ObjectiveTo determine the effect of falls-prevention exercise compared with nothing, sham or another exercise intervention on reducing falls after stroke. To also determine the effect of falls-prevention exercise on balance, mobility and quality of life.Data sourcesSearches were conducted from inception to December 2025 on MEDLINE, EMBASE, Scopus and PEDro databases according to predefined search terms with details provided in supplementary materials.Review methodsRandomised trials were included if the intervention targeted falls and the primary outcome was the rate of falls or the number of people experiencing one or more falls. Other outcomes of interest were balance, mobility and quality of life. Methodological quality was rated with the PEDro scale. Two researchers independently extracted data, which was synthesised by meta-analysis.ResultsThree trials (n = 677) were included in the review. Exercise trended towards a lower rate of falls compared to no/sham intervention (IRR 0.84, 95% CI 0.62 to 1.15, p = 0.29) with uncertainty in the estimate (confidence interval includes the possibility of no effect). Exercise did not reduce the number of individuals experiencing one or more falls (RR 0.98, 95% CI 0.81 to 1.18, p = 0.84). There was a trend towards improved balance (MD 0.49 steps in the Step Test, 95% CI -0.11 to 1.08, p = 0.11) and exercise did improve mobility a small amount (MD 0.04 m/s preferred walking speed, 95% CI 0.01 to 0.07, p < 0.01). No trials compared two exercise interventions.ConclusionThere is a suggestion that exercise can reduce the rate of falls after stroke but does not affect the number of individuals falling.RegistrationPROSPERO CRD42024520272.

OBJECTIVE:To investigate the effectiveness of a multidisciplinary, home based, tailored intervention to reduce falls after stroke. DESIGN:Two armed, randomised trial. SETTING:Three states in Australia. PARTICIPANTS:People within 5 years of stroke, aged >50 years, discharged from formal rehabilitation to the community, and able to walk 10 m across flat ground with or without an aid. Those with moderate-to-severe receptive aphasia or walking speed >1.4 m/s without falls in the previous year were excluded. INTERVENTION:Over 6 months, the experimental group received a habit forming functional exercise, home fall hazard reduction, and goal directed community mobility coaching; the control group received usual care. Physiotherapist and occupational therapist dyadic teams worked collaboratively to deliver the intervention. MAIN OUTCOME MEASURES:The primary outcome was rate of falls over 12 months. Secondary outcomes were proportion of participants having a fall, community participation, self-efficacy, balance, mobility, physical activity, activities of daily living, depression, and health related quality of life. RESULTS:Between August 2019 and December 2023, 370 people with stroke were enrolled. At 12 months, a significant between group difference was seen in the rate of falls in favour of the experimental group, representing a 33% reduction in falls (incidence rate ratio 0.67, 95% confidence interval (CI) 0.48 to 0.94; P=0.02). No significant between group difference was seen in the number of participants having a fall (absolute risk reduction 0.03, 95% CI -0.07 to 0.13; P=0.52). The main between group differences in favour of the experimental group were in community participation (Late Life Function and Disability Instrument disability limitation: mean difference 3% (95% CI 1% to 6%); P=0.02), self-efficacy (mean difference 0.6 (0.2 to 1.0); P=0.004), mobility (fast walking speed: mean difference 0.13 (0.06 to 0.19) m/s (P<0.001); preferred walking speed: 0.06 (0.02 to 0.10) m/s (P=0.02)), and balance (Step Test: mean difference 0.06 (0.01 to 0.12) steps/s; P=0.03). CONCLUSION:A tailored intervention prevented falls in community dwelling, ambulatory people with stroke. The decrease in the rate of falls was underpinned by clinically worthwhile improvements in self-efficacy, mobility, community participation, and balance. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN12619001114134.

Background: Reablement programs are recommended for people living with dementia to maintain and improve independence and activities of daily living function, however worldwide, access to quality, evidence-informed programs remains limited. This scoping review aimed to explore barriers, facilitators and strategies when implementing reablement programs for community-dwelling people living with dementia. Methods: A comprehensive scoping review following PRISMA-ScR guidelines (from inception to February 2026) across five databases and grey literature was undertaken to identify publications that reported on implementation of reablement programs for community-dwelling people living with dementia. Two reviewers independently screened abstracts and full texts and independently completed quality appraisal. Thematic analysis using the Consolidated Framework for Implementation Research (CFIR) explored implementation barriers, facilitators, strategies, and stakeholder-specific factors. Results: Fifty papers were included in the review. A range of reablement approaches were reported, with six programs constituting 62% of the papers. Barriers and facilitators for implementing community-based dementia reablement programs were identified and fit within the CFIR domains. For example, barriers included lack of health professional confidence delivering reablement, workforce capacity within service providers, policy pressures, and challenges around maintaining intervention fidelity. Facilitators included health professional confidence and motivation from perceived reablement benefits, teams working together with good communication, interorganisational collaboration, and promoting awareness of the evidence-base for dementia reablement. Conclusion: This review highlighted that although barriers exist to implementing dementia reablement, there are a range of facilitators and strategies that can be leveraged to promote implementation. With reablement recommended as an important intervention to support people living with dementia, it is imperative that service providers take action towards implementation. Future research should explore the implementation of reablement programs across diverse settings, to bridge the gap between evidence and practice and contribute to accessible reablement programs for all people living with dementia.

BACKGROUND:Gait disorders are common among older adults and contribute to falls and immobility. This study aimed to explore gait characteristics in older adults with higher-level gait disorders during normal, dual-task, and destabilising walking conditions at home, and their association with cognitive impairment. METHODS:A cross-sectional study was conducted in the community with two groups (n = 60): older adults with higher-level gait disorders and an age- and gender-matched non-gait disorder (control) group. Both groups underwent cognitive assessments and gait assessments using inertial measurement units (IMUs). RESULTS:Compared to controls, those with gait disorders exhibited worse cognitive and gait performance. Measures of gait speed, stride length, stride length variability, and double support time reflected higher-level gait disorders. Small associations were found between gait speed and stride length with attention and processing speed (Stroop, SDMT), and between double support with motor planning and processing speed (LEMOCOT, SDMT). Larger decrements (between-group effect size) in gait performance compared to controls during dual-task and destabilising walking conditions. CONCLUSION:Instrumented gait assessment and cognitive assessment can be conducted at home in older adults with higher-level gait disorders. Their gait characteristics include reduced gait speed, increased double support and gait variability. Certain cognitive domains such as attention, processing speed, and motor planning are associated with gait control. Monitoring subtle changes in key gait parameters may provide opportunities for early intervention to address gait deficits and reveal cognitive changes requiring further investigation to formulate effective management plans.

Date Presented 04/03/2025 Dementia-related behaviors are distressing. The Tailored Activity Program was beneficial for people with dementia and their caregivers when implemented by OTs in a clinical context in Australia. Primary Author and Speaker: Sally Bennett Contributing Authors: Lindy Clemson, Brenda Gannon, Trevor Russell, Maria O’Reilly, Kate Laver, Elizabeth Beattie, Lee-Fay Low, Alison Pighills, Jacki Liddle, Claire O’Connor, Asad Khan, Sandra Smith, Catherine Travers, Monique Smets, Gerard Byrne, Tammy Aplin, Laura Gitlin

OBJECTIVE:Mobility limitations and falls are common in people with Parkinson's disease (PwP). Compared with exercise alone, a tailored, multidomain intervention has the potential to be more effective in improving mobility safety and preventing falls. This study aimed to explore the feasibility and potential effectiveness of a multidomain fall prevention intervention (Integrate) designed for PwP who experience frequent falls. METHODS:The home-based intervention was delivered over a span of 6 months by occupational therapists and physiotherapists. The personalized intervention included home fall hazard reduction, exercise, and safer mobility behavior training. The participants received 8 to 12 home visits and were supported by care-partners (when necessary) to participate in the intervention. RESULTS:Twenty-nine people (recruitment rate: 49%; drop-out rate: 10%) with moderate to advanced Parkinson's disease, a history of recurrent falls, and mild to moderate cognitive impairment participated in the study, with 26 people completing the study. A moderate-to-high adherence to the intervention was observed, and there were no adverse events related to the intervention. Twenty-one (81%) participants met or exceeded their safer mobility goal based on the Goal Attainment Scale. The participants exhibited a median 1.0-point clinically meaningful improvement according to the Short Physical Performance Battery. An exploratory analysis revealed that fall rates were reduced by almost 50% in the 6-month follow-up period (incidence rate ratio: 0.51; 95% confidence interval 0.28-0.92). CONCLUSION:A multidomain occupational therapy and physiotherapy intervention for PwP experiencing recurrent falls was feasible and appeared to improve mobility safety. A randomized trial powered to detect the effects of the intervention on falls and mobility is warranted.

Background and Aims:LiFE is a habit-forming functional exercise program that is not widely used in stroke but could facilitate exercise and support long-term physical activity. The purpose of this study was to determine, in people after stroke participating in the Falls After Stroke Trial: (1) exercise beliefs and behaviours, (2) differences between LiFE and usual care participants and (3) in LiFE participants, perceptions of the program. Methods:Participants (n = 49) were consecutively invited to complete a 43-item survey about exercise beliefs and behaviours. LiFE participants also provided program feedback. Data were analysed using descriptive and frequency analyses, Wilcoxon rank-sum tests, Fisher's exact tests and content analyses. Results:Thirty-eight complete surveys (n = 22 LiFE, n = 16 usual care) were analysed. Participants had moderately strong outcome expectations for exercise and reported a mean (SD) of 2 (2) barriers and 2 (1) facilitators to exercise. Only 15 participants (39%) reported meeting Australian physical activity guidelines, of which most (67%) received LiFE. More LiFE than usual care participants were confident in overcoming barriers to exercise (62% vs. 33%, p = 0.18) and satisfied with their reported physical activity levels (50% vs. 37%, p = 0.41). Most LiFE participants (95%) agreed that the program made it easier for them to be more physically active and all agreed that they would continue with the program. Conclusion:People after stroke in both the LiFE and usual care groups had positive views of exercise; however, most reported that they were not completing recommended physical activity levels. There appeared to be some differences in exercise beliefs and behaviours between LiFE and usual care participants, though these were not statistically significant. LiFE participants provided positive feedback about the program and reported that it could help them to engage in physical activity behaviours.

BACKGROUND:Falls among people aged 65 years and older represent a global health challenge, with substantial morbidity, mortality and economic costs. Despite strong evidence supporting the efficacy of multifactorial falls prevention interventions, their implementation in community settings remains inconsistent. There is a need to systematically develop and proactively tailor multifactorial falls prevention interventions and implementation strategies to the context. This study aims to describe the systematic development of the BE-EMPOWERed program, a comprehensive falls prevention initiative, and its corresponding implementation strategies to enhance the uptake and effectiveness of a multifactorial falls prevention interventions in community-dwelling older people. METHODS:The BE-EMPOWERed program was developed using Intervention Mapping (IM) and Implementation Mapping guided by the Medical Research Council (MRC) framework. The development process involved co-production with key stakeholders, including older people, healthcare professionals, and local policymakers, ensuring the program's relevance and feasibility in real-world settings. The program components were pretested, refined, and evaluated through iterative cycles within primary care areas, incorporating continuous feedback from participants and implementation facilitators to address the complexities of the context and real-world implementation. RESULTS:The BE-EMPOWERed program includes a group-based intervention for older people and workshops for healthcare professionals. A detailed implementation plan was created and implementation facilitators were trained to support the adoption of multifactorial falls prevention interventions across primary care areas in Flanders. Key implementation strategies for older people included tailored interventions, personal risk assessments, active learning, participation and opportunities for social comparison. For healthcare professionals, the strategies focused on raising awareness, guided practice and coalition-building. Additionally, active learning, guided practice, stakeholder engagement, community development and agenda setting were pivotal in training implementation facilitators and executing the implementation plan. CONCLUSIONS:The successful implementation of multifactorial falls prevention interventions in community settings requires addressing multiple contextual levels, from individual to organizational and policy-related factors. This study provides a comprehensive guide for the systematic development and implementation of complex interventions, offering practical insights for future initiatives aimed at improving community-based health outcomes, enhancing program sustainability, and facilitating the broader application of falls prevention interventions.

Background We investigated the effectiveness of an Interdisciplinary Home-bAsed Reablement Programme (I-HARP) on improving functional independence, health and well-being of people with dementia, family carer outcomes and costs.Method A multicentre pragmatic parallel-arm randomised controlled trial compared I-HARP to usual care in community-dwelling people with mild to moderate dementia and their family carers in Sydney, Australia (2018-2022). I-HARP is a 4-month, home-based, dementia rehabilitation model delivered by an interdisciplinary team. Assessments were conducted at baseline (time-1), 4-month (time-2) and 12-month (time-3) follow-up. The primary outcome measure was the client's functional independence using the Disability Assessment for Dementia (DAD) scale at time-2, based on intention-to-treat analyses.Result Of 130 recruited client-carer dyads, 116 dyads (58/group) completed the trial. The I-HARP group were not significantly better in most outcome measures than usual care at both time-2 and time-3; with the only statistically significant difference being a reduction in home environment hazards at time-2. Post hoc subgroup analysis of 66 clients with mild dementia found significantly better functional independence in the intervention group compared with those in usual care: difference 8.99 on DAD (95% CI 1.21, 16.79) at time-2 and difference 12.16 (95% CI 1.93, 22.38) at time-3. Economic evaluation suggests potentially lower resource use in I-HARP compared with usual care, but the cost-effectiveness is uncertain.Conclusion Primary outcomes were not met for a population of people with dementia, with severity ranging from mild to moderate and severe. The I-HARP model appeared to benefit functional independence of participants with mild dementia, with potential cost savings.Trial registration number ACTRN12618000600246.

We adapted the Stepping On fall prevention program, conducted a pilot feasibility trial and explored program acceptability. Using a pilot randomized controlled trial (RCT) design, participants from the Older People’s Mental Health Service (OPMHS) Ryde, Sydney were randomly allocated to the adapted program or usual care. Trial participation data, self-reported falls and other fall-related outcomes were recorded. Aspects of program acceptability were recorded in fieldnotes and analyzed using content analysis. Due to the COVID-19 pandemic, recruitment was limited to 1 program only. Eighteen participants were screened, 11 were recruited and randomized (Stepping On n = 6, Usual Care n = 5), 8 returned falls calendars, while 7 provided other fall-related outcome data. Tailoring of the program was valued, however, exercise completion between program sessions was challenging. Evaluation of the adapted program for people living with mental illness using an RCT design demonstrated feasibility, and the program was acceptable to participants. A larger trial is needed to determine program effectiveness. Trial registration number: ACTRN12619001642178 (Australian New Zealand Clinical Trials Registry).

The association between device-based (activPAL) and self-reported [Incidental Exercise and Planned Exercise Questionnaire (IPEQ)] measures of physical activity has not been investigated. This study aimed to determine the association between activPAL and IPEQ measures of physical activity in a sample of community-dwelling older people after stroke. Data from an exploratory analysis embedded within a randomized trial was used. Spearman correlation was used to assess the relationship between activPAL (upright time and step count) and IPEQ (self-reported total exercise time) measures at three timepoints [months 0 (n = 46), 6 (n = 39) and 12 (n = 36)] Strong Spearman correlation between upright time and self-reported total exercise time (r = 0.51-0.72) and step count and self-reported total exercise time was found at all timepoints (r = 0.54-0.62). Though further research could confirm these results in a larger sample, there is potential for the IPEQ to be used as a simple estimate of physical activity in a clinical setting.

Background StandingTall uses eHealth to deliver evidence-based balance and functional strength exercises. Clinical trials have demonstrated improved balance, reduced falls and fall-related injuries and high adherence. This study aimed to evaluate the implementation of StandingTall into health services in Australia and the UK.Methods Two hundred and forty-six participants (Australia, n = 184; UK, n = 62) were recruited and encouraged to use StandingTall for 2 h/week for 6-months. A mixed-methods process evaluation assessed uptake and acceptability of StandingTall. Adherence, measured as % of prescribed dose completed, was the primary outcome.Results The study, conducted October 2019 to September 2021 in Australia and November 2020 to April 2022 in the UK, was affected by COVID-19. Participants' mean age was 73 +/- 7 years, and 196 (81%) were female. Of 129 implementation partners (e.g. private practice clinicians, community exercise providers, community service agencies) approached, 34% (n = 44) agreed to be implementation partners. Of 41 implementation partners who referred participants, 15 (37%) referred >= 5. Participant uptake was 42% (198/469) with mean adherence over 6 months being 41 +/- 39% of the prescribed dose (i.e. 39 +/- 41 min/week) of exercise. At 6 months, 120 (76%) participants indicated they liked using StandingTall, 89 (56%) reported their balance improved (moderately to a great deal better) and 125 (80%) rated StandingTall as good to excellent. For ongoing sustainability, health service managers highlighted the need for additional resources.Conclusions StandingTall faced challenges in uptake, adoption and sustainability due to COVID-19 and a lack of ongoing funding. Adherence levels were lower than the effectiveness trial, but were higher than other exercise studies. Acceptance was high, indicating promise for future implementation, provided sufficient resources and support are made available.Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12619001329156.

The iSOLVE implementation project established and evaluated integrated processes and pathways, including a decision-making tool and educational interventions for general medical practitioners (GPs) and the upskilling of allied health professionals (AHPs). The study used a mixed-methods (parallel) design comprising surveys, qualitative methodologies, and an embedded cluster randomized controlled trial (RCT). Sampling was conducted within a Primary Health Network (PHN) geographic area in Sydney, Australia. AHP workshops (n = 367 attendees) covered six evidence-based interventions, resulting in increased confidence (p < 0.001) and numerous enhancements in fall prevention delivery. Among GPs, 75 were recruited from 27 practices. GPs in the experimental group were more likely to engage in fall prevention activities, including risk assessments, medication reviews, and providing advice, compared to the control group (p = 0.002). They were also more likely to refer patients to AHPs at 3 months (p = 0.002); however, this effect was not significant at 12 months (p = 0.13), as referral behaviors increased in the control group over time. Responses to free-text questions of practice change highlighted differences, with the experimental group reporting a more proactive and comprehensive approach to fall prevention. In a subset of GP patients (n = 560), no significant effect was observed in reducing the rate of falls (IRR = 0.96). The pragmatic nature of the project and potential contamination across multiple elements likely influenced this outcome. However, an area-wide survey of GPs (n = 562) revealed an increase in fall prevention referrals to AHPs over 5 years, from 70 to 82% (p = 0.028). Our findings highlight the importance of equipping GPs with tools and strategies to adopt a proactive approach to fall prevention among older patients. AHPs play a crucial role in this effort, and fostering relationships and connectivity across primary care networks is essential to maximizing the impact of fall prevention initiatives.Clinical trial registrationAustralian New Zealand Clinial Trials Registry, ACTRN12615000401550, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368286.

We study the monetary value and the relative importance of several program characteristics for an evidence-based intervention provided at home for people living with dementia and their carers in Australia. Using a discrete choice experiment, advised through an expert and consumer co-design approach, we consider the total number of sessions, the delivery mode, the primary outcome and focus of the program as well as its costs as attributes. Results from a representative sample of the Australian adult population show a high willingness to pay for the program overall, even greater than the actual costs. Choice data from 940 respondents show preferences for in-person sessions over telehealth options and respondents place a high value on improving mood and dementia-related behaviour as well as independence in daily activities. Preference heterogeneity shows that people who have experience with home care services place an even higher monetary value on the program, compared to the rest of the sample. In light of the increased emphasis of governments on expanding home care options over residential care, these results contribute towards the design and implementation of a home-based program for people with dementia and their carers and highlight its social value.

Background Poor vision has been associated with an increased risk of falls. However, longitudinal data are lacking, which could inform programs to enable safe mobility in older people with low vision and blindness. Objective To describe the incidence of falls, physical function and level of physical activity in older people with low vision and blindness living in the community. Methods Falls were reported prospectively using monthly falls calendars with active follow-up in people aged 50 years and older who were accessing orientation and mobility services from a community organisation for people with low vision and blindness. Physical performance was assessed using the short physical performance battery (SPPB). Activity was self-reported using the Incidental and Planned Exercise Questionnaire (IPEQ) at baseline and 12 months. Results Average age was 73±11 years (range 50–99), 171/294 (58%) were female, visual acuity was a median of 1.0 logMAR (inter-quartile range [IQR] 0.4–1.9), 225/294 (76.5%) had peripheral visual field loss and 242/294 (82.3%) used a mobility aid. There was an average of 2.1±3.8 falls per year and 1.2±1.8 falls per year requiring medical care. The SPPB score was 7.90±2.9, which is lower than age-matched population norms. Total incidental and planned physical activity was an average of 23.9±15.8 hours per week at baseline and 25.6±17.1 hours per week at 12 months. Conclusions This study found a high rate of falls, with on average at least one fall per year requiring medical care. Orientation and mobility programs can support safe and independent travel, but additional programs are required to prevent fall related injuries in older people with low vision and blindness.

PURPOSE:The Falls After Stroke Trial (FAST) intervention involves habit-forming functional exercise and mobility practice which may increase physical activity. This substudy of FAST explores physical activity in community-dwelling people after stroke comparing the FAST intervention to usual care. METHODS:This study used a subset of 49 participants from a randomised trial. Outcome measures were taken at baseline, 6- and 12-months. The primary outcome was physical activity (step count, upright time and sedentary time, activPAL4™ micro). RESULTS:Thirty-nine participants (80%) had valid primary outcome data at 6 months and 36 participants (73%) at 12 months. Compared to baseline, the experimental group completed 485 (95% CI -434 to 1405) more steps/day than the control group at 6 months and 724 (95% CI -239 to 1667) more steps/day at 12 months; and spent 36 (95% CI -46 to 118) fewer min/day in sedentary behaviour than the control group at 6 months and 34 (95% CI -51 to 119) fewer min/day at 12 months, although the differences were not significant. CONCLUSIONS:FAST may improve physical activity more than usual care at 6- and 12-months but results are inconclusive. Further research could be conducted to confirm any benefit in a larger sample.

Background and Purpose:With an aging population, falls have become an increasing public health concern. While face-to-face exercise programs have demonstrated efficacy in reducing falls, their effectiveness is hampered by low participation and adherence. Digital technologies are a novel and potentially effective method for delivering tailored fall prevention exercise programs to older adults. In addition, they may increase the reach, uptake, and sustainability of fall prevention programs. Therefore, understanding older adults' experiences of using technology-driven methods is essential. This study explored the user experience of StandingTall, a home-based fall prevention program delivered through a tablet computer. Methods:Fifty participants were recruited using purposive sampling, from a larger randomized controlled trial. Participants were selected to ensure maximum variability with respect to age, gender, experience with technology, and adherence to the program. Participants undertook a one-on-one structured interview. We followed an iterative approach to develop themes. Results and Discussion:Eight themes were identified. These fall under 2 categories: user experience and program design. Participants found StandingTall enjoyable, and while its flexible delivery facilitated exercise, some participants found the technology challenging. Some participants expressed frustration with technological literacy, but most demonstrated an ability to overcome these challenges, and learn a new skill. Older adults who engaged in a technology-driven fall prevention program found it enjoyable, with the flexibility provided by the online delivery central to this experience. While the overall experience was positive, participants expressed mixed feelings about key design features. The embedded behavior change strategies were not considered motivating by most participants. Furthermore, some older adults associated the illustrated characters with gender-based stereotypes and negative views of aging, which can impact on motivation and preventive behavior. Conclusion:This study found digital technologies are an effective and enjoyable method for delivering a fall prevention program. This study highlights that older adults are interested in learning how to engage successfully with novel technologies.