Critically appraised paper: A home-based, tailored program of habit-forming exercise, home safety and mobility coaching reduces the rate of falls in community-dwelling stroke survivors [commentary]

Critically appraised paper: A home-based, tailored program of habit-forming exercise, home safety and mobility coaching reduces the rate of falls in community-dwelling stroke survivors [commentary] Commentary This is the first effectiveness trial to demonstrate the prevention of falls among stroke survivors.Whether the findings translate to low-income and middle-income countries (LMICs), where the burden of stroke is high, warrants consideration.In most LMICs, falls after stroke remain under-recognised and are rarely addressed through structured fall prevention programs.1 The level of disability after stroke is high in LMICs, and the proportion of stroke survivors achieving community ambulation is low.The FAST trial predominantly included high-functioning participants, and the number of participants with very slow walking speeds was small.Hence, the generalisability of this program across higher levels of disability remains uncertain.The built environment presents another major challenge in LMICs.Modifying the home and the surroundings may be considerably more difficult than in the setting where the trial was conducted.Future efforts should focus on contextualised solutions using locally manufactured items, along with policy advocacy for accessible public spaces.Another challenge is the availability of trained professionals.Although there are relatively high numbers of physiotherapists in LMICs, especially in countries such as India, the availability of occupational therapists makes it difficult to deliver a dual support program.Because most stroke survivors live in remote areas, it is difficult for professionals to reach them and deliver such a program.