Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA.
Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA.
Gait Posture. 2021 Feb;84:377-388. doi: 10.1016/j.gaitpost.2020.12.034. Epub 2021 Jan 9.
Falls are a serious challenge facing individuals post-stroke. In the past decades, various fall prevention interventions have been developed. It remains unknown if any of these interventions are effective in reducing falls in this population. Such a knowledge gap could impede the effort of preventing falls in people post-stroke.
Eleven databases were searched for randomized controlled trials which included falls in people post-stroke as an outcome measure. Information on the participants, training protocol, and outcome measures were collected for each study. The primary outcome is the number of fallers and the explanatory variables included mean difference and standard deviation for fall risk factors. Studies were quality appraised using the Physiotherapy Evidence Database scale and the funnel plot.
Thirteen studies enrolling 1352 participants were identified. Effect size quantified by the odds ratio (OR) for falls and standardized mean difference (SMD) for fall risk factors were calculated. Overall no intervention appears to be significantly more effective in preventing falls than placebo training (OR = 0.88 with a range of [0.23 3.66]; 95 % confidence interval = [0.64 1.21], p = 0.44). All interventions showed little effect in improving the fall risk factors (SMD = -0.01 to 0.06 and p-value = 0.38-0.86), except one (the combined treadmill and overground walking) which significantly improved mobility.
Currently no program is effective in reducing falls in people post-stroke. Future studies should measure falls as a primary outcome based on a consistent definition of falls and reliable approaches to collect falls data.
跌倒对于脑卒中后患者来说是一个严峻的挑战。在过去的几十年里，已经开发出了各种预防跌倒的干预措施。目前还不清楚这些干预措施中是否有任何一种能有效降低该人群的跌倒率。这种知识上的差距可能会阻碍预防脑卒中后患者跌倒的努力。
1）针对处于脑卒中后急性和慢性阶段的人群，是否存在有效的预防跌倒干预措施？2）预防跌倒的干预措施如何改变该人群的三个关键跌倒风险因素：平衡、移动能力和下肢力量？
对 11 个数据库进行了检索，以寻找将跌倒作为结果指标的随机对照试验。每个研究都收集了关于参与者、训练方案和结果测量的信息。主要结果是跌倒者的数量，解释变量包括跌倒风险因素的均数差和标准差。使用物理治疗证据数据库量表和漏斗图对研究进行质量评估。
共确定了 13 项纳入 1352 名参与者的研究。通过计算跌倒的比值比（OR）和跌倒风险因素的标准化均数差（SMD）来量化效果大小。总体而言，与安慰剂训练相比，没有一种干预措施在预防跌倒方面明显更有效（OR=0.88，范围为[0.23-3.66]；95%置信区间为[0.64-1.21]，p=0.44）。除了一种（组合跑步机和地面行走）显著改善了移动能力外，所有干预措施在改善跌倒风险因素方面效果都很小（SMD=-0.01 至 0.06，p 值为 0.38-0.86）。
目前，没有任何方案能有效减少脑卒中后患者的跌倒。未来的研究应该将跌倒作为主要结果进行测量，基于对跌倒的一致定义和收集跌倒数据的可靠方法。
