None listed
Conditions
Brief summary
The aim of the Falls After Stroke Trial (FAST) is to test the effect of homebased, tailored intervention to reduce falls. A sample of communitydwelling stroke survivors who have finished formal rehabilitation, and therefore are at a high risk of falling again will assigned to an experimental group (habit-forming exercise and safety training) to test the feasibility of the intervention. The primary hypothesis is that the home-based, tailored intervention will be safe and reduce both the proportion of people falling and rate of falls over a one-year period in stroke survivors living in the community. The secondary hypotheses are: 2. That home-based, tailored intervention will also be associated with improvements in improving: balance, self-efficacy, mobility, physical activity, community participation, and health-related quality of life. This feasibility trial will test the experimental intervention over 6 months and evaluate feasibility of recruitment, intervention and assessment protocols as well as monitoring outcomes and adverse events.
Interventions
Community dwelling-stroke survivors will be assigned to the experimental group to test the feasibility of the intervention. The experimental group will receive a home-based, tailored intervention consisting of habit forming exercise and/or safety training depending on their level of disability. For example, the faster walkers (> 0.8 m/s) will have most emphasis on habit-forming exercise, the slower walkers (< 0.4 m/s) will have most emphasis on safety training, while the middle group (0.4-0.8
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Community dwelling-stroke survivors will be assigned to the experimental group to test the feasibility of the intervention. The experimental group will receive a home-based, tailored intervention consisting of habit forming exercise and/or safety training depending on their level of disability. For example, the faster walkers (> 0.8 m/s) will have most emphasis on habit-forming exercise, the slower walkers (< 0.4 m/s) will have most emphasis on safety training, while the middle group (0.4-0.8 m/s) will have a combination of both habit-forming exercise and safety training. Habit-forming exercise will be based on the successful Lifestyle integrated Functional Exercise program (Clemson et al., 2012). This program encourages participants to look for ways of doing more physical activity. Activities which challenge their balance and strength will be incorporated into specific daily tasks. They will be performed intentionally and consciously until they become habitual and embedded in daily occupation. Feedback, monitoring and positive reinforcement will be used to enhance the performance of these activities and the self-efficacy of the participants. The safety intervention will focus on environmental adaptations to reduce fall hazards and protective behaviours to reduce risk. The Westmead Home Safety Assessment (Clemson et al 1999), and the Falls Behavioural Scale for Older People, validated by Clemson and colleagues (Clemson et al., 2008a), will be used to identify environmental hazards, as well as risks, so that the participants and therapist can generate solutions. The home-based tailored intervention will be delivered through 7 weekly home visits followed by three booster sessions at Weeks 9, 13, 19 with two phone calls during Week 15 and 23. All home visits will be pproximately 1 hour duration and all home visits and phone calls will be delivered by a physiotherapists or an occupational therapist with experience in neurological rehabilitation. The herapists delivering the intervention and participants will keep exercise logs to monitor adherence and adverse events.
Sponsors
Professor Catherine dean
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
People with stroke will be screened and invited to participate if they: a) are within 2 years of their first stroke (either ischaemic or haemorrhagic) b) have been discharged from formal rehabilitation and are communitydwelling c) can walk, defined as ‘being able to walk 10 m across flat ground with or without a gait aid’ d)are adults capable of providing consent (ie, score greater than or equal to 20 on Mini-Mental State Examination score, Folstein et al 1975)
Exclusion criteria
They will be excluded if they: a) have moderate to severe receptive aphasia as determined by a score of less than 25/30 on the Frenchay Screening Aphasia Test (Enderby et al., 1987).
Outcome results
None listed