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Published on: March 19, 2020
Perturbation-Based Balance Training Reduces Falls and Fall Injuries in Older People: Insights on Mechanisms and
Shivam Sharma1, Ildiko-Zsuzsa Szabo2, Mathias Brix Danielsen3
1School of Population Health, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Movement Care Lab (MCL), Chandigarh, Punjab and Haryana, India.
Objectives:
To evaluate the efficacy of perturbation-based balance training (PBT) in reducing falls, injurious falls, and fall risk factors in older adults.
Design:
Systematic review and meta-analysis.
Setting And Participants:
Community-dwelling older adults (aged 65 years and older).
Methods:
PubMed, CINAHL, EMBASE, and Cochrane databases were searched from inception to June 2024. Randomized controlled trials assessing the effects of PBT on falls or fall risk factors, including reactive balance via laboratory-induced perturbations, were included. Two reviewers independently screened studies and extracted data. Meta-analyses were conducted using a random-effects model, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Results:
PBT significantly reduced fall rates by 23% (rate ratio, 0.77; 95% CI, 0.60-0.99; I2 = 57%, low certainty) and injurious falls by 24% (rate ratio, 0.76; 95% CI, 0.58-0.98; I2 = 0%) compared with controls. PBT improved reactive balance (eg, lab-induced falls) but had limited effects on other fall risk factors (eg, gait). In the dosage subgroup analysis, only PBT programs for at least 6 hours reduced falls by 33%.
Conclusions And Implications:
PBT reduces falls and related injuries, likely through enhanced reactive balance rather than physical improvements. While most PBT programs are low doses (∼2 hours), higher doses (6+ hours) likely offer greater fall protection. Further high-quality trials using accessible PBT methods are required to inform policy and guideline development and support scalable implementation of PBT in fall-prevention strategies.