The impact of the Stroke Action Falls program on Falls In Stroke Survivors

Usual care plus Stroke Action Falls (SAF) Usual care Usual care is the care prescribed by the participant's healthcare team that may include community rehabilitation services that the participants may be referred to after they leave the hospital such as physiotherapy, occupational therapy, general practitioner visits or other routine post-stroke healthcare. SAF program (intervention) The SAF Intervention is an expert-led, self-management approach to reduce falls, guided by a SAF checklist, which is used to identify risks and actions to address identified risks. Significant others such as carers or family members may be involved in SAF sessions. Participants receive an education booklet, specifically designed for this study, and the completed SAF checklist and action plan which is individualised for each participant with stroke. The SAF checklist outlines the definition of a fall, risk factors, and suggested actions across key areas such as falls history, medical history, and home environment. The action plan is personalised for each participant based on their individual risks, which are identified during the initial SAF session. The SAF checklist and action plan serves as a reminder of the actions and allows them to track their progress. Registered, SAF trained health care professionals will deliver SAF to trial participants either in their home or via telehealth depending on their preference and location (for a home visit participant residence must be less than or equal to one hour from where the SAF clinician is based). Participants in the intervention arm receive three scheduled sessions, including an initial session within two weeks of randomisation, a follow-up phone call within four weeks, and a third session six months after randomisation. A fourth session may be triggered if the participant reports that they have had a fall or changed residence during the first six months. Session 1 (within two weeks of randomisation) The session will take about an hour to complete. Participant will be provided with the education booklet, SAF checklist and action plan and work with participants and significant others (where appropriate), to review the SAF checklist and identify appropriate actions. Participants will be advised to contact their SAF clinician if they fall or move residence during the first six months of their trial participation. This participant-initiated contact will trigger an additional SAF session (see description for triggered session). Session 2 (within four weeks of randomisation) Two weeks after the initial session, the SAF clinician will phone the participant to check on their progress by reviewing progress on completion of actions that were identified during the initial session and discuss provide guidance as necessary with regards to unresolved actions. The session will take about 30 minutes to complete. Session 3 (six months post randomisation) Six months after randomisation the SAF clinician will complete a SAF session with the participant where they will work with participants and significant others (where appropriate) and use the SAF checklist to review risks and relevant actions, to update the participant’s action plan. The session will take about an hour to complete. Triggered session (following notification of fall or change of residence) Where a SAF clinician receives notification from a participant of a fall or a change of residence, the SAF clinician will contact the participant to arrange an additional SAF session to review and update their action plan using the SAF checklist. If the participant has not moved residence since their first SAF session, this follow-up session will be conducted by telehealth or at the participant's home (for a home visit participant residence must be less than or equal to one hour from where the SAF clinician is based). Adherence to SAF intervention delivery will be monitored by completion of a SAF session record by clinicians at the end of each SAF session, capturing details of the session (i.e. completion of risk and action identification according to the checklist, session date and duration). A sample of recorded SAF sessions will be independently reviewed to enable fidelity checking.