The FISS-Australia trial: The clinical and cost effectiveness of the Action Falls rehabilitation programme compared to usual care alone to reduce falls in stroke survivors

The Australian Falls In Stroke Study (FISS-Australia) is a national, multi-centre, randomised controlled trial that will determine the effectiveness and cost-effectiveness of the Action Falls intervention in stroke survivors who are discharged from hospital to home.

Background

In Australia, approximately 28,000 people experience stroke each year, with 820,000 stroke survivors expected to be living in the community by 2050. Up to 75% of stroke survivors fall, with most falls occurring at home in the first year after stroke. Falls requiring hospitalisation mostly occur at home, and 42% of injury-related hospitalisations and 40% of injury-related deaths in Australia are due to falls, equating to $3.7 billion in annual health spending. Despite these statistics, there is surprisingly little evidence about how to reduce falls after stroke and high quality RCTs are needed.

Action Falls is a systematic falls prevention intervention involving clinician-led assessment of falls risks, followed by personalised action planning.The Action Falls intervention has been shown to reduce falls by 43% in older people living in nursing home settings in the UK and is cost effective compared to other falls interventions. The Australian Falls In Stroke Study (FISS-Australia) is a national, multi-centre, randomised controlled trial that will determine the effectiveness and cost-effectiveness of the Action Falls intervention in stroke survivors who are discharged from hospital to home.

Project aim

The aim of this research is to determine if following the Action Falls intervention reduces the rate of falls in stroke survivors and is more cost effective than the usual care.

Methodology

In this research, people who have been hospitalised due to stroke and are discharged home will be invited to participate and will be randomised to either receive their usual care, or usual care plus Action Falls. Those randomised to Action Falls will receive an intervention session soon after discharge home and a second intervention session 6 months later delivered by trained allied health professionals, with a third session offered to those who report a fall or change of address. The Action Falls intervention will be delivered in-person and via telehealth. The primary outcome is falls incidence over 12 months. Secondary outcomes include fear of falling, activities of daily living, psychological well-being and work status over 12 months follow-up. Quality of life and healthcare resource use data will be used in our health economic analysis. Qualitative interviews with a purposive sample of participants, family members and clinicians providing Action Falls will explore intervention acceptability and delivery.

The FISS-Australia trial will directly benefit Australia by providing best evidence to inform falls prevention in people with stroke. The delivery of Action Falls via telehealth will enable recruitment of people living in non-metropolitan areas of Australia. People living in regional and rural areas of Australia are 17% more likely to experience stroke compared to those in metropolitan areas. 43% of Australians with stroke live in regional areas, often geographically remote from rehabilitation centres, meaning that offering Action Falls in-person and via telehealth is key to ensure equitable access. FISS-Australia will determine if the Action Falls intervention is an effective and affordable way to reduce falls over 12 months in this high-risk group. Together, FISS-Australia and FISS-UK will provide world-leading evidence to inform policy and practice internationally.