Background: falls are one of the most common medical complications after stroke with a reported incidence of 7% in the first week after stroke onset. Studies investigating falls in the later phase after stroke report an incidence of up to 73% in the first year post-stroke. Objectives: to evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. Search methods: we searched the trials registers of the Cochrane Stroke Group (November 2012) and the Cochrane Bone, Joint and Muscle Trauma Group (May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012, Issue 5, MEDLINE (1950 to May 2012), EMBASE (1980 to May 2012), CINAHL (1982 to May 2012), PsycINFO (1806 to May 2012), AMED (1985 to May 2012) and PEDro (May 2012). We also searched trials registers, checked reference lists and contacted authors. Selection criteria: randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. Data collection and analysis: review authors independently selected studies for inclusion, assessed trial quality, and extracted data. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate. Main results: we included 10 studies with a total of 1004 participants. One study evaluated the effect of exercises in the acute and subacute phase after stroke but found no significant difference in rate of falls (rate ratio 0.92, 95% CI 0.45 to 1.90, 95 participants). The pooled result of four studies investigating the effect of exercises on preventing falls in the chronic phase also found no significant difference for rate of falls (rate ratio 0.75, 95% CI 0.41 to 1.38, 412 participants). For number of fallers, one study examined the effect of exercises in the acute and subacute phase after stroke but found no significant difference between the intervention and control group (risk ratio 1.19, 95% CI 0.83 to 1.71, 95 participants). The pooled result of six studies examining the effect of exercises in the chronic phase also found no significant difference in number of fallers between the intervention and control groups (risk ratio 1.02, 95% CI 0.83 to 1.24, 616 participants). The rate of falls and the number of fallers was significantly reduced in two studies evaluating the effect of medication on preventing falls; one study (85 participants) compared vitamin D versus placebo in institutionalised women after stroke with low vitamin D levels, and the other study (79 participants) evaluated alendronate versus alphacalcidol in hospitalised people after stroke. One study provided single lens distance glasses to regular wearers of multifocal glasses. In a subgroup of 46 participants post-stroke there was no significant difference in the rate of falls (rate ratio 1.08, 95% CI 0.52 to 2.25) or the number of fallers between both groups (risk ratio 0.74, 95% CI 0.47 to 1.18). Authors' conclusions: there is currently insufficient evidence that exercises or prescription of single lens glasses to multifocal users prevent falls or decrease the number of people falling after being discharged from rehabilitation following their stroke. Two studies testing vitamin D versus placebo and alendronate versus alphacalcidol found a significant reduction in falls and the number of people falling. However, these findings should be replicated before the results are implemented in clinical practice

/pdf/interventions-for-preventing-falls-in-people-after-stroke-2hgs210xjg.pdf

Interventions for preventing falls in people after stroke

Purpose: Stepped psychological care is the delivery of routine assessment and interventions for psychological problems, including depression. The aim of this systematic review was to analyze and sy...

A systematic review of rehabilitation interventions to prevent and treat depression in post-stroke aphasia

Discharge planning is a routine feature of health systems in many countries that aims to reduce delayed discharge from hospital, and improve the co-ordination of services following discharge from hospital and reduce the risk of hospital readmission. This is the fifth update of the original review.To assess the effectiveness of planning the discharge of individual patients moving from hospital.We searched CENTRAL, MEDLINE, Embase and two trials registers on 20 April 2021. We searched two other databases up to 31 March 2020. We also conducted reference checking, citation searching and contact with study authors to identify additional studies.Randomised trials that compared an individualised discharge plan with routine discharge that was not tailored to individual participants. Participants were hospital inpatients.Two review authors independently undertook data analysis and quality assessment using a pre-designed data extraction sheet. We grouped studies by older people with a medical condition, people recovering from surgery, and studies that recruited participants with a mix of conditions. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous data using fixed-effect meta-analysis. When combining outcome data it was not possible because of differences in the reporting of outcomes, we summarised the reported results for each trial in the text.We included 33 trials (12,242 participants), four new trials included in this update. The majority of trials (N = 30) recruited participants with a medical diagnosis, average age range 60 to 84 years; four of these trials also recruited participants who were in hospital for a surgical procedure. Participants allocated to discharge planning and who were in hospital for a medical condition had a small reduction in the initial hospital length of stay (MD - 0.73, 95% confidence interval (CI) - 1.33 to - 0.12; 11 trials, 2113 participants; moderate-certainty evidence), and a relative reduction in readmission to hospital over an average of three months follow-up (RR 0.89, 95% CI 0.81 to 0.97; 17 trials, 5126 participants; moderate-certainty evidence). There was little or no difference in participant's health status (mortality at three- to nine-month follow-up: RR 1.05, 95% CI 0.85 to 1.29; 8 trials, 2721 participants; moderate certainty) functional status and psychological health measured by a range of measures, 12 studies, 2927 participants; low certainty evidence). There was some evidence that satisfaction might be increased for patients (7 trials), caregivers (1 trial) or healthcare professionals (2 trials) (very low certainty evidence). The cost of a structured discharge plan compared with routine discharge is uncertain (7 trials recruiting 7873 participants with a medical condition; very low certainty evidence).A structured discharge plan that is tailored to the individual patient probably brings about a small reduction in the initial hospital length of stay and readmissions to hospital for older people with a medical condition, may slightly increase patient satisfaction with healthcare received. The impact on patient health status and healthcare resource use or cost to the health service is uncertain. 

/pdf/discharge-planning-from-hospital-1tznxsrt.pdf

Discharge planning from hospital

https://pure.rug.nl/ws/files/38052458/1_s2.0_S1353829215001616_main.pdf

Home-making after stroke. A qualitative study among Dutch stroke survivors

/pdf/noejoljung-jaehwalciryoreul-wihan-hangughyeong-pyojun-jinryo-3mxcpdou38.pdf

뇌졸중 재활치료를 위한 한국형 표준 진료 지침 2016

Objective
To conduct a randomised controlled trial (RCT) of occupational therapy predischarge home visits for people after stroke in order to assess the feasibility of a definitive trial.
Design
Two studies; a randomised controlled trial and a cohort study. We randomised eligible patients for whom there was clinical uncertainty about the need to conduct a home visit in to an RCT; patients for whom a visit was deemed ‘essential’, were enrolled into a cohort study.
Setting
Stroke rehabilitation unit of teaching hospital Participants 126 participants hospitalised following recent stroke. Interventions Pre-discharge home visit with an occupational therapist or structured hospital based interview with occupational therapist.
Main outcome measures
The primary objective was to collect information on the feasibility of an RCT, including eligibility criteria, consent procedures, control intervention, and outcome assessments. The primary outcome measure was the Nottingham Extended Activities of Daily Living scale (NEADL) at one month after
discharge from hospital. Secondary outcomes were measures of activities of daily living, mood, quality of life and costs at one week and one month following discharge.
Results
Ninety- three people were allocated to the RCT. Of these 47 were randomised to intervention and 46 to the control. Thirty-three patients were enrolled into the cohort study and received a home visit. Forty-one (87%) participants in the RCT intervention group and 29 (88%) participants in the cohort study received the intervention. There were no significant differences in outcome between the groups in the RCT for the primary outcome measure (performance in extended activities of daily living) at one month. The average cost of a home visit was £208 (£183 for those in the RCT and £243 for those in the cohort study). The average cost of the interview for the control group was £75.
Conclusion
Our main finding was that recruitment to the trial was feasible and no safety issues were raised. A trial is warranted given the resource implications of pre- discharge occupational therapy home visits.

https://journals.sagepub.com/doi/pdf/10.1177/0269215512462145

Occupational therapy predischarge home visits for patients with a stroke (HOVIS): results of a feasibility randomized controlled trial

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Occupational therapy predischarge home visits for patients with a stroke (HOVIS): results of a feasibility randomized controlled trial