近日，澳大利亚悉尼大学Lindy Clemson团队报道了降低卒中后跌倒率的家庭定制干预（FAST）的效果。这一研究成果发表在2026年3月24日出版的《英国医学杂志》杂志上。

为了探讨一项多学科、以家庭为基础的个体化干预措施在减少脑卒中后跌倒方面的有效性，研究组在澳大利亚三个州进行了一项双组随机试验。招募脑卒中后5年内、年龄>50岁、已完成正规康复并回归社区、能在平地上借助或不借助辅助工具行走10米的人群。排除标准为：存在中重度感受性失语症，或既往一年内无跌倒史且步行速度>1.4米/秒者。

在6个月的干预期内，试验组接受习惯形成的功能性锻炼、家庭跌倒隐患消除以及目标导向的社区行动能力指导；对照组接受常规照护。由物理治疗师和作业治疗师组成两人团队，协作实施干预。主要结局指标为12个月内的跌倒发生率。次要结局指标包括发生跌倒的参与者比例、社区参与度、自我效能感、平衡能力、行动能力、体力活动、日常生活活动能力、抑郁状况以及健康相关生活质量。

2019年8月至2023年12月，共纳入370名脑卒中患者。在12个月时，试验组的跌倒发生率显著低于对照组，即跌倒减少了33%（发生率比值为0.67，95%置信区间为0.48至0.94；P=0.02）。两组在发生跌倒的参与者比例方面无显著差异（绝对风险降低0.03，95%置信区间−0.07至0.13；P=0.52）。试验组优于对照组的主要差异体现在：社区参与度（《晚年生活功能与残疾指数》残疾限制评分：平均差异3%，95%置信区间1%至6%；P=0.02）、自我效能感（平均差异0.6，95%置信区间0.2至1.0；P=0.004）、行动能力（快速步行速度：平均差异0.13米/秒，95%置信区间0.06至0.19米/秒，P<0.001；偏好步行速度：平均差异0.06米/秒，95%置信区间0.02至0.10米/秒，P=0.02）以及平衡能力（步进测试：平均差异0.06步/秒，95%置信区间0.01至0.12步/秒；P=0.03）。

研究结果表明，个体化干预措施能够预防社区居住的可行走脑卒中患者发生跌倒。跌倒发生率的降低得益于自我效能感、行动能力、社区参与度及平衡能力方面具有临床意义的改善。

附：英文原文

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

Author: 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

Issue&Volume: 2026/03/24

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.

DOI: 10.1136/bmj-2025-085519

Source: https://www.bmj.com/content/392/bmj-2025-085519