing relationship between fear of

falling and falls efficacy, the effect on balance and physical disability, continuations in

deteriorated health, and future falls and development of fear of falling [194].

 Clearly, more interventions are needed to assist stroke survivors and their

caregivers to effectively manage this cycle. It is important to acknowledge the number of

individuals who return home with significant residual mobility losses. This was a

relatively high functioning post-stroke population, and still many discussed fear of falling

and the necessity to manage it with assistive devices, activity restriction, and decreased

functioning.

 Future studies are needed to better define the natural history and experience of the

development of post-stroke fear of falling in the home and community. The utilization of

standardized fear of falling assessments, such as the Falls Efficacy Scale or the

Activities-Specific Balance Confidence Scale, both recently found valid and reliable for

the post-stroke population, [173-175] combined with qualitative data will provide more

complete explanations to better understand fear of falling development. This dual

qualitative and quantitative research study provided preliminary information to justify

future research. Addressing the impact of fear on quality of life and life satisfaction will

be an important step in determining the impact of fear on post-stroke management.

Important future research will include the advent of a fear of falling intervention specific

for the post-stroke population. Likely, interventions to manage fear of falling and reduce