BACKGROUND: Falls are one of the most common medical complications after stroke 
with a reported incidence of 7% in the first week after stroke onset. Studies 
investigating falls in the later phase after stroke report an incidence of up to 
73% in the first year post-stroke.
OBJECTIVES: To evaluate the effectiveness of interventions aimed at preventing 
falls in people after stroke.
SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group 
(November 2012) and the Cochrane Bone, Joint and Muscle Trauma Group (May 2012), 
the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane 
Library 2012, Issue 5, MEDLINE (1950 to May 2012), EMBASE (1980 to May 2012), 
CINAHL (1982 to May 2012), PsycINFO (1806 to May 2012), AMED (1985 to May 2012) 
and PEDro (May 2012). We also searched trials registers, checked reference lists 
and contacted authors.
SELECTION CRITERIA: Randomised controlled trials of interventions where the 
primary or secondary aim was to prevent falls in people after stroke.
DATA COLLECTION AND ANALYSIS: Review authors independently selected studies for 
inclusion, assessed trial quality, and extracted data. We used a rate ratio and 
95% confidence interval (CI) to compare the rate of falls (e.g. falls per person 
year) between intervention and control groups. For risk of falling we used a 
risk ratio and 95% CI based on the number of people falling (fallers) in each 
group. We pooled results where appropriate.
MAIN RESULTS: We included 10 studies with a total of 1004 participants. One 
study evaluated the effect of exercises in the acute and subacute phase after 
stroke but found no significant difference in rate of falls (rate ratio 0.92, 
95% CI 0.45 to 1.90, 95 participants). The pooled result of four studies 
investigating the effect of exercises on preventing falls in the chronic phase 
also found no significant difference for rate of falls (rate ratio 0.75, 95% CI 
0.41 to 1.38, 412 participants).For number of fallers, one study examined the 
effect of exercises in the acute and subacute phase after stroke but found no 
significant difference between the intervention and control group (risk ratio 
1.19, 95% CI 0.83 to 1.71, 95 participants). The pooled result of six studies 
examining the effect of exercises in the chronic phase also found no significant 
difference in number of fallers between the intervention and control groups 
(risk ratio 1.02, 95% CI 0.83 to 1.24, 616 participants).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 (85 participants) compared 
vitamin D versus placebo in institutionalised women after stroke with low 
vitamin D levels, and the other study (79 participants) 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 of 46 participants post-stroke there was no significant difference in 
the rate of falls (rate ratio 1.08, 95% CI 0.52 to 2.25) or the number of 
fallers between both groups (risk ratio 0.74, 95% CI 0.47 to 1.18).
AUTHORS' CONCLUSIONS: There is currently insufficient evidence that exercises or 
prescription of single lens glasses to multifocal users prevent falls or 
decrease the number of people falling after being discharged from rehabilitation 
following their stroke. Two studies testing vitamin D versus placebo and 
alendronate versus alphacalcidol found a significant reduction in falls and the 
number of people falling. However, these findings should be replicated before 
the results are implemented in clinical practice.