Risk factors for falls in community stroke survivors: A systematic review and meta-analysis

Publication date: Available online 7 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Tianma Xu, Lindy Clemson, Kate O'Loughlin, Natasha A. Lannin, Catherine Dean, Gerald Koh
ObjectiveTo identify the risk factors for falls in community stroke survivors.Data SourcesA comprehensive search for articles indexed on MEDLINE, EMBASE, CINAHL, PsychINFO, Cochrane Library, and Web of Science databases was conducted.Study SelectionProspective studies investigating fall risk factors in community stroke survivors were included. Reviewers in pair independently screened the articles and determined inclusion through consensus. Studies meeting acceptable quality rating using the Q-Coh were included in the meta-analysis.Data ExtractionData extraction was done in duplicate by four reviewers using a standardized data extraction sheet, and confirmed by another independent reviewer for completeness and accuracy.Data SynthesisTwenty-one articles met the minimum criteria for inclusion; risk factors investigated by three or more studies (n=16) were included in a meta-analysis. The following risk factors had strong association with all fallers: impaired mobility (OR 4.36, CI 2.68-7.10); reduced balance (OR 3.87, CI 2.39-6.26); use of sedative / psychotropic medications (OR 3.19, CI 1.36-7.48); disability in self-care (OR 2.30, CI 1.51-3.49); depression (OR 2.11, CI 1.18-3.75); cognitive impairment (OR 1.75, CI 1.02-2.99); and history of fall (OR 1.67, CI 1.03-2.72). A history of falling (OR 4.19, CI 2.05-7.01) had a stronger association with recurrent fallers.ConclusionsThis study confirms that balance and mobility problems, assisted self-care, taking sedative or psychotropic medications, cognitive impairment, depression, and history of falling are associated with falls in community stroke survivors. We recommend that any future research into falls prevention programs should consider addressing these modifiable risk factors. As the risk factors for falls in community stroke survivors are multifactorial, interventions should be multi-dimensional.



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