Interventions for Preventing Falls after Stroke

Summary

A Cochrane review [Abstract] 1 included 14 studies with a total of 1358 patients. The studies investigated exercises, predischarge home visits for hospitalised patients, the provision of single lens distance vision glasses instead of multifocal glasses, a servo-assistive rollator and non-invasive brain stimulation for preventing falls.

• Exercise compared to control for preventing falls in people after stroke: The pooled result of 8 studies (n=765) showed that exercise may reduce the rate of falls (RR 0.72, 95% CI 0.54 to 0.94). Sensitivity analysis for single exercise interventions, omitting studies using multiple/multifactorial interventions, showed that exercise may reduce the rate of falls (RR 0.66, 95% CI 0.50 to 0.87; n=626). Sensitivity analysis for the effect in the chronic phase post-stroke resulted in little or no difference in rate of falls (RR 0.58, 95% CI 0.31 to 1.12; n= 205). A sensitivity analysis including only studies with low risk of bias found little or no difference in rate of falls (RR 0.88, 95% CI 0.65 to 1.20; n=462). For the outcome of number of fallers, there was no effect of exercises vs. the control condition (RR 1.03, 95% CI 0.90 to 1.19; 10 trials, n=969). The sensitivity analyses showed that there are little or no differences in number of fallers (single interventions: RR 1.09, 95% CI 0.93 to 1.28; n=796; chronic phase post stroke: RR 0.94, 95% CI 0.73 to 1.22; n= 375; low risk of bias studies: RR 0.96, 95% CI 0.77 to 1.21; n=462).
• Other interventions for preventing falls in people after stroke: Interventions other than exercise may not reduce the rate of falls or number of fallers. There was no effect of predischarge home visits (RR 0.85, 95% CI 0.43 to 1.69; n=85), provision of single lens distance glasses to regular wearers of multifocal glasses (RR 1.08, 95% CI 0.52 to 2.25; n=46) and a servo-assistive rollator (RR 0.44, 95% CI 0.16 to 1.21; n=42). Transcranial direct current stimulation (tDCS) was used in one study (n=60) to examine the effect on falls post-stroke. Active tDCS may reduce the number of fallers compared to sham tDCS (RR 0.30, 95% CI 0.14 to 0.63).

Comment: The quality of evidence is downgraded by study quality (reporting bias: the data on falls were self-reported, possibly leading to over- or under-reporting of falls, use of unvalidated outcome measures) and inconsistency (heterogeneity in patients and interventions).