This randomized controlled trial evaluated a multidisciplinary, home-based intervention designed to reduce falls in stroke survivors. Conducted across three states in Australia, the study included 370 participants over 50 years old, within five years post-stroke, who were ambulatory and discharged from formal rehabilitation. The intervention group received a six-month program involving functional exercises, home fall hazard reduction, and community mobility coaching, delivered by physiotherapist and occupational therapist teams. The primary outcome was the rate of falls over 12 months, which showed a significant 33% reduction in the intervention group compared to usual care (incidence rate ratio 0.67, 95% CI 0.48 to 0.94; P=0.02). However, there was no significant difference in the proportion of participants experiencing a fall (absolute risk reduction 0.03, 95% CI -0.07 to 0.13; P=0.52). Secondary outcomes favored the intervention group, with improvements in community participation (mean difference 3%, 95% CI 1% to 6%; P=0.02), self-efficacy (mean difference 0.6, 95% CI 0.2 to 1.0; P=0.004), mobility (fast walking speed: mean difference 0.13 m/s, 95% CI 0.06 to 0.19; P<0.001), and balance (Step Test: mean difference 0.06 steps/s, 95% CI 0.01 to 0.12; P=0.03). No significant safety concerns or adverse events were reported. Clinically, this intervention suggests a viable strategy to enhance mobility and reduce fall risk in community-dwelling stroke survivors.
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· Auto-published
This study focuses on stroke survivors, who may struggle with balance and mobility after their stroke. Researchers created a tailored home program that included exercises, safety tips for the home, and coaching to help people move around their communities. After a year, they found that participants in this program had fewer falls compared to those who received regular care. Additionally, those in the program reported feeling more confident, improved their ability to move, and participated more in community activities. This suggests that such a home program could be very beneficial for stroke survivors, helping them stay safe and active. However, it’s important to note that not everyone in the program avoided falls completely, and more research is needed to understand the best ways to support stroke survivors in their recovery.
What this means for you: A special home program can help stroke survivors reduce falls and improve confidence and mobility.
View Original Abstract ↓
OBJECTIVE: To investigate the effectiveness of a multidisciplinary, home based, tailored intervention to reduce falls after stroke.
DESIGN: Two armed, randomised trial.
SETTING: Three states in Australia.
PARTICIPANTS: People within 5 years of stroke, aged >50 years, discharged from formal rehabilitation to the community, and able to walk 10 m across flat ground with or without an aid. Those with moderate-to-severe receptive aphasia or walking speed >1.4 m/s without falls in the previous year were excluded.
INTERVENTION: Over 6 months, the experimental group received a habit forming functional exercise, home fall hazard reduction, and goal directed community mobility coaching; the control group received usual care. Physiotherapist and occupational therapist dyadic teams worked collaboratively to deliver the intervention.
MAIN OUTCOME MEASURES: The primary outcome was rate of falls over 12 months. Secondary outcomes were proportion of participants having a fall, community participation, self-efficacy, balance, mobility, physical activity, activities of daily living, depression, and health related quality of life.
RESULTS: Between August 2019 and December 2023, 370 people with stroke were enrolled. At 12 months, a significant between group difference was seen in the rate of falls in favour of the experimental group, representing a 33% reduction in falls (incidence rate ratio 0.67, 95% confidence interval (CI) 0.48 to 0.94; P=0.02). No significant between group difference was seen in the number of participants having a fall (absolute risk reduction 0.03, 95% CI -0.07 to 0.13; P=0.52). The main between group differences in favour of the experimental group were in community participation (Late Life Function and Disability Instrument disability limitation: mean difference 3% (95% CI 1% to 6%); P=0.02), self-efficacy (mean difference 0.6 (0.2 to 1.0); P=0.004), mobility (fast walking speed: mean difference 0.13 (0.06 to 0.19) m/s (P<0.001); preferred walking speed: 0.06 (0.02 to 0.10) m/s (P=0.02)), and balance (Step Test: mean difference 0.06 (0.01 to 0.12) steps/s; P=0.03).
CONCLUSION: A tailored intervention prevented falls in community dwelling, ambulatory people with stroke. The decrease in the rate of falls was underpinned by clinically worthwhile improvements in self-efficacy, mobility, community participation, and balance.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619001114134.