Purpose: Fear of falling (FoF) and low balance self-efficacy are key contributors to reduced physical activity (PA) among stroke survivors, often leading to avoidance behaviors that limit PA and community reintegration. The CATCHES (Community Health Worker–Assisted Task-Specific Training and Cognitive Behavioral Therapy at Home with Exposure after Stroke) intervention combines task-specific training with cognitive restructuring and graded exposure to reduce FoF and promote PA. The primary aim of CATCHES was achieved with feasibility measures all exceeding target thresholds. Here we explore underlying behavioral mechanisms through changes in FoF and their impact on physical function. Methods: Adults with mild stroke (mRS ≤2) and low balance confidence (ABC <80) were recruited at hospital discharge. Over three months, participants completed an initial home visit with a physical therapist, a telehealth session with a neuropsychologist, and five every other week Community Health Worker–led sessions. These included task-specific motor practice, reinforcement of cognitive strategies to address FoF, and review of step-count data from wearable monitors. Outcomes were assessed at baseline and study completion using the Activities-specific Balance Confidence (ABC) scale, Timed Up and Go (TUG), and daily step counts. Results: Twenty-two participants enrolled after confirming eligibility, and 19 completed all study visits. Pre to post ABC mean scores improved by 27.3 points (p < 0.0001); 16 improved from baseline and 10 exceeded the clinically meaningful cut point of 80. Pre- to post-intervention mean TUG scores improved by 7.3 seconds (p = 0.04) with 16 improved from baseline. Participants logged a median of 6,586 steps per day (IQR: 1,798–8,127) and reached the 5,000-stepson 44% of days. Among the 17 with ≥60 valid days, average daily steps increased from 5,584 in the first 30 days to 6,101 in the final 30 days. Although not statistically significant, the proportion of days reaching 5,000 steps rose from 47% to 52%. Conclusions: The CATCHES intervention was associated with meaningful improvements in balance confidence and functional mobility, while maintaining engagement in daily PA. Findings suggest that reductions in FoF may support recovery of physical function and sustained PA participation. A larger, controlled trial is warranted to confirm efficacy and evaluate scalability.
Huang et al. (Thu,) studied this question.