Influence of Reactive Balance Training Program Characteristics on Reactive Balance Control and Fall Risk: A...

Reactive balance training (RBT) programs have been developed to address age-related deterioration in reactive balance control and increased fall risk. Despite the demonstrated effectiveness of those programs, there is significant variability in intervention characteristics (e.g., perturbation type, total volume and intensity of training) and study findings. It is likely that intervention effectiveness depends on the intervention features; however, little is known about the optimal way to deliver RBT. The purpose of this systematic review and meta-regression was to determine the optimal intervention characteristics for RBT for improving reactive balance control and preventing falls in daily life.

We searched MEDLINE ALL (July 2023), Embase (July 2023), Physiotherapy Evidence Database (August 2023), and Cochrane (July 2023) for randomized controlled trials of RBT that reported measures of reactive balance control and/or falls in daily life. Results were screened by two reviewers independently to determine eligibility. The following details were extracted: study population; intervention characteristics (number, frequency and duration of sessions, type, intensity and number of perturbations; description of the control), number of participants in each group; reactive balance outcomes pre- and post-intervention, and number of falls post-intervention. Risk of bias (RoB) and certainty of evidence (GRADE) were assessed. Meta-regressions were performed to explore the influence of different study components on reactive balance control and falls.

After screening 7,677 records, 32 studies were included; 25 reported a reactive balance outcome, and 19 reported falls in daily life. RoB of reactive balance control revealed main concerns arising from selection of reported results. RoB of falls in daily life had high or some concerns in the measurements of the outcome and selection of reported results. RBT programs that included manual perturbations were associated with reduced fall rates compared to waist-pull perturbations (rate ratio: 0.45; 95% confidence interval: 0.22, 0.91, p = 0.042). There were no other significant relationships between any other training parameters and falls in daily life or reactive balance control. Quality of evidence (GRADE) was low for reactive balance control and very low for falls in daily life.

Optimal RBT training characteristics remain unclear due to substantial variability in training protocols and underreporting of key intervention details across studies, which limited meaningful synthesis and interpretation of findings. Although programs incorporating manual perturbations were associated with reduced fall rates, no other training parameters showed consistent relationships with reactive balance control or falls in daily life. Future RBT studies should provide more detailed and standardized descriptions of RBT protocols, include head-to-head comparisons of training parameters, and report outcomes for both reactive balance control and real-world falls to strengthen the evidence base.