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.

中文翻译：

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预防中风后跌倒的干预措施：一项随机对照试验的荟萃分析

背景

跌落是中风后个人面临的严峻挑战。在过去的几十年中，已经开发了各种预防跌倒的干预措施。这些干预措施中的任何一种是否能有效减少该人群的跌落尚不清楚。这样的知识鸿沟可能会阻碍预防中风后人员跌倒的努力。

研究问题

1）是否有有效的干预措施来防止中风后急性期和慢性期患者跌倒？2）预防跌倒的干预措施如何改变该人群的三个主要跌倒危险因素：平衡，活动能力和下肢力量？

方法

在11个数据库中搜索了随机对照试验，其中包括卒中后跌倒作为结果指标。为每个研究收集了有关参与者，培训方案和结果测量的信息。主要结果是跌倒人数，解释变量包括跌倒危险因素的均值差和标准差。使用物理疗法证据数据库量表和漏斗图对研究进行质量评估。

结果

确定了十三项研究，招募了1352名参与者。计算了跌倒的比值比（OR）和跌倒风险因子的标准化平均差（SMD）量化的效果大小。总体上看，没有任何一种干预措施比预防训练更有效（OR = 0.88，范围[0.23 3.66]； 95％置信区间= [0.64 1.21]，p = 0.44）。所有干预措施对改善跌倒危险因素（SMD = -0.01至0.06，p值= 0.38–0.86）影响不大，只有一种措施（跑步机和地面行走相结合）可显着改善活动能力。

意义

当前没有有效的方案来减少中风后的跌倒。未来的研究应基于对跌倒的一致定义和收集跌倒数据的可靠方法，将跌倒作为主要结果进行测量。