falls are a serious complication after suffering a stroke , with up to 76% of stroke 
 survivors experience falls1 , 2 .
stroke survivors who have 
 fallen have an increased incidence of serious adverse outcomes , including loss of 
 self - confidence in ability to perform daily activities , fractures , depression , and 
 mortality , compared with adults who have not suffered a stroke4 , 5 .
serious fall injuries 
 become aggravating factors in health - related quality of life ( hrqol ) , putting limitations on 
 mobility , necessitating admission to nursing homes , and increasing health - care 
 expenditures6 , 7 .
hrqol refers to an individual s 
 perceived physical and mental health , and an assessment of hrqol helps us understand the 
 association between health and daily life functioning9 . although stroke patients may recover most of their physical 
 functions , their qol decreases 40% compared with before stroke10 .
. falls and hrqol of older 
 adults have been studied ; however , the literature is limited regarding differences between 
 fallers and non - fallers and the direct influence of falls on stroke patients3 , 12,13,14,15,16 . 

identifying the relationship between falls and hrqol of stroke patients would provide 
 important base data for rehabilitation services .
this study compared the hrqol of stroke 
 survivors between fallers and non - fallers in to increase favorable outcomes .
this study used raw data from the 2014 korean community health survey ( kchs ) .
the survey 
 was conducted from august 16 , 2014 , to october 31 , 2014 , by the korean centers for disease 
 control and prevention ( kcdcp ) .
the kchs uses a cross - sectional design to extract data from 
 health centers in south korea .
the protocol of kchs was reviewed and approved by the 
 institutional review board of the kcdcp ( 2013 - 06exp-01 - 3c ) .
this study used the data for the 
 subset of community - dwelling stroke patients ( n = 4,560 ) diagnosed by a doctor .
trained 
 surveyors visited households selected from the sample and conducted face - to - face interviews 
 with a computer notebook loaded with survey .
the content of the survey included demographic data and the eq-5d-3l ( 3 level version of 
 the euroqol 5- dimensional questionnaire ) . the demographic questions addressed age , gender , 
 living status , occupation , experience of smoking , exprience of drinking , participation in 
 hard physical activities ( e.g. , exercise such as running , riding a bicycle quickly , fast 
 swimming , and carrying heavy objects for more than 10 minutes in a normal a week ) , 
 participation in moderate physical activity ( e.g. , exercise such as slow swimming , playing 
 table tennis , badminton , and carrying light objects for more than 10 minutes in a normal a 
 week ) , and participation in walking ( e.g. , walking to work or school , and exercise for more 
 than 10 minutes in a normal a week ) .
the eq-5d-3l is a generic measure of health status 
 widely used in a variety of patient populations17 .
it defines health in terms of five domains : mobility , self - care , 
 usual activities , pain / discomfort , and anxiety / depression .
each domain is scored on a 
 3-point likert scale : no problem ( 1 ) , a moderate problem ( 2 ) , or an extreme problem ( 3 ) . in 
 addition
, the subjects rate their overall health on a visual analogue scale ( vas ) from 0 
 ( worst imaginable health state ) to 100 ( best state ) .
the collected data were analyzed using a complex sampling design and spss statistics 21.0 
 software ( ibm corporation , armonk , ny , usa ) .
the  test was performed to identify differences in the demographic 
 distributions of fallers and non - fallers .
a general linear model was used to compare hrqol 
 between the fallers and non - fallers .
among the 4,560 stroke survivors who were studied , 1,425 ( 31.25% ) reported falls during the 
 1  year period . for the remaining subjects , 3,125 ( 68.53% ) reported no falls and 10 ( 0.22% ) 
 answered unknown . in the demographic distribution , gender ( p = 0.000 ) , living status ( p = 
 0.001 ) , occupation ( p = 0.012 ) , and experience of smoking ( p = 0.001 ) differed significantly 
 between the fallers and non - fallers ( table 
 1table 1.characteristics of the subjectsparametersfallersnon - fallersn ( % ) n ( % ) age1965343 ( 32.4)815 ( 67.6) 651,082 ( 34.2)2,320 ( 65.8)gender*male632 ( 29.3)1,675 ( 70.7)female793 ( 38.8)1,460 ( 61.2)living status*living alone858 ( 31.2)2,168 ( 68.8)living with spouse567 ( 38.3)967 ( 61.7)occupation*employed346 ( 29.1)970 ( 70.9)unemployed1,079 ( 35.2)2,165 ( 64.8)experience of drinkingyes961 ( 32.9)2,151 ( 67.1)no464 ( 35.4)984 ( 64.6)experience of smoking*yes580 ( 29.9)1,455 ( 70.1)no845 ( 36.8)1,678 ( 63.2)participation in hard physical activityyes149 ( 31.9)356 ( 68.1)no1,276 ( 33.8)2,777 ( 66.2)participation in moderate physical activityyes286 ( 32.4)660 ( 67.6)no1,139 ( 33.9)2,472 ( 66.1)participation in walkingyes872 ( 33.7)1,917 ( 66.3)no553 ( 33.3)1,217 ( 66.7)*p<0.05 ) .
the domains of hrqol , excluding vas , also differed significantly between the 
 fallers and non - fallers .
the means of the fallers were higher than those of the non - fallers 
 in each domain ( mobility = 0.183 , p = 0.000 , self care = 0.184 , p = 0.000 , usual activities 
 = 0.031 , p = 0.000 , pain / discomfort = 0.280 , p = 0.000 , anxiety / depression = 0.232 , p = 
 0.000 ) ( table 2table 2.difference of hrqol between fallers and non - fallershrqolparametersmeanestimate ( se)95% cimobility*fallers1.7980.183 ( 0.026)0.1310.234non - fallers1.6151 ( ref.)self - care*fallers1.5820.184 ( 0.031)0.1230.245non - fallers1.3981 ( ref.)usual activities*fallers1.7810.203 ( 0.031)0.1430.263non - fallers1.5781 ( ref.)pain / discomfort*fallers2.0180.280 ( 0.033)0.2140.345non - fallers1.7381 ( ref.)anxiety / depression*fallers1.6310.232 ( 0.032)0.1700.294non - fallers1.3991 ( ref.)vasfallers59.7774.785 ( 3.465)11.5772.006non - fallers64.5621 ( ref.)*p<0.05 . se : standard error ; ref . :
se : standard error ; ref . : reference or baseline ; ci : confidence 
 interval
this study identified differences in the hrqol of stroke survivors between fallers and 
 non - fallers .
the results show that 31.25% of the survey population experienced falls during 
 the 1  year period .
this fall incidence is lower than the 76% previously reported for 
 post - stroke populations1 , 2 , however , similar results were reported by schmid et al18 . a possible explanation for the difference 
 may be that this study included only community - dwelling adults and excluded in - patients in 
 acute or rehabilitation hospitals .
it was reported that in acute - care settings , 3.8 to 22.0% 
 of in - patients experienced falls while 10.5 to 47.0% of in - patients experienced falls in 
 rehabilitation hospitals19 . regarding the demographic distribution , the faller group contained more females than males 
 and more unemployed than employed subjects .
another study of older adults in the community also found that women were more likely to 
 fall than men , and that those participating in economic activity were more likely to fall 
 than those who were not15 , but the 
 differences were not significant .
the results of other studies of older adults and people 
 without a history of stroke contradict those of the present study14 , 21 , 22 .
the hrqol results of fallers and non - fallers were similar to those of previous studies14 , 21 .
in particular , the study of choo et al.14 , which used a short form-8 health survey to assess various 
 subdomains of hrqol , found there were significant differences in physical function , bodily 
 pain , social function , role functioning - emotional , and mental health .
in addition , bodily 
 pain showed the highest difference between the two groups , similar to the results of the 
 present study .
fallers and non - fallers among community - dwelling stroke survivors and older 
 adults exhibited differences in hrqol .
first , the study excluded stroke patients in 
 hospital and those who had died as a result of a fall . also , the results do not reflect the 
 opinions and situations of all those who had suffered a stroke .
however , as the subjects 
 were selected from a systematically randomized sample by trained surveyors , the potential 
 for generalization to the community - dwelling stroke population is strong .
second , the 
 results do not distinguish between cause and effect of variables related to falls because of 
 the cross - sectional design .
further studies with a longitudinal design are needed to 
 identify the cause and effect of falls and consider variables such as the number of falls , 
 fear of falling , and circumstances of falls .
 [ purpose ] the purpose of this study was to compare the health - related quality of life 
 ( hrqol ) of stroke survivors between fallers and non - fallers . 
 [ subjects ] the subjects were 
 community - dwelling stroke patients ( n = 4,560 ) in south korea . 
 all stroke patients were 
 diagnosed by a doctor . [ methods ] this study used raw data from the 2014 korean community 
 health survey . 
 the survey was conducted from august 16 , 2014 , to october 31 , 2014 . 
 trained 
 surveyors visited households selected from the sample and conducted face - to - face 
 interviews . 
 the content of the survey included demographic data and hrqol . 
 [ results ] 
 fallers were 1,425 ( 31.25% ) , non - fallers 3,125 ( 68.53% ) , and 10 ( 0.22% ) answered unknown . 
 
 gender , living status , occupation , and smoking experience differed significantly between 
 the fallers and non - fallers . 
 the domains of hrqol , excluding vas , also differed 
 significantly between the fallers and non - fallers . 
 [ conclusion ] these results provide 
 important base data for rehabilitation services for fallers among stroke survivors . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION