Home based, tailored intervention to reduce rate of falls after stroke (FAST): randomised trial

Lindy Clemson; Katharine Scrivener; Natasha Lannin; Louise Ada; Sally Day; Ingrid Lin; Stephen Isbel; Anne Cusick; Benjamin Gardner; Elisabeth Preston; Gillian Heller; Catherine M. Dean; FAST Study Group

doi:10.1136/bmj-2025-085519

Home based, tailored intervention to reduce rate of falls after stroke (FAST): randomised trial

Lindy Clemson^*, Katharine Scrivener, Natasha Lannin, Louise Ada, Sally Day, Ingrid Lin, Stephen Isbel, Anne Cusick, Benjamin Gardner, Elisabeth Preston, Gillian Heller, Catherine M. Dean, FAST Study Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

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.

Original language	English
Article number	e085519
Pages (from-to)	1-8
Number of pages	8
Journal	BMJ
Volume	392
DOIs	https://doi.org/10.1136/bmj-2025-085519
Publication status	Published - 24 Mar 2026

Bibliographical note

Copyright the Author(s). Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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Cite this

@article{90fd6235b286409b8701f616cad8c024,

title = "Home based, tailored intervention to reduce rate of falls after stroke (FAST): randomised trial",

abstract = "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.",

author = "Lindy Clemson and Katharine Scrivener and Natasha Lannin and Louise Ada and Sally Day and Ingrid Lin and Stephen Isbel and Anne Cusick and Benjamin Gardner and Elisabeth Preston and Gillian Heller and Dean, \{Catherine M.\} and \{FAST Study Group\} and Karla Armson and Gregory Bowring and Kelly Baker and Lucy Barton and Ella Borgeaud and Johannah Campbell and Marian Cappellari and Suzanne Currie and Laura Davidson and Emma Dorward and Nadia Downey and Steven Faux and Clare Griffin and Alena Haines and Nikki Hokin and Will Hunt and Sharon Kramer and Richard Lindley and Joanne Lo and Laura McCredie and Alicia McCulloch and Katelyn Moloney and Madeline Morton and Virginia Mumford and Rebecca Nicks and Stefanie Pearce and Michael Pellegrini and Fiona Penrose and Tamsin Philipps and Kyrene Ramos and Tayne Ryall and Roslyn Savage and Katherine Sewell and Michelle Shannon and Christine Shiner and Jenny Spiers and Laura Wales and Gemma Wall and Lyndell Webster and Kevin Weeks and Ann Winkler and Genevieve Zelma",

note = "Copyright the Author(s). Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2026",

month = mar,

day = "24",

doi = "10.1136/bmj-2025-085519",

language = "English",

volume = "392",

pages = "1--8",

journal = "BMJ",

issn = "0959-535X",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Home based, tailored intervention to reduce rate of falls after stroke (FAST)

T2 - randomised trial

AU - Clemson, Lindy

AU - Scrivener, Katharine

AU - Lannin, Natasha

AU - Ada, Louise

AU - Day, Sally

AU - Lin, Ingrid

AU - Isbel, Stephen

AU - Cusick, Anne

AU - Gardner, Benjamin

AU - Preston, Elisabeth

AU - Heller, Gillian

AU - Dean, Catherine M.

AU - FAST Study Group

AU - Armson, Karla

AU - Bowring, Gregory

AU - Baker, Kelly

AU - Barton, Lucy

AU - Borgeaud, Ella

AU - Campbell, Johannah

AU - Cappellari, Marian

AU - Currie, Suzanne

AU - Davidson, Laura

AU - Dorward, Emma

AU - Downey, Nadia

AU - Faux, Steven

AU - Griffin, Clare

AU - Haines, Alena

AU - Hokin, Nikki

AU - Hunt, Will

AU - Kramer, Sharon

AU - Lindley, Richard

AU - Lo, Joanne

AU - McCredie, Laura

AU - McCulloch, Alicia

AU - Moloney, Katelyn

AU - Morton, Madeline

AU - Mumford, Virginia

AU - Nicks, Rebecca

AU - Pearce, Stefanie

AU - Pellegrini, Michael

AU - Penrose, Fiona

AU - Philipps, Tamsin

AU - Ramos, Kyrene

AU - Ryall, Tayne

AU - Savage, Roslyn

AU - Sewell, Katherine

AU - Shannon, Michelle

AU - Shiner, Christine

AU - Spiers, Jenny

AU - Wales, Laura

AU - Wall, Gemma

AU - Webster, Lyndell

AU - Weeks, Kevin

AU - Winkler, Ann

AU - Zelma, Genevieve

N1 - Copyright the Author(s). Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2026/3/24

Y1 - 2026/3/24

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/105034386400

UR - https://purl.org/au-research/grants/nhmrc/GNT1157739

U2 - 10.1136/bmj-2025-085519

DO - 10.1136/bmj-2025-085519

M3 - Article

C2 - 41876122

AN - SCOPUS:105034386400

SN - 0959-535X

VL - 392

SP - 1

EP - 8

JO - BMJ

JF - BMJ

M1 - e085519

ER -

Home based, tailored intervention to reduce rate of falls after stroke (FAST): randomised trial

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