Risk Factors for Falls in Community Stroke Survivors: A Systematic Review and Meta-Analysis

Tianma Xu, Lindy Clemson, Kate O'Loughlin, Natasha A. Lannin, Catherine Dean, Gerald Koh

Research output: Contribution to journalReview ArticleResearchpeer-review

116 Citations (Scopus)


Objective: To identify the risk factors for falls in community stroke survivors. Data Sources: A comprehensive search for articles indexed in MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, and Web of Science databases was conducted. Study Selection: Prospective studies investigating fall risk factors in community stroke survivors were included. Reviewers in pair independently screened the articles and determined inclusion through consensus. Studies meeting acceptable quality rating using the Q-Coh tool were included in the meta-analysis. Data Extraction: Data extraction was done in duplicate by 4 reviewers using a standardized data extraction sheet and confirmed by another independent reviewer for completeness and accuracy. Data Synthesis: Twenty-one articles met the minimum criteria for inclusion; risk factors investigated by ≥3 studies (n=16) were included in the meta-analysis. The following risk factors had a strong association with all fallers: impaired mobility (odds ratio [OR], 4.36; 95% confidence interval [CI], 2.68–7.10); reduced balance (OR, 3.87; 95% CI, 2.39–6.26); use of sedative or psychotropic medications (OR, 3.19; 95% CI, 1.36–7.48); disability in self-care (OR, 2.30; 95% CI, 1.51–3.49); depression (OR, 2.11; 95% CI, 1.18–3.75); cognitive impairment (OR, 1.75; 95% CI, 1.02–2.99); and history of fall (OR, 1.67; 95% CI, 1.03–2.72). A history of fall (OR, 4.19; 95% CI, 2.05–7.01) had a stronger association with recurrent fallers. Conclusions: This study confirms that balance and mobility problems, assisted self-care, taking sedative or psychotropic medications, cognitive impairment, depression, and history of falling are associated with falls in community stroke survivors. We recommend that any future research into fall prevention programs should consider addressing these modifiable risk factors. Because the risk factors for falls in community stroke survivors are multifactorial, interventions should be multidimensional.

Original languageEnglish
Pages (from-to)563-573.e5
Number of pages16
JournalArchives of Physical Medicine and Rehabilitation
Issue number3
Publication statusPublished - 1 Mar 2018
Externally publishedYes


  • Accidental falls
  • Rehabilitation
  • Risk factors
  • Stroke

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