Home-based program reduces falls among stroke survivors by one-third

New Australian research has shown that a tailored, home-based program can dramatically cut the number of falls, one of the most dangerous risks faced by survivors of stroke.

The "falls after stroke trial" or FAST, published in the British Medical Journal, found a co-ordinated program of functional exercise, preventing hazards around the home and out-of-home mobility coaching reduced falls by 33 per cent over 12 months.

Led by researchers from the University of Sydney and Macquarie University with collaborators from Monash University and the University of Canberra, FAST is the first study to show a non-drug intervention after stroke can effectively prevent falls.

Stroke survivors in three Australian states were randomly assigned to receive either a structured intervention program or usual care for Australians living in the community after their initial stroke rehabilitation.

The three-part intervention program was delivered by a physiotherapist and an occupational therapist working together, via a series of ten home visits and follow-up phone calls.

FAST therapy teams delivered an individualised in-home program encompassing three components:

• Habit-forming exercise to improve balance and strength, embedded into daily activities, based on the Lifestyle integrated Functional Exercise (LiFE) program
• Fall hazard reduction focused on adapting the home environment and encouraging protective behaviours to reduce risk
• Coaching participants towards a goal for mobility outside the home, such as walking in the park, a shopping trip or using public transport.

More than twice as many people with stroke have falls compared with the general older population, and they are also likely to be repeat fallers.

Falls after stroke can lead to serious injury and hospitalization, delaying recovery and rehabilitation, and jeopardizing long-term health and wellbeing."

Professor Emeritus Lindy Clemson, School of Health Sciences, University of Sydney, lead author of the study

"The decrease we saw in the rate of falls among people receiving the active intervention program was underpinned by worthwhile improvements in their mobility, balance, community participation, and self-efficacy," said Professor Clemson.

"By focusing on stroke survivors living in their communities and testing an intervention delivered in the home, we've ensured the intervention reflects something that can readily be implemented," said co-author Professor Catherine Dean of the School of Health Sciences and Nursing at Macquarie University.

"We believe our world-first finding could help reduce the global burden of falls after stroke."