What is Effective for Fall Prevention Among Individuals Post- Stroke? A Systematic Review
DOI:
https://doi.org/10.15621/ijphy/2022/v9i1/1145Keywords:
Stroke, Falls, Balance, Interventions, Systematic Review.Abstract
Background: Falls are a significant concern for people post-stroke. Interventions that effectively prevent or reduce the number of falls should be well documented and appraised for effectiveness. Therefore, our study aimed to identify and appraise the literature on interventions aimed at preventing or reducing falls among people post-stroke.
Methods: A comprehensive literature search was conducted in five databases. Two independent reviewers screened the literature search results to include relevant studies. Subsequently, reviewers extracted the data using a standardized form, and the quality of studies was assessed using a critical appraisal tool.
Results: 26 studies met the selection criteria and were included in our review. We identified eight categories for preventing and reducing falls. These categories were: electrotherapy, multifactorial fall prevention programs, educational programs, multifaceted stroke telerehabilitation, virtual reality, vitamin-D supplements, rehabilitation instruments, and physical activities.
Conclusion: The evidence for these interventions varied between studies, with no single intervention superior to others. The current review findings indicate that there is limited evidence to recommend one fall intervention to be generalized among people post-stroke. Further studies involving large sample sizes and different fall outcomes are needed to make valuable recommendations for clinical practice.
References
Norrving B, Kissela B. The global burden of stroke and need for a continuum of care. Neurology. 2013;80(3 Suppl 2):S5-12. doi: 10.1212/WNL.0b013e3182762397.
Geurts AC, de Haart M, van Nes IJ, Duysens J. A review of standing balance recovery from stroke. Gait & posture. 2005;22(3):267-81. doi: 10.1016/j.gaitpost.2004.10.002.
Forster A, Young J. Incidence and consequences of falls due to stroke: a systematic inquiry. BMJ. 1995;311(6997):83-6. doi: 10.1136/bmj.311.6997.83.
Weerdesteyn V, de Niet M, van Duijnhoven HJ, Geurts AC. Falls in individuals with stroke. Journal of rehabilitation research and development. 2008;45(8):1195-213.
Batchelor F, Hill K, Mackintosh S, Said C. What works in falls prevention after stroke?: a systematic review and meta-analysis. Stroke. 2010;41(8):1715-22. doi: 10.1161/STROKEAHA.109.570390.
Bower K, Thilarajah S, Pua YH, Williams G, Tan D, Mentiplay B, et al. Dynamic balance and instrumented gait variables are independent predictors of falls following stroke. J Neuroeng Rehabil. 2019;16(1):3. doi: 10.1186/s12984-018-0478-4.
Oliveira CB, Medeiros IR, Greters MG, Frota NA, Lucato LT, Scaff M, et al. Abnormal sensory integration affects balance control in hemiparetic patients within the first year after stroke. Clinics (Sao Paulo). 2011;66(12):2043-8. doi: 10.1590/s1807-59322011001200008.
Denissen S, Staring W, Kunkel D, Pickering RM, Lennon S, Geurts AC, et al. Interventions for preventing falls in people after stroke. Cochrane Database Syst Rev. 2019;10:CD008728. doi: 10.1002/14651858.CD008728.pub3.
Hannan MT, Gagnon MM, Aneja J, Jones RN, Cupples LA, Lipsitz LA, et al. Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study. Am J Epidemiol. 2010;171(9):1031-6. doi: 10.1093/aje/kwq024.
Hauer KA, Kempen GI, Schwenk M, Yardley L, Beyer N, Todd C, et al. Validity and sensitivity to change of the falls efficacy scales international to assess fear of falling in older adults with and without cognitive impairment. Gerontology. 2011;57(5):462-72. doi: 10.1159/000320054.
Park SH, Lee YS. The Diagnostic Accuracy of the Berg Balance Scale in Predicting Falls. West J Nurs Res. 2017;39(11):1502-25. doi: 10.1177/0193945916670894.
Schmid AA, Rittman M. Consequences of poststroke falls: activity limitation, increased dependence, and the development of fear of falling. Am J Occup Ther. 2009;63(3):310-6. doi: 10.5014/ajot.63.3.310.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9, W64. doi: 10.7326/0003-4819-151-4-200908180-00135.
Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-21.
Olivo SA, Macedo LG, Gadotti IC, Fuentes J, Stanton T, Magee DJ. Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther. 2008;88(2):156-75. doi: 10.2522/ptj.20070147.
Batchelor FA, Hill KD, Mackintosh SF, Said CM, Whitehead CH. Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93(9):1648-55. doi: 10.1016/j.apmr.2012.03.031.
Chumbler NR, Li X, Quigley P, Morey MC, Rose D, Griffiths P, et al. A randomized controlled trial on Stroke telerehabilitation: The effects on falls self-efficacy and satisfaction with care. J Telemed Telecare. 2015;21(3):139-43. doi: 10.1177/1357633X15571995.
Hahn J, Shin S, Lee W. The effect of modified trampoline training on balance, gait, and falls efficacy of stroke patients. J Phys Ther Sci. 2015;27(11):3351-4. doi: 10.1589/jpts.27.3351.
Holmgren E, Gosman-Hedstrom G, Lindstrom B, Wester P. What is the benefit of a high-intensive exercise program on health-related quality of life and depression after stroke? A randomized controlled trial. Adv Physiother. 2010;12(3):125-33. doi: 10.3109/14038196.2010.488272.
Jung Y, Lee K, Shin S, Lee W. Effects of a multifactorial fall prevention program on balance, gait, and fear of falling in post-stroke inpatients. J Phys Ther Sci. 2015;27(6):1865-8. doi: 10.1589/jpts.27.1865.
Lau RW, Yip SP, Pang MY. Whole-body vibration has no effect on neuromotor function and falls in chronic stroke. Med Sci Sports Exerc. 2012;44(8):1409-18. doi: 10.1249/MSS.0b013e31824e4f8c.
Lee JM, Moon HH, Lee SK, Lee HL, Park YJ. The effects of a community-based walking program on walking ability and fall-related self-efficacy of chronic stroke patients. J Exerc Rehabil. 2019;15(1):20-5. doi: 10.12965/jer.1836502.251.
Lee NG, You JSH, Yi CH, Jeon HS, Choi BS, Lee DR, et al. Best Core Stabilization for Anticipatory Postural Adjustment and Falls in Hemiparetic Stroke. Arch Phys Med Rehabil. 2018;99(11):2168-74. doi: 10.1016/j.apmr.2018.01.027.
Andrade SM, Ferreira JJA, Rufino TS, Medeiros G, Brito JD, da Silva MA, et al. Effects of different montages of transcranial direct current stimulation on the risk of falls and lower limb function after stroke. Neurol Res. 2017;39(12):1037-43. doi: 10.1080/01616412.2017.1371473.
Kim DY, Lim CG. Effects of Pedalo((R)) training on balance and fall risk in stroke patients. J Phys Ther Sci. 2017;29(7):1159-62. doi: 10.1589/jpts.29.1159.
Onal B, Karaca G, Sertel M. Immediate Effects of Plantar Vibration on Fall Risk and Postural Stability in Stroke Patients: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis. 2020;29(12):105324. doi: 10.1016/j.jstrokecerebrovasdis.2020.105324.
Park D, Cynn HS, Yi C, Choi WJ, Shim JH, Oh DW. Four-week training involving self-ankle mobilization with movement versus calf muscle stretching in patients with chronic stroke: a randomized controlled study. Top Stroke Rehabil. 2020;27(4):296-304. doi: 10.1080/10749357.2019.1690831.
Handelzalts S, Kenner-Furman M, Gray G, Soroker N, Shani G, Melzer I. Effects of Perturbation-Based Balance Training in Subacute Persons With Stroke: A Randomized Controlled Trial. Neurorehabil Neural Repair. 2019;33(3):213-24. doi: 10.1177/1545968319829453.
Huang S, Yu X, Lu Y, Qiao J, Wang H, Jiang LM, et al. Body weight support-Tai Chi footwork for balance of stroke survivors with fear of falling: A pilot randomized controlled trial. Complement Ther Clin Pract. 2019;37:140-7. doi: 10.1016/j.ctcp.2019.101061.
Cattaneo D, Gervasoni E, Pupillo E, Bianchi E, Aprile I, Imbimbo I, et al. Educational and Exercise Intervention to Prevent Falls and Improve Participation in Subjects With Neurological Conditions: The NEUROFALL Randomized Controlled Trial. Front Neurol. 2019;10:865. doi: 10.3389/fneur.2019.00865.
Pedreira da Fonseca E, da Silva Ribeiro NM, Pinto EB. Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial. J Stroke Cerebrovasc Dis. 2017;26(1):94-100. doi: 10.1016/j.jstrokecerebrovasdis.2016.08.035.
Sato Y, Iwamoto J, Kanoko T, Satoh K. Low-dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke: a randomized controlled trial. Cerebrovasc Dis. 2005;20(3):187-92. doi: 10.1159/000087203.
Morone G, Annicchiarico R, Iosa M, Federici A, Paolucci S, Cortes U, et al. Overground walking training with the i-Walker, a robotic servo-assistive device, enhances balance in patients with subacute stroke: a randomized controlled trial. J Neuroeng Rehabil. 2016;13(1):47. doi: 10.1186/s12984-016-0155-4.
Nikamp CDM, Hobbelink MSH, van der Palen J, Hermens HJ, Rietman JS, Buurke JH. The effect of ankle-foot orthoses on fall/near fall incidence in patients with (sub-)acute stroke: A randomized controlled trial. PloS one. 2019;14(3):e0213538. doi: 10.1371/journal.pone.0213538.
Cheng PT, Wu SH, Liaw MY, Wong AM, Tang FT. Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. Arch Phys Med Rehabil. 2001;82(12):1650-4. doi: 10.1053/apmr.2001.26256.
Correia A, Pimenta C, Alves M, Virella D. Better balance: a randomised controlled trial of oculomotor and gaze stability exercises to reduce risk of falling after stroke. Clin Rehabil. 2021;35(2):213-21. doi: 10.1177/0269215520956338.
Dean CM, Rissel C, Sherrington C, Sharkey M, Cumming RG, Lord SR, et al. Exercise to enhance mobility and prevent falls after stroke: the community stroke club randomized trial. Neurorehabil Neural Repair. 2012;26(9):1046-57. doi: 10.1177/1545968312441711.
Mansfield A, Aqui A, Danells CJ, Knorr S, Centen A, DePaul VG, et al. Does perturbation-based balance training prevent falls among individuals with chronic stroke? A randomised controlled trial. BMJ Open. 2018;8(8):e021510. doi: 10.1136/bmjopen-2018-021510.
Marigold DS, Eng JJ, Dawson AS, Inglis JT, Harris JE, Gylfadottir S. Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke. J Am Geriatr Soc. 2005;53(3):416-23. doi: 10.1111/j.1532-5415.2005.53158.x.
Pang MYC, Yang L, Ouyang H, Lam FMH, Huang M, Jehu DA. Dual-Task Exercise Reduces Cognitive-Motor Interference in Walking and Falls After Stroke. Stroke. 2018;49(12):2990-8. doi: 10.1161/STROKEAHA.118.022157.
Taylor-Piliae RE, Hoke TM, Hepworth JT, Latt LD, Najafi B, Coull BM. Effect of Tai Chi on physical function, fall rates and quality of life among older stroke survivors. Arch Phys Med Rehabil. 2014;95(5):816-24. doi: 10.1016/j.apmr.2014.01.001.
Sato Y, Iwamoto J, Honda Y. RETRACTED: An open-label trial comparing alendronate and alphacalcidol in reducing falls and hip fractures in disabled stroke patients. J Stroke Cerebrovasc Dis. 2011;20(1):41-6. doi: 10.1016/j.jstrokecerebrovasdis.2009.10.007.
Yang F, Lees J, Simpkins C, Butler A. Interventions for preventing falls in people post-stroke: A meta-analysis of randomized controlled trials. Gait & posture. 2021;84:377-88. doi: 10.1016/j.gaitpost.2020.12.034.
Published
Abstract Display: 1188 
PDF Downloads: 962 How to Cite
Issue
Section
Copyright © Author(s) retain the copyright of this article.
This work is licensed under a