Home based, tailored intervention to reduce rate of falls after stroke (FAST): randomised trial.

The experimental intervention reduced the rate of falls by 33% over 12 months compared to usual care.

• Incidence rate ratio 0.67 (95% CI 0.48 to 0.94; P=0.02) in favour of the experimental group.
• 370 people with stroke were enrolled between August 2019 and December 2023.
• Primary outcome was rate of falls over 12 months.
• The trial was conducted across three states in Australia.

No significant between-group difference was found in the proportion of participants who experienced at least one fall.

• Absolute risk reduction 0.03 (95% CI -0.07 to 0.13; P=0.52).
• While fall rate was reduced, the number of fallers did not differ significantly between groups.
• This suggests the intervention reduced recurrent falls rather than preventing first falls.

The experimental intervention improved community participation compared to usual care.

• Late Life Function and Disability Instrument disability limitation scale showed a mean difference of 3% (95% CI 1% to 6%; P=0.02) in favour of the experimental group.
• Community participation was a secondary outcome measured at 12 months.

Self-efficacy was significantly improved in the experimental group compared to the control group.

• Mean difference of 0.6 (95% CI 0.2 to 1.0; P=0.004) in favour of the experimental group.
• Self-efficacy was identified as one of the factors underpinning the decrease in fall rate.

The experimental intervention significantly improved both fast and preferred walking speed compared to usual care.

• Fast walking speed mean difference: 0.13 m/s (95% CI 0.06 to 0.19; P<0.001) in favour of the experimental group.
• Preferred walking speed mean difference: 0.06 m/s (95% CI 0.02 to 0.10; P=0.02) in favour of the experimental group.
• Mobility improvement was identified as one of the factors underpinning the decrease in fall rate.

Balance as measured by the Step Test was significantly improved in the experimental group.

• Mean difference of 0.06 steps/s (95% CI 0.01 to 0.12; P=0.03) in favour of the experimental group.
• Balance improvement was identified as one of the factors underpinning the decrease in fall rate.

The intervention was delivered by physiotherapist and occupational therapist dyadic teams over 6 months to community-dwelling stroke survivors.

• The experimental intervention comprised habit-forming functional exercise, home fall hazard reduction, and goal-directed community mobility coaching.
• The intervention was delivered over 6 months, with outcome follow-up at 12 months.
• Eligible participants were within 5 years of stroke, aged >50 years, discharged from formal rehabilitation to the community, and able to walk 10 m across flat ground with or without an aid.
• Exclusion criteria included moderate-to-severe receptive aphasia or walking speed >1.4 m/s without falls in the previous year.
• Control group received usual care.