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Meta-Analysis
. 2013 May 31;2013(5):CD008728.
doi: 10.1002/14651858.CD008728.pub2.

Interventions for preventing falls in people after stroke

Geert S A F Verheyden  1 , Vivian Weerdesteyn, Ruth M Pickering, Dorit Kunkel, Sheila Lennon, Alexander C H Geurts, Ann Ashburn
Affiliations
Meta-Analysis

Interventions for preventing falls in people after stroke

Geert S A F Verheyden et al. Cochrane Database Syst Rev. .

Abstract

Background: Falls are one of the most common medical complications after stroke with a reported incidence of 7% in the first week after stroke onset. Studies investigating falls in the later phase after stroke report an incidence of up to 73% in the first year post-stroke.

Objectives: To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke.

Search methods: We searched the trials registers of the Cochrane Stroke Group (November 2012) and the Cochrane Bone, Joint and Muscle Trauma Group (May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012, Issue 5, MEDLINE (1950 to May 2012), EMBASE (1980 to May 2012), CINAHL (1982 to May 2012), PsycINFO (1806 to May 2012), AMED (1985 to May 2012) and PEDro (May 2012). We also searched trials registers, checked reference lists and contacted authors.

Selection criteria: Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke.

Data collection and analysis: Review authors independently selected studies for inclusion, assessed trial quality, and extracted data. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate.

Main results: We included 10 studies with a total of 1004 participants. One study evaluated the effect of exercises in the acute and subacute phase after stroke but found no significant difference in rate of falls (rate ratio 0.92, 95% CI 0.45 to 1.90, 95 participants). The pooled result of four studies investigating the effect of exercises on preventing falls in the chronic phase also found no significant difference for rate of falls (rate ratio 0.75, 95% CI 0.41 to 1.38, 412 participants).For number of fallers, one study examined the effect of exercises in the acute and subacute phase after stroke but found no significant difference between the intervention and control group (risk ratio 1.19, 95% CI 0.83 to 1.71, 95 participants). The pooled result of six studies examining the effect of exercises in the chronic phase also found no significant difference in number of fallers between the intervention and control groups (risk ratio 1.02, 95% CI 0.83 to 1.24, 616 participants).The rate of falls and the number of fallers was significantly reduced in two studies evaluating the effect of medication on preventing falls; one study (85 participants) compared vitamin D versus placebo in institutionalised women after stroke with low vitamin D levels, and the other study (79 participants) evaluated alendronate versus alphacalcidol in hospitalised people after stroke.One study provided single lens distance glasses to regular wearers of multifocal glasses. In a subgroup of 46 participants post-stroke there was no significant difference in the rate of falls (rate ratio 1.08, 95% CI 0.52 to 2.25) or the number of fallers between both groups (risk ratio 0.74, 95% CI 0.47 to 1.18).

Authors' conclusions: There is currently insufficient evidence that exercises or prescription of single lens glasses to multifocal users prevent falls or decrease the number of people falling after being discharged from rehabilitation following their stroke. Two studies testing vitamin D versus placebo and alendronate versus alphacalcidol found a significant reduction in falls and the number of people falling. However, these findings should be replicated before the results are implemented in clinical practice.

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Conflict of interest statement

None known

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 3
Figure 3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Analysis 1.1
Analysis 1.1
Comparison 1 Exercise, Outcome 1 Rate of falls.
Analysis 1.2
Analysis 1.2
Comparison 1 Exercise, Outcome 2 Number of fallers.
Analysis 2.1
Analysis 2.1
Comparison 2 Environment: single lens distance glasses versus usual (multifocal) glasses, Outcome 1 Rate of falls.
Analysis 2.2
Analysis 2.2
Comparison 2 Environment: single lens distance glasses versus usual (multifocal) glasses, Outcome 2 Number of fallers.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD008728

References

References to studies included in this review

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References to studies excluded from this review

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References to studies awaiting assessment

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Additional references

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