Risk Factors for Falls in Community Stroke Survivors: A Systematic Review and Meta-Analysis

Arch Phys Med Rehabil. 2018 Mar;99(3):563-573.e5. doi: 10.1016/j.apmr.2017.06.032. Epub 2017 Aug 7.

Abstract

Objective: To identify the risk factors for falls in community stroke survivors.

Data sources: A comprehensive search for articles indexed in MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, and Web of Science databases was conducted.

Study selection: Prospective 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 tool were included in the meta-analysis.

Data extraction: Data extraction was done in duplicate by 4 reviewers using a standardized data extraction sheet and confirmed by another independent reviewer for completeness and accuracy.

Data synthesis: Twenty-one articles met the minimum criteria for inclusion; risk factors investigated by ≥3 studies (n=16) were included in the meta-analysis. The following risk factors had a strong association with all fallers: impaired mobility (odds ratio [OR], 4.36; 95% confidence interval [CI], 2.68-7.10); reduced balance (OR, 3.87; 95% CI, 2.39-6.26); use of sedative or psychotropic medications (OR, 3.19; 95% CI, 1.36-7.48); disability in self-care (OR, 2.30; 95% CI, 1.51-3.49); depression (OR, 2.11; 95% CI, 1.18-3.75); cognitive impairment (OR, 1.75; 95% CI, 1.02-2.99); and history of fall (OR, 1.67; 95% CI, 1.03-2.72). A history of fall (OR, 4.19; 95% CI, 2.05-7.01) had a stronger association with recurrent fallers.

Conclusions: This 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 fall prevention programs should consider addressing these modifiable risk factors. Because the risk factors for falls in community stroke survivors are multifactorial, interventions should be multidimensional.

Keywords: Accidental falls; Rehabilitation; Risk factors; Stroke.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Accidental Falls / statistics & numerical data*
  • Aged
  • Cognitive Dysfunction / etiology
  • Cognitive Dysfunction / physiopathology
  • Female
  • Humans
  • Independent Living
  • Male
  • Middle Aged
  • Odds Ratio
  • Postural Balance
  • Prospective Studies
  • Psychotropic Drugs / therapeutic use
  • Risk Factors
  • Stroke / complications*
  • Stroke / physiopathology
  • Stroke / psychology
  • Survivors / statistics & numerical data*

Substances

  • Psychotropic Drugs