A Cochrane review included 10 studies with a total of 1004 subjects. One study (n=95) evaluated the effect of exercises in the acute and subacute phase after stroke, founding no significant difference in rate of falls (RR 0.92, 95% CI 0.45 to 1.90). The pooled result of 4 studies (n=412) investigating the effect of exercises on preventing falls in the chronic phase also found no significant difference for rate of falls (RR 0.75, 95% CI 0.41 to 1.38). For number of fallers, one study (n=95) examined the effect of exercises in the acute and subacute phase after stroke but found no significant difference between the intervention and control group (RR 1.19, 95% CI 0.83 to 1.71). The pooled result of 6 studies (n=616) examining the effect of exercises in the chronic phase also found no significant difference in number of fallers between the intervention and control groups (RR 1.02, 95% CI 0.83 to 1.24). 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 (n=85) compared vitamin D vs. placebo in institutionalised women after stroke with low vitamin D levels, and the other study (n=79) 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 (n=46) there was no significant difference in the rate of falls (RR 1.08, 95% CI 0.52 to 2.25) or the number of fallers between both groups (RR 0.74, 95% CI 0.47 to 1.18).
Comment: The quality of evidence is downgraded by study quality (reporting bias: the data on falls were self-reported, possibly leading to over- or under-reporting of falls, use of unvalidated outcome measures) and inconsistency (heterogeneity in patients and interventions).
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