Development of Stepping On After Stroke fall prevention program in Singapore

The aim of the work was to develop a group-based fall prevention program for community-living stroke survivors by adapting an evidence-based fall prevention program, Stepping On. This thesis comprises of five studies using mixed methodologies. The first study, a systematic review and meta-analysis confirmed that fall risk factors in this studied group are multifactorial and suggested that interventions should be multi-dimensional. In the second study, semi-structured interviews with community-living stroke survivors and caregivers conducted in Singapore identified the common self-perceived fall risk factors post-stroke, main challenges and common safety and coping strategies after a fall post-stroke. The third study, focus groups with therapists trained in Stepping On reported a lack of structured fall prevention programs and suggested adapting the Stepping On with some changes and additional key elements to suit the target population. In the fourth study, building on the earlier work, the key elements of Stepping On After Stroke (SOAS) program were reviewed by international and Singapore experts using a modified Delphi method. The program was further refined based on the review findings. In the final study, the adapted SOAS program was piloted with two groups of stroke survivors and their caregivers in two community centres. The results suggest that it is acceptable and feasible to implement this group-based SOAS program with the target population in Singapore. In summary, the findings from this research have made novel contributions to fall prevention in community-living stroke survivors in Singapore and other countries. The research suggests the need for a structured fall prevention program targeting both stroke survivors and caregivers and focusing on the modifiable fall risk factors with its aim to reduce fall risk and increase community participation. However, further fine-tuning of the program is needed before moving to a larger scale study