Introduction

A fall happens due to failure in recovering from a loss of balance, causing a sudden irrepressible descent. To an individual, falls can be costly in terms of medical and rehabilitation disbursement. It can eventuate to loss of dependency, societal participation and self-imposed activity restriction due to possible disability or fear of falling. Stroke has been noted as a risk factor for falls, although little research has encompassed on risk factors around other pathologies other than aging. Mobility impairment is one of the common clinical symptoms that is presented during a stroke and in all stages of stroke recovery. As such, being in a high risk of fall remains a considerable health concern throughout the post stroke lifespan. This leads to a significantly increased risk of falling, 7 times more compared to similarly aged people without stroke (Bridenbaugh & Kressig, 2011). Studies showed that approximately three-fourths of individuals with stroke have fallen in the 6 months following discharge from hospital (Forster & Young, 1995) and fall rates remained as high as 50% among community dwelling people with stroke (Hyndman, Ashburn, MPhil & Stack, 2002). It is known that the incidence and prevalence of stroke increase due to aging and other risk factors, which happens to be a prominent concern in Singapore’s demographic.  Thus, it is crucial that we understand the importance and impact of fall interventions. The purpose of this review is to evaluate the efficacy of a multifactorial falls prevention programme, Tai Chi intervention and perturbation training in reducing the number of fall occurrence among the stroke community. These findings may be relevant in the nursing field in which we can provide a better quality of life and higher life expectancy for stroke survivors. Subsequently, nurses can cultivate a better understanding and knowledge in stroke care and implement the appropriate fall prevention interventions promptly.

 

Multifactorial falls prevention program

The first research highlighted was to examine the effect of a multifactorial falls prevention program on reducing falls in stroke patients who are at risk of recurrent falls while assessing improvements in gait, stretch, balance and fall-related efficacy (Batchelor, Hill, Mackintosh, Said & Whitehead, 2012). Purposive sampling was used to select 156 participants with stroke aged 45 years or more, who had been discharged home after rehabilitation and were placed in a randomized controlled trial. The intervention group was provided with a multifactorial, tailored falls prevention program consisted of the following; individualized home exercise program based on the Otago Exercise Program (OEP), falls risk minimization strategies based on falls risk factors identified at baseline from the Falls Risk for Older People – Community setting (FROP-Com), education on identified risk factor and minimization of falls and injury risk strategies including hip protector prescription for patients who are at high risk of fracture. Participants were given a fall calendar, to observe falls rates and the proportion of fallers in 12 months when baseline assessment was done. Following are the secondary data collection accordance to the tests that several factors were based on; leg strength (Sit-To-Stand test), gait speed over 5 metres, balance (Step test), activity (Human Activity Profile, functional independence (FIM), fear of falling (Falls Efficacy Scale – Swedish Modifications) and falls risk (FROP-Com). There was no significant difference on fall rate (Intervention: 1.89 falls/person-year. Control: 1.76 falls/person-year) or in injurious fall rate (Intervention: 0.74 injurious falls/person-year, Control: 0.49 injurious falls/person-year). Based on the findings, the prevention program was not effective in reducing falls in stroke people who are at risk of falls nor was it more effective than usual care in improving gait, balance and strength.

 

Tai Chi intervention

A research was done to identity the effect of Tai Chi intervention on physical function, fall rates and quality of life among older stroke survivors (Taylor-Pillae et al., 2014). Similar to the previous study that has been discussed, this research used purposive sampling to select 145 community-dwelling survivors of stroke who are at least aged 50 years and were 3 months in post-stroke and group them in a randomized controlled trial in which participants were allocated into either the Tai Chi (TC) group, SilverSneakers (SS) group or usual care group. Participants assigned in the TC group were required to attend Tai Chi lessons and those assigned in the SS group were required to attend various types of group-based exercise classes up to a span of 12 weeks. Data is collected by the following assessments on physical function (Short Physical Performance Battery, fall rates and Step test) and medical outcomes (Study 36-Item Short-Form Health Survey, Centre for Epidemiologic Studies Depression Scale and Pittsburg Sleep Quality Index). During the intervention period, there were a total of 123 falls-related events (34 falls, 89 near falls). TC participants had two thirds fewer falls (5 falls) than the SS (14 falls) and UC (15 falls) groups. This suggest that the TC intervention was more effective in reducing fall rates than SS or UC interventions. All groups reported to have significant improvements in perceived mental health and aerobic endurance level were seen significantly better from TC and SS groups. This proves that both are suitable community-based programmes that may aid in stroke recovery and community integration.

Perturbation Training

As falls occur due to a loss of balance, balance training that improves balance reactions might help prevent falls. Hence, this research aimed to evaluate the effect of perturbation training (PTB) on fall occurrence after discharge from stroke rehabilitation (Mansfield et al.,2017).  The research includes a case-control study at the Toronto Rehabilitation Institute since 2013, focusing on subacute stroke patients receiving inpatient rehabilitation in which 31 individuals were selected by purposive sampling in each of the observational studies; PBT group and historical control group (HIS). Inpatients typically receive 1 hour of physiotherapy per day, 5 days per week. Participants in PBT group were required a portion (estimated 30 minutes/day) of their regular physiotherapy with PBT. Falls rates were recorded and reported in the daily life up to 6 months post discharge by the participants and to be sent to the research team fortnightly. Physical activities were recorded through Physical Activity Scale for Individuals with Physical Disabilities at an interval of 2, 4 and 6 months post discharge. Other assessment includes the National Institutes of Health Stroke Scale and clinical assessment scores upon admission and discharge extracted from patient charts. 5 of 31 PBT participants and 15 of 31 HIS participants reported at least 1 fall. There was a significant difference on fall rates (PBT: 10 falls, HIS: 31 falls). Based on the findings, PBT is effective in reducing falls post strokes.

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