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Interventions for preventing falls in people after stroke.

Stijn Denissen1, Wouter Staring, Dorit Kunkel

  • 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

The Cochrane Database of Systematic Reviews
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Falls are a common post-stroke complication. While exercise may reduce the rate of falls, evidence for reducing the number of fallers is uncertain. More research is needed to confirm exercise effectiveness and explore other interventions for fall prevention.

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Area of Science:

  • Neurology and Rehabilitation
  • Gerontology
  • Public Health

Background:

  • Falls are a frequent and serious complication following stroke, with incidence rates varying significantly in the first year post-stroke.
  • This review is an update to the original Cochrane Review published in 2013, reflecting new research on fall prevention strategies.

Purpose of the Study:

  • To evaluate the effectiveness of interventions designed to prevent falls in individuals who have experienced a stroke.
  • Primary objectives include assessing the impact of interventions on the rate of falls and the number of individuals experiencing falls.
  • Secondary objectives focus on fall-related fractures, hospital admissions, near-fall events, economic impact, quality of life, and adverse effects.

Main Methods:

  • A systematic search of multiple trial registers and databases (Cochrane, MEDLINE, Embase, etc.) was conducted up to September 2018.
  • Included were randomized controlled trials (RCTs) where fall prevention was a primary or secondary aim for post-stroke individuals.
  • Data were independently extracted by two reviewers, with fall rates compared using rate ratios and number of fallers using risk ratios; GRADE was used to assess evidence quality.

Main Results:

  • Fourteen studies involving 1358 participants were included. Interventions investigated included exercises, home visits, vision correction, assistive devices, and brain stimulation.
  • Exercise interventions showed a potential to reduce the rate of falls (low-quality evidence), but certainty regarding the effect on the number of fallers is very low.
  • Evidence for other interventions, such as home visits, vision aids, and assistive devices, is very uncertain; transcranial direct current stimulation (tDCS) showed low certainty of reducing fallers.

Conclusions:

  • There is limited evidence for interventions other than exercise in reducing post-stroke falls. Exercise shows low to very low quality evidence for preventing falls but not necessarily reducing the number of fallers.
  • Methodological limitations in current fall research, particularly in fall definition and timing post-stroke, necessitate more rigorous, adequately powered studies.
  • Further research is crucial to establish the value of exercises in fall reduction, especially considering different phases post-stroke, and to explore other potential interventions.