Scalability evaluation of a complex community-based falls prevention intervention in Australian stroke rehabilitation

Ingrid Lin; Sally Day; Catherine M. Dean; Lindy Maxted Clemson; Joanne Valentina Glinsky; Anne Cusick; Natasha A. Lannin; Katharine Scrivener

doi:10.1136/bmjopen-2024-093487

Scalability evaluation of a complex community-based falls prevention intervention in Australian stroke rehabilitation

Ingrid Lin, Sally Day, Catherine M. Dean, Lindy Maxted Clemson, Joanne Valentina Glinsky, Anne Cusick, Natasha A. Lannin, Katharine Scrivener

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Abstract

Objectives: To investigate the scalability of the multi-component Falls After Stroke Trial (FAST) intervention tailored to community-dwelling adults with stroke to enable post-trial implementation. Design: A mixed-methods formative evaluation of FAST data guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Setting: Community settings across three states in Australia. Participants: Stroke participants were a subset of FAST trial participants (n=50) who were community-dwelling adults who had experienced a stroke up to 5 years prior and were at risk of falling. Therapists who delivered the intervention in the trial (interventionists) were physiotherapists and occupational therapists, trained in the FAST intervention. Interventions: The FAST intervention is an individually tailored home safety and functional exercise programme designed to reduce falls and improve community mobility. It is offered over a 6-month period using 10 home visits, two telephone calls and programme resources, for example, manual and worksheets. Primary and secondary outcome measures: Trial data, including interventionist training records and delivery data, resources and stroke participants' adherence data were used to assess the Adoption, Implementation and Maintenance dimensions of the RE-AIM framework. Results: The FAST intervention was delivered by 22 interventionists. High implementation fidelity was shown with 90% of the stroke participants receiving FAST dose and content. Effective strategies supporting implementation included standardised programme resources, comprehensive pre-programme training, regular interventionist feedback and interventionist mentoring from experts. Online training and peer support networks will be required for scale up. Conclusions: This study identifies how a complex intervention to prevent falls after stroke was successfully delivered. The AIM dimensions provided insights to FAST features essential for scale-up. Interventionist training, resources and mentoring/feedback were essential for adoption within the trial. Training and resources should be accessible in an online format for scale up (maintenance). Trial registration number: ACTRN12619001114134.

Original language	English
Article number	e093487
Pages (from-to)	1-13
Number of pages	13
Journal	BMJ Open
Volume	15
Issue number	9
DOIs	https://doi.org/10.1136/bmjopen-2024-093487
Publication status	Published - 25 Sept 2025

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Copyright the Author(s) 2025. 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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title = "Scalability evaluation of a complex community-based falls prevention intervention in Australian stroke rehabilitation",

abstract = "Objectives: To investigate the scalability of the multi-component Falls After Stroke Trial (FAST) intervention tailored to community-dwelling adults with stroke to enable post-trial implementation. Design: A mixed-methods formative evaluation of FAST data guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Setting: Community settings across three states in Australia. Participants: Stroke participants were a subset of FAST trial participants (n=50) who were community-dwelling adults who had experienced a stroke up to 5 years prior and were at risk of falling. Therapists who delivered the intervention in the trial (interventionists) were physiotherapists and occupational therapists, trained in the FAST intervention. Interventions: The FAST intervention is an individually tailored home safety and functional exercise programme designed to reduce falls and improve community mobility. It is offered over a 6-month period using 10 home visits, two telephone calls and programme resources, for example, manual and worksheets. Primary and secondary outcome measures: Trial data, including interventionist training records and delivery data, resources and stroke participants' adherence data were used to assess the Adoption, Implementation and Maintenance dimensions of the RE-AIM framework. Results: The FAST intervention was delivered by 22 interventionists. High implementation fidelity was shown with 90\% of the stroke participants receiving FAST dose and content. Effective strategies supporting implementation included standardised programme resources, comprehensive pre-programme training, regular interventionist feedback and interventionist mentoring from experts. Online training and peer support networks will be required for scale up. Conclusions: This study identifies how a complex intervention to prevent falls after stroke was successfully delivered. The AIM dimensions provided insights to FAST features essential for scale-up. Interventionist training, resources and mentoring/feedback were essential for adoption within the trial. Training and resources should be accessible in an online format for scale up (maintenance). Trial registration number: ACTRN12619001114134.",

author = "Ingrid Lin and Sally Day and Dean, \{Catherine M.\} and Clemson, \{Lindy Maxted\} and Glinsky, \{Joanne Valentina\} and Anne Cusick and Lannin, \{Natasha A.\} and Katharine Scrivener",

note = "Copyright the Author(s) 2025. 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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doi = "10.1136/bmjopen-2024-093487",

language = "English",

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T1 - Scalability evaluation of a complex community-based falls prevention intervention in Australian stroke rehabilitation

AU - Lin, Ingrid

AU - Day, Sally

AU - Dean, Catherine M.

AU - Clemson, Lindy Maxted

AU - Glinsky, Joanne Valentina

AU - Cusick, Anne

AU - Lannin, Natasha A.

AU - Scrivener, Katharine

N1 - Copyright the Author(s) 2025. 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 - 2025/9/25

Y1 - 2025/9/25

N2 - Objectives: To investigate the scalability of the multi-component Falls After Stroke Trial (FAST) intervention tailored to community-dwelling adults with stroke to enable post-trial implementation. Design: A mixed-methods formative evaluation of FAST data guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Setting: Community settings across three states in Australia. Participants: Stroke participants were a subset of FAST trial participants (n=50) who were community-dwelling adults who had experienced a stroke up to 5 years prior and were at risk of falling. Therapists who delivered the intervention in the trial (interventionists) were physiotherapists and occupational therapists, trained in the FAST intervention. Interventions: The FAST intervention is an individually tailored home safety and functional exercise programme designed to reduce falls and improve community mobility. It is offered over a 6-month period using 10 home visits, two telephone calls and programme resources, for example, manual and worksheets. Primary and secondary outcome measures: Trial data, including interventionist training records and delivery data, resources and stroke participants' adherence data were used to assess the Adoption, Implementation and Maintenance dimensions of the RE-AIM framework. Results: The FAST intervention was delivered by 22 interventionists. High implementation fidelity was shown with 90% of the stroke participants receiving FAST dose and content. Effective strategies supporting implementation included standardised programme resources, comprehensive pre-programme training, regular interventionist feedback and interventionist mentoring from experts. Online training and peer support networks will be required for scale up. Conclusions: This study identifies how a complex intervention to prevent falls after stroke was successfully delivered. The AIM dimensions provided insights to FAST features essential for scale-up. Interventionist training, resources and mentoring/feedback were essential for adoption within the trial. Training and resources should be accessible in an online format for scale up (maintenance). Trial registration number: ACTRN12619001114134.

AB - Objectives: To investigate the scalability of the multi-component Falls After Stroke Trial (FAST) intervention tailored to community-dwelling adults with stroke to enable post-trial implementation. Design: A mixed-methods formative evaluation of FAST data guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Setting: Community settings across three states in Australia. Participants: Stroke participants were a subset of FAST trial participants (n=50) who were community-dwelling adults who had experienced a stroke up to 5 years prior and were at risk of falling. Therapists who delivered the intervention in the trial (interventionists) were physiotherapists and occupational therapists, trained in the FAST intervention. Interventions: The FAST intervention is an individually tailored home safety and functional exercise programme designed to reduce falls and improve community mobility. It is offered over a 6-month period using 10 home visits, two telephone calls and programme resources, for example, manual and worksheets. Primary and secondary outcome measures: Trial data, including interventionist training records and delivery data, resources and stroke participants' adherence data were used to assess the Adoption, Implementation and Maintenance dimensions of the RE-AIM framework. Results: The FAST intervention was delivered by 22 interventionists. High implementation fidelity was shown with 90% of the stroke participants receiving FAST dose and content. Effective strategies supporting implementation included standardised programme resources, comprehensive pre-programme training, regular interventionist feedback and interventionist mentoring from experts. Online training and peer support networks will be required for scale up. Conclusions: This study identifies how a complex intervention to prevent falls after stroke was successfully delivered. The AIM dimensions provided insights to FAST features essential for scale-up. Interventionist training, resources and mentoring/feedback were essential for adoption within the trial. Training and resources should be accessible in an online format for scale up (maintenance). Trial registration number: ACTRN12619001114134.

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

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ER -

Scalability evaluation of a complex community-based falls prevention intervention in Australian stroke rehabilitation

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