Interventions for preventing falls in people after stroke

Is it possible to prevent falls after stroke?

Most stroke survivors experience mobility problems, and up to 73% report fall in the first year after stroke. Falls may produce serious injuries, but even when they don’t, they often end up in further restrictions of mobility and participation. 
To investigate evidence in favour of interventions preventing falls and fall-related adverse outcomes, Stig Denissen and colleagues updated a previous 2013 Cochrane systematic review, searching for all randomized controlled trials where the primary or secondary aim was to prevent falls in people after stroke.
Overall, they included 14 studies, with a total of 1358 participants. Investigated interventions included exercises, either as a single intervention or integrated by a more comprehensive approach to fall prevention; pre-discharge home visits for hospitalized patients; the provision of single lens distance vision glasses instead of multifocal glasses; a servo-assistive rollator; repetitive Transcranial Direct Current brain Stimulation (rTDCS) for preventing falls.
No adverse events were reported for any of the considered interventions, but evidence of benefits was also either lacking or classified as very low-low quality. Only exercises, pooling results from 8 studies including either ambulation, perturbation/vibration-based, balance/strength-oriented or Tai-Chi training, provided very low-low quality evidence of reducing the rate of falls after stroke, but not the number of fallers; however, when the analysis excluded studies with a high risk of bias, this result was more uncertain. As to the explored environmental adaptations, the authors concluded that current evidence is insufficient to reach conclusions about their impact on falls and fall-related outcomes. There is only one study on rTDCS, providing low-quality evidence that this intervention may reduce the number of fallers, but results should be replicated in a larger cohort of stroke patients. Further, no evidence was found for any intervention to prevent fall-related fractures or hospital admissions, nor to influence near-fall events, economic factors, quality of life, or adverse events.
For current clinical practice, the authors still advise to promote exercise interventions, for their potential benefit, low cost, and easy administration, while further research should focus on larger cohorts of stroke patients, restrict inclusion criteria to specific post-stroke phases, better define the chosen intervention components, and adopt both a standardized definition of a fall, and appropriate and accurate methods of fall ascertainment.

Comment by Francesca Cecchi