Fall-prevention education after achieving independent walking is associated with reduced subsequent fall risk in patients with stroke: a retrospective pre-post intervention study

OBJECTIVE: To evaluate the association between standardized fall-prevention education delivered immediately after achieving independent walking and subsequent fall risk in patients with stroke. DESIGN: Retrospective pre-post intervention study. SETTING: Post-acute inpatient rehabilitation hospital. PARTICIPANTS: 1,437 hospitalized patients with stroke INTERVENTIONS: Standardized fall-prevention education delivered immediately after achieving independent walking versus usual care without a standardized education program. The education emphasized that walking independence did not ensure absolute safety, clarified safe activity boundaries, and encouraged patients to seek assistance when performing hazardous activities. MAIN OUTCOME MEASURES: The time to first fall after achieving independent walking was analyzed using the Kaplan-Meier method and compared between groups with the log-rank test, followed by multivariable Cox proportional hazards regression. The total number of falls was analyzed using negative binomial regression. RESULTS: A total of 816 patients received usual care and 621 received standardized fall-prevention education. Among 1,437 patients, 217 experienced at least one fall after achieving independent walking. The standardized education group had a significantly longer time to the first fall (log-rank P=.005), a lower adjusted hazard of the first fall (adjusted hazard ratio: 0.58, 95% confidence interval [CI]: 0.43-0.76, P<.001), and a lower fall incidence rate (incidence rate ratio: 0.68, 95% CI: 0.51-0.90, P=.006). CONCLUSIONS: Standardized fall-prevention education delivered upon achieving independent walking was associated with a lower subsequent fall risk among patients with subacute stroke.