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

Methods

Two armed, randomised trial.

双臂、随机试验。

Three states in Australia.

澳大利亚的三个州。

People 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.

在中风后5年内，年龄超过50岁，已从正式康复出院回到社区，并且能够在平坦地面上行走10米，无论是否需要辅助工具。

Those with moderate-to-severe receptive aphasia or walking speed >1.4 m/s without falls in the previous year were excluded.

排除了那些有中度至重度接受性失语症或过去一年内步速超过1.4米/秒且未跌倒的患者。

intervention

Over 6 months, the experimental group received a habit forming functional exercise, home fall hazard reduction, and goal directed community mobility coaching; the control group received usual care.

在6个月的时间里，实验组接受了习惯形成的功能性锻炼、家庭跌倒危险因素减少以及目标导向的社区移动性指导；对照组则接受了常规护理。

Physiotherapist and occupational therapist dyadic teams worked collaboratively to deliver the intervention.

物理治疗师和职业治疗师的双人团队协作提供干预。

Methods

The primary outcome was rate of falls over 12 months.

主要结果是12个月内的跌倒率。

Secondary outcomes were proportion of participants having a fall, community participation, self-efficacy, balance, mobility, physical activity, activities of daily living, depression, and health related quality of life.

次要结果包括参与者跌倒的比例、社区参与度、自我效能感、平衡能力、移动性、身体活动量、日常生活活动能力、抑郁情况以及与健康相关的生活质量。

Results

Between August 2019 and December 2023, 370 people with stroke were enrolled.

在2019年8月至2023年12月期间，共有370名中风患者被纳入研究。

At 12 months, a significant between group difference was seen in the rate of falls in favour of the experimental group, representing a 33% reduction in falls (incidencerate ratio 0.67, 95% confidence interval(CI) 0.48 to 0.94; P=0.02).

在12个月时，实验组与对照组之间跌倒率存在显著差异，实验组显示出33%的跌倒率降低（发生率比为0.67，95%置信区间为0.48至0.94；P=0.02）。

No significant between group difference was seen in the number of participants having a fall (absolute risk reduction 0.03, 95% CI -0.07 to 0.13; P=0.52).

在跌倒人数方面，未见实验组与对照组之间存在显著差异（绝对风险降低为0.03，95%置信区间为-0.07至0.13；P=0.52）。

The main between group differences in favour of the experimental group were in community participation (Late Life Function and Disability Instrument disability limitation: mean difference 3% (95% CI 1% to 6%); P=0.02), self-efficacy (mean difference 0.6 (0.2 to 1.0); P=0.004), mobility (fast walking speed: mean difference 0.13 (0.06 to 0.19) m/s (P<0.001); preferred walking speed: 0.06 (0.02 to 0.10) m/s (P=0.02)), and balance (Step Test: mean difference 0.06 (0.01 to 0.12) steps/s; P=0.03).

实验组相较于对照组的主要组间差异体现在社区参与度（晚期生活功能和残疾工具残疾限制：平均差异3%（95%置信区间1%至6%）；P=0.02）、自我效能感（平均差异0.6（0.2至1.0）；P=0.004）、移动性（快速步行速度：平均差异0.13（0.06至0.19）米/秒（P<0.001）；首选步行速度：0.06（0.02至0.10）米/秒（P=0.02））以及平衡能力（步态测试：平均差异0.06（0.01至0.12）步/秒；P=0.03）。

Conclusions

A tailored intervention prevented falls in community dwelling, ambulatory people with stroke.

定制化的干预措施预防了社区居住且能够行走的中风患者跌倒。

The decrease in the rate of falls was underpinned by clinically worthwhile improvements in self-efficacy, mobility, community participation, and balance.

跌倒率的降低得到了自我效能、移动性、社区参与和平衡方面的临床上有价值的改善的支持。

trial_registration

Australian New Zealand Clinical Trials Registry ACTRN12619001114134.

澳大利亚新西兰临床试验注册处 ACTRN12619001114134。