Therapists' perspectives on adapting the Stepping On falls prevention programme for community-dwelling stroke survivors in Singapore.

This study investigates the perspectives of rehabilitation therapists on the implementation of fall prevention programmes with community-dwelling stroke survivors in the Singapore context, and elicits recommendations to adapt the Stepping On programme with stroke survivors. Qualitative data were elicited during 4 focus groups with 23 rehabilitation therapists (15 occupational therapists [OTs]; 8 physiotherapists [PTs]) who had received training to deliver the original Stepping On programme, and had experienced delivery of fall-prevention intervention programmes locally. Collected data were analysed using thematic analysis method. Three themes emerged from the focus groups describing: (a) limitations of existing falls prevention intervention for stroke clients; (b) the need to adapt the Stepping On programme to use with stroke clients; and (c) challenges in implementing fall prevention programmes in the stroke context. A series of new components were suggested to be included as part of the Stepping On after stroke (SOAS) programme, including involvement of family members and caregivers, and tailored community reintegration sessions (such as taking public transport and shopping). Rehabilitation therapists describe challenges in addressing fall prevention within a stroke context, and findings highlight the need for a structured, stroke-specific fall prevention programme rather than a more general approach to education and training. Contextual components identified provide valuable inputs towards the development of a culturally relevant fall prevention programme for stroke survivors in Singapore. Implications for Rehabilitation Stroke survivors living in the community are at a high risk of falls. A structured and culturally relevant fall prevention programme for community-living stroke survivors is needed. Falls prevention for community-living stroke survivors should be multi-dimensional and targeting the modifiable risk factors for falls in this group. Both stroke survivors and caregivers should be involved in any fall prevention after stroke programmes.