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Interventions for preventing falls in people post-stroke: A meta-analysis of randomized controlled trials.

Gait & posture
February 1, 2021
Feng Yang et al. (4 authors)
Journal ArticleMeta-AnalysisResearch Support, Non-U.S. Gov'tReviewHuman Study
Study Details

Study Goal

The researchers aimed to determine if fall prevention interventions, including walking-based programs, are effective in reducing falls and improving balance, mobility, and lower limb strength in people post-stroke.

Results Summary

The study found no intervention significantly more effective than placebo in preventing falls, with most showing little effect on fall risk factors, except combined treadmill and overground walking, which improved mobility.

Population

Individuals in the post-acute and chronic stages of stroke (1,352 participants across 13 studies).

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (3)
InterventionDirectionEndpointPopulationDosageImpactClaim #
fall prevention interventions
no change
falls
people post-stroke
OR = 0.88 with a range of [0.23 3.66]; 95 % confidence interval = [0.64 1.21], p = 0.44
no intervention appears to be significantly more effective in preventing falls than placebo training
#1
All interventions
no change
fall risk factors
people post-stroke
SMD = -0.01 to 0.06 and p-value = 0.38-0.86
showed little effect in improving the fall risk factors
#2
the combined treadmill and overground walking
increase
mobility
people post-stroke
-
significantly improved
#3
Abstract

BACKGROUND: Falls are a serious challenge facing individuals post-stroke. In the past decades, various fall prevention interventions have been developed. It remains unknown if any of these interventions are effective in reducing falls in this population. Such a knowledge gap could impede the effort of preventing falls in people post-stroke. RESEARCH QUESTIONS: 1) Are there effective interventions to prevent falls among people in the post-acute and chronic stages of stroke? and 2) How do fall prevention interventions change three key fall risk factors in this population: balance, mobility, and lower limb strength? METHODS: Eleven databases were searched for randomized controlled trials which included falls in people post-stroke as an outcome measure. Information on the participants, training protocol, and outcome measures were collected for each study. The primary outcome is the number of fallers and the explanatory variables included mean difference and standard deviation for fall risk factors. Studies were quality appraised using the Physiotherapy Evidence Database scale and the funnel plot. RESULTS: Thirteen studies enrolling 1352 participants were identified. Effect size quantified by the odds ratio (OR) for falls and standardized mean difference (SMD) for fall risk factors were calculated. Overall no intervention appears to be significantly more effective in preventing falls than placebo training (OR = 0.88 with a range of [0.23 3.66]; 95 % confidence interval = [0.64 1.21], p = 0.44). All interventions showed little effect in improving the fall risk factors (SMD = -0.01 to 0.06 and p-value = 0.38-0.86), except one (the combined treadmill and overground walking) which significantly improved mobility. SIGNIFICANCE: Currently no program is effective in reducing falls in people post-stroke. Future studies should measure falls as a primary outcome based on a consistent definition of falls and reliable approaches to collect falls data.

Medical Subject Headings (MeSH)
Accidental FallsFemaleHumansMalePhysical Therapy ModalitiesRandomized Controlled Trials as TopicStroke
Study Links
Quality Scores
SafetyNot Assessed
Efficacy30/10
Quality75/10
Citation Metrics
Total Citations16
Citations/Year4.0
Relative Citation Ratio2.36
NIH Percentile79.3%
Research Impact Scores
APT Score0.75
Weight Score2.46
Normalized Score0.47
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