Objective To analyze the change trajectory and its influencing factors of fear of falling among stroke patients, so as to provide a reference for developing targeted nursing intervention to alleviate their fear of falling. Methods A total of 223 stroke patients hospitalized in neurology department were selected by convenience sampling, then they were investigated at discharge by using a general information questionnaire, the Falls Efficacy Scale International (ESF-I) and the Hospital Anxiety and Depression Scale (HADS), and they were followed up to assess their degree of fear of falling at one, three and six months after discharge.The potential categories of the change trajectory of fear of falling were identified by latent class growth model, and the influencing factors were analyzed by logistic regression. Results The change trajectory of fear of falling was divided into a slow decline fear of falling group (50%), a persistent fear of falling group (28%) and a rapid decline fear of falling group (22%).The results of logistic regression analysis showed that, gender, occupation, activity of daily living, history of fall in the past 6 months, walking ability, anxiety and depression symptom were influencing factors of change trajectory of fear of falling (all P＜0.05). Conclusion The change trajectory of fear of falling in stroke patients can be divided into three different groups, and there is group heterogeneity.It is necessary to conduct targeted assessment and intervention based on the homogeneous groups of their fear of falling.