A multidisciplinary, home-based, tailored intervention succeeds in preventing falls among community-dwelling, ambulatory people with stroke, a study has shown.
“The decrease in the rate of falls was underpinned by clinically worthwhile improvements in self-efficacy, mobility, community participation, and balance,” the investigators said.
Three hundred seventy people with 5 years of stroke, aged 50 years, were enrolled between August 2019 and December 2023 to this two-armed, randomized trial conducted in three states in Australia. Those with moderate-to-severe receptive aphasia or walking speed >1.4 m/s without falls in the previous year were excluded.
Participants in the intervention group received a habit-forming functional exercise, home fall hazard reduction, and goal-directed community mobility coaching over 6 months, while those in the control group received usual care. The intervention was delivered by physiotherapist and occupational therapist dyadic teams.
The 12-month difference in the rate of falls was significant and favoured the intervention group, with a 33-percent reduction in falls (incidence rate ratio, 0.67, 95 percent confidence interval [CI], 0.48‒0.94; p=0.02). No significant difference in the number of participants having a fall was noted between groups (absolute risk reduction, 0.03, 95 percent CI, ‒0.07 to 0.13; p=0.52). [BMJ 2026;392:e085519]
The main differences in favour of the intervention group were as follows: community participation (Late Life Function and Disability Instrument disability limitation: mean difference [MD], 3 percent, 95 percent CI, 1‒6; p=0.02), self-efficacy (MD, 0.6, 95 percent CI, 0.2‒1.0; p=0.004), mobility (fast walking speed: MD, 0.13 m/s, 95 percent CI, 0.06‒0.19; p<0.001; preferred walking speed: MD, 0.06 m/s, 95 percent CI, 0.02‒0.10; p=0.02), and balance (Step Test: MD, 0.06 steps/s, 95 percent CI, 0.01‒0.12; p=0.03).
“We have established the effectiveness of a home-based, multidisciplinary, tailored intervention comprising habit forming exercise, community mobility, and safety training,” the investigators said.
“By recruiting community-dwelling stroke survivors and testing an intervention delivered collaboratively by an occupational therapy/physiotherapy dyad in the home and local community, we have ensured that the intervention reflects what can be readily implemented,” they added.
Nondrug intervention
Three previous trials have examined the efficacy of a nondrug intervention to prevent falls following stroke and found no effect. [Arch Phys Med Rehabil 2012;93:1648-1655; Neurorehabil Neural Repair 2012;26:1046-1057; Arch Phys Med Rehabil 2024;105:1623-1631]
“This may be because adherence to exercise was low and exercise was segregated from everyday activities in two of the earlier trials, and home modification did not directly target falls risk in the other trial,” the investigators said.
In the current study, participants added exercise into daily activities, which helped form a habitual behaviour. Each component of the intervention was also tailored to the participant’s level of disability.
“For example, for participants with very poor mobility, the initial emphasis was on home safety before exercise was introduced,” the investigators said.
The latest Cochrane review of environmental interventions and falls supported this approach, showing high-certainty evidence that home fall hazard interventions can reduce the rate of falls in community-dwelling people at increased risk of falling.
On the other hand, the current findings are in contrast to the trial by Dean and colleagues, which showed that exercise with no home safety intervention could increase the number of falls for people with more disability. [Arch Phys Med Rehabil 2024;105:1623-1631]