What Works in Falls Prevention After Stroke?: A Systematic Review and Meta-Analysis
Open accessAbstract
Background and Purpose— Falls are common after stroke. Despite evidence that single and multifactorial interventions can reduce falls in older people, this issue remains relatively underexplored in stroke survivors. Effective fall prevention in this population has the potential to prevent injury, improve quality of life, and decrease the likelihood of subsequent fear of falling and activity restriction. The aim of this article was to review and integrate the research evidence relating to interventions that reduce falls after stroke. Methods— Published studies evaluating interventions to reduce falls in stroke survivors were retrieved and screened according to predetermined criteria. Included studies were independently assessed. Quality of trials was assessed using the Physiotherapy Evidence Database score. Pooling of results was undertaken for similar interventions with comparable outcomes using the inverse variance method. Results— Thirteen studies met the inclusion criteria, with pooling of results possible for only 2 types of intervention. Methodological quality of the included studies was variable with the main bias because of lack of blinding of participants and those administering the intervention. Variability in falls data reporting was seen across the studies. The only intervention shown to be effective in reducing falls was vitamin D for female stroke survivors in an institutional setting. Other interventions were no more effective than usual care. Conclusions— Fall risk is high in stroke survivors; however, the only intervention shown to be effective in reducing falls in this review was vitamin D supplementation. Consistency in outcome measurement would enable comparisons across studies. Additionally, further research evaluating a range of single and multifactorial interventions for fall prevention in the stroke population is required.
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Data from two affected trial reports were included in unpooled meta-analyses in the review by Batchelor et al, in which the affected trial report data were not outlying.
“Data from two affected trial reports were included in unpooled meta-analyses in the review by Batchelor et al 31 (65 citations, September 2018), in which the affected trial report data were not outlying.”
From An investigation into the impact and implications of published papers from retracted research: systematic search of affected literature (2019) · cites this paper as [31]
The Effectiveness section (page unavailable) says the review presents unpooled effect estimates, and the Meta-Analysis section describes combining data from pairs of studies. Our copy does not identify which trial reports the citing sentence calls “affected” or establish that their data were not outlying. (LLM, conf=0.76)
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“Strong positive outcomes were observed especially in studies with land-based exercise, medication withdrawal, vitamin D supplementation, footwear intervention, and home environment modification [14,43].”
BackgroundSelf-citationCattaneo, D., Gervasoni, E., Pupillo, E., Bianchi, E., Aprile, I. G., Imbimbo, I., Russo, R., Cruciani, A., Turolla, A., Jonsdottir, J., et al. (2019) · Frontiers in Neurology · doi:10.3389/fneur.2019.00865 · Cited by 36 · see citing works
“Mixed results were also reported for PD since the only two trials showing reductions in fall frequency (34, 35) were fully supervised.”
ResultPost-acute care for stroke – a retrospective cohort study in Taiwan
Lai, C.-L., Tsai, M.-M., Luo, J.-Y., Liao, W.-C., Hsu, P.-S., & Chen, H. (2017) · Patient Preference and Adherence · doi:10.2147/ppa.s136041 · Cited by 35 · see citing works
“Between 14% and 65% of stroke survivors had fallen in the hospital, while 73% of stroke survivors had fallen within 6 months after returning home.(32) Moreover, fear of falling was significantly associated with earlier falls and poor physical function.”
Clinical Practice Guideline for Stroke Rehabilitation in Korea
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Yang, F., Lees, J., Simpkins, C., & Butler, A. (2021) · Gait & Posture · doi:10.1016/j.gaitpost.2020.12.034 · Cited by 33 · see citing works
"Merging Yoga and Occupational Therapy (MY-OT): A feasibility and pilot study".
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Ramage, E. R., Fini, N. A., Lynch, E. A., Marsden, D. L., Patterson, A. J., Said, C. M., & English, C. (2021) · Physical Therapy · doi:10.1093/ptj/pzab073 · Cited by 32 · see citing works
Self-citationRisk of osteoporotic fractures following stroke in older persons
Benzinger, P., Rapp, K., König, H. ‐., Bleibler, F., Globas, C., Beyersmann, J., Jaensch, A., Becker, C., & Büchele, G. (2015) · Osteoporosis International · doi:10.1007/s00198-014-3005-x · Cited by 31 · see citing works
Exercise Interventions for Individuals With Neurological Disorders
Lai, C., Chen, H., Liou, T., Li, W., & Chen, S.-C. (2019) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000001247 · Cited by 30 · see citing works
Fisher, A., Srikusalanukul, W., Davis, M., & Smith, P. N. (2013) · Stroke Research and Treatment · doi:10.1155/2013/641943 · Cited by 30 · see citing works
Morgan, P. E., McDonald, R. L., & McGinley, J. L. (2015) · Rehabilitation Research and Practice · doi:10.1155/2015/196395 · Cited by 29 · see citing works
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“Models of stroke care interventions One systematic review of critically low methodological quality investigating the effect of different models of stroke care on falls outcomes for people with stroke concluded that home rehabilitation with multidisciplinary team outreach had no significant effect on falls rate [56].”
BackgroundResultInfluentialA Phase 1 Exercise Dose Escalation Study for Stroke Survivors with Impaired Walking
Dite, W., Langford, Z., Cumming, T. B., Churilov, L. P., Blennerhassett, J. M., & Bernhardt, J. A. (2015) · International Journal of Stroke · doi:10.1111/ijs.12548 · Cited by 28 · see citing works
Advances in Brain Recovery and Rehabilitation 2010
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Risk of hip fracture following stroke, a meta-analysis of 13 cohort studies
Yuan, Z., Mo, H., Guan, J., He, J., & Wu, Z. (2016) · Osteoporosis International · doi:10.1007/s00198-016-3603-x · Cited by 26 · see citing works
Xu, T., O’Loughlin, K., Clemson, L. M., Lannin, N. A., Dean, C. M., & Koh, G. C. (2017) · Disability and Rehabilitation · doi:10.1080/09638288.2017.1419293 · Cited by 26 · see citing works
“Given the lack of evidence of any effective fall prevention program for community stroke survivors [42,43], there is a need to consider the personal motivational factors of service users when developing a fall prevention program for community stroke survivors.”
BackgroundStroke: Physical Fitness, Exercise, and Fatigue
Mead, G. E., Bernhardt, J., & Kwakkel, G. (2012) · Stroke Research and Treatment · doi:10.1155/2012/632531 · Cited by 24 · see citing works
Knowledge and performance among nurses before and after a training programme on patient falls
Enein, N. Y. A. E., Ghany, A. S. A. E., & Zaghloul, A. A. Z. (2012) · Open Journal of Nursing · doi:10.4236/ojn.2012.24053 · Cited by 23 · see citing works
Ainuddin, H. A., Romli, M. H., Hamid, T. A., Salim, M. S., & Mackenzie, L. A. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.611793 · Cited by 61 · see citing works
“Compared with international literature pertaining to falls and stroke, research in Southeast Asia was one dimensional, not comprehensive, and has yet to mature (30, 31, 45, 139).”
BackgroundDesign and Control of an Omni-Directional Robotic Walker Based on Human–Machine Interaction
Ji, J., Chen, W., Wang, W., & Xi, J. (2021) · IEEE Access · doi:10.1109/access.2021.3103202 · Cited by 22 · see citing works
“This is extremely worrisome as age serves as a major risk fact for dysbasia and increased risk of falling [3].”
BackgroundFalls Are Associated With Lower Self-Reported Functional Status in Patients After Stroke
van der Kooi, E., Schiemanck, S. K., Nollet, F., Kwakkel, G., Meijer, J.-W. G., & van de Port, I. G. L. (2017) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2017.05.003 · Cited by 21 · see citing works
Design and Analysis of a Smart Rehabilitation Walker With Passive Pelvic Mechanism
Ji, J., Guo, S., Xi, F., & Zhang, L. (2019) · Journal of Mechanisms and Robotics · doi:10.1115/1.4045509 · Cited by 21 · see citing works
Hip Fractures in Persons with Stroke
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Falls, fear of falling and falls risk in adults with cerebral palsy: A pilot observational study
Morgan, P. E., & McGinley, J. L. (2013) · European Journal of Physiotherapy · doi:10.3109/21679169.2013.795241 · Cited by 20 · see citing works
Morgan, P. E., Murphy, A., Opheim, A. I., Pogrebnoy, D., Kravtsov, S., & McGinley, J. L. (2014) · Clinical Rehabilitation · doi:10.1177/0269215514556299 · Cited by 20 · see citing works
Mixed slip-trip perturbation training for improving reactive responses in people with chronic stroke
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Factors associated with fracture after stroke and TIA: a long-term follow-up
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Brown, D., Simpkins, C., & Yang, F. (2023) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2023.106078 · Cited by 15 · see citing works
Exercise Protects Bone after Stroke, or Does It? A Narrative Review of the Evidence
Borschmann, K. (2011) · Stroke Research and Treatment · doi:10.1155/2012/103697 · Cited by 17 · see citing works
The effect of limited English proficiency on falls risk and falls prevention after stroke
Fryer, C. E., Mackintosh, S. F., Batchelor, F., Hill, K., & Said, C. M. (2011) · Age and Ageing · doi:10.1093/ageing/afr127 · Cited by 16 · see citing works
Self-citationRedesigned Fall and Injury Management of Patients With Stroke
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Benlidayı, İ. C., Başaran, S., Şeydaoğlu, G., & Güzel, R. (2016) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-150615 · Cited by 16 · see citing works
“Other approaches including balance exercises, training with biofeedback, early mobilization techniques and risedronate sodium therapy revealed no more benefit than usual care in terms of reducing the fall risk [31].”
Pigman, J., Reisman, D. S., Pohlig, R. T., Wright, T. R., & Crenshaw, J. R. (2019) · BMC Neurology · doi:10.1186/s12883-019-1320-8 · Cited by 16 · see citing works
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Pinto, E. B., do Nascimento, C. F., Monteiro, M., Castro, M., Maso, I., Campos, A., Marinho, C. B., Barreto-Neto, N., Lopes, A. A., de Jesus, P. A. P., et al. (2016) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2016.06.045 · Cited by 15 · see citing works
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Falls After Stroke: A Follow-up after Ten Years in Lund Stroke Register
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Long-Term Risk of Hip Fracture After Ischemic Stroke
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“Such studies are necessary in order to effectively develop and implement strategies to minimize falls and increase awareness and treatment of osteoporosis in this high-risk cohort.(27) In the meantime, clinicians should be mindful of the high risk of hip fractures among elderly patients with ischemic stroke.”
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“Stroke survivors are at high risk of falls (1, 2) and the risk is higher when compared with the older population (3–5).”
BackgroundAssistive Mobility Control of a Robotic Hip-Knee Exoskeleton for Gait Training
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Falls in Patients With Communication Disability Secondary to Stroke
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“The inability to identify the contributing factors and circumstances of a fall limits the ability of staff to implement appropriate falls prevention strategies (Batchelor et al., 2010; A.-M. Hill et al., 2015).”
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Huang, H., Lin, S., Yang, C. S. H., Liang, C. C., & Cheng, H. Y. (2017) · PLoS ONE · doi:10.1371/journal.pone.0175825 · Cited by 10 · see citing works
- Authors
- Batchelor, F., Hill, K., Mackintosh, S., & Said, C.
- Affiliations
- The University of Melbourne (AU)
- Venue
- Stroke
- Published
- 2010-08
- Volume
- 41
- Issue
- 8
- Pages
- 1715-1722
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2059929936
- Cited by
- 171
- References
- 38
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 6 · 2023: 7 · 2022: 4 · 2021: 12 · 2020: 14 · 2019: 17 · 2018: 9 · 2017: 13 · 2016: 14 · 2015: 13 · 2014: 10 · 2013: 11 · 2012: 9
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- eSpace (Curtin University) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Keywords
- fall prevention, stroke survivors, fall risk, vitamin D supplementation, multifactorial intervention, older adults, fear of falling, activity limitation, physiotherapy intervention
- MeSH terms
- Accidental Falls, Accidents, Home, Environment Design, Humans, Patient Education as Topic, Treatment Outcome, Stroke
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