Effectiveness of interventions to prevent falls for people with multiple sclerosis, Parkinson’s disease and stroke: an umbrella review

Abstract

Background The implementation of condition-specific falls prevention interventions is proving challenging due to lack of critical mass and resources. Given the similarities in falls risk factors across stroke, Parkinson’s Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for groups comprising of people with these three neurological conditions may provide a pragmatic solution to these challenges. The aims of this umbrella review were to investigate the effectiveness of falls prevention interventions in MS, PD and stroke, and to identify the commonalities and differences between effective interventions for each condition to inform the development of an intervention for mixed neurological groups. Methods A systematic literature search was conducted using 15 electronic databases, grey literature searches and hand-screening of reference lists. Systematic reviews of studies investigating the effects of falls prevention interventions in MS, PD and stroke were included. Methodological quality of reviews was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2. A matrix of evidence table was used to assess the degree of overlap. The Grading of Recommendations Assessments, Development and Evaluation framework was used to rate the quality of evidence. Findings were presented through narrative synthesis and a summary of evidence table. Results Eighteen reviews were included; three investigating effectiveness of falls prevention interventions in MS, 11 in PD, three in stroke, and one in both PD and stroke. Exercise-based interventions were the most commonly investigated for all three conditions, but differences were identified in the content and delivery of these interventions. Low to moderate quality evidence was found for the effectiveness of exercise-based interventions at reducing falls in PD. Best available evidence suggests that exercise is effective at reducing falls in stroke but no evidence of effect was identified in MS. Conclusions The findings suggest that exercise-based interventions are effective at reducing falls in PD, however, the evidence for MS and stroke is less conclusive. A strong theoretical rationale remains for the use of exercise-based interventions to address modifiable physiological falls risk factors for people with MS, PD and stroke, supporting the feasibility of a mixed-diagnosis intervention. Given the high overlap and low methodological quality of primary studies, the focus should be on the development of high-quality trials investigating the effectiveness of falls prevention interventions, rather than the publication of further systematic reviews.

Is telehealth an effective and feasible option for improving falls-related outcomes in community-dwelling adults with neurological conditions? A systematic review and meta-analysis

“…It is promising that several of the studies included interventions based on contemporary evidence. Multidisciplinary interventions align with emerging falls prevention evidence in neurological populations, 9 and with the strong evidence from systematic reviews in older adults. 72 A recent systematic review on telehealth delivered falls prevention exercise for older adults found reduced falls rates, where the largest effect was found for a multidisciplinary intervention.…”

“…[5][6][7] Fear of falling is common in neurological conditions and can lead to activity avoidance and participation restrictions. 8 Among neurological populations, low-to-moderate certainty evidence indicates exercise programs targeting strength, balance or mobility reduce falls rates for people with Parkinson's disease and stroke, [9][10][11] and improves physical outcomes in multiple sclerosis. 12 Other effective interventions for reducing falls include falls risk assessments, education and environmental modifications.…”

Accidental Falls in Patients with Hyperkinetic Movement Disorders: A Systematic Review

“…O’Malley et al, for example, in a recent compilation of systematic reviews on the effectiveness of exercise-based interventions at reducing falls, identified 11 PD studies of poor to intermediate quality of evidence. The majority of evaluations found the intervention to have a significant effect on documented fall outcomes, but three found inconsistent results on both efficacy and outcomes [ 86 ]. We conclude that even though neurorehabilitation in movement disorders has made progress due to better understanding of pathophysiology and compensatory mechanisms, the rise of promising approaches, such as increased practice intensity, and the use of new technology, high quality research continues to be needed both in areas where data are abundant and in areas where they are scarce.…”

Protocol for the development of a core outcome set for evaluating mixed-diagnosis falls prevention interventions for people with Multiple Sclerosis, Parkinson’s Disease and stroke

“…This will be an international, multi-perspective consensus study, which will involve five stages as demonstrated in Figure 1: 42 . This umbrella review was registered with PROSPERO (CRD42020175409) and the protocol published in an open access repository 43 .…”