Methodological characteristics of perturbation-based balance training in healthy older adults: A scoping review

Perturbation-based balance training (PBT) targets reactive balance control through exposure to unexpected mechanical disturbances. Although growing evidence supports its potential role in fall prevention, methodological variability across studies limits synthesis and clinical translation. This review aimed to systematically map and characterize the methodological features of mechanically induced PBT interventions in healthy older adults.

This scoping review followed the Arksey and O'Malley framework with refinements by Levac et al. and the Joanna Briggs Institute. Reporting adhered to PRISMA-ScR guidelines. PubMed, EMBASE, Scopus, and Web of Science were searched from inception through April 2025. Eligible studies included peer-reviewed empirical investigations of mechanically induced PBT in adults ≥ 65 years reporting balance, gait, or fall-related outcomes. Data were extracted on perturbation modality, task context, training dosage, outcome domains, and follow-up assessment.

Thirty-three studies met the inclusion criteria. Five primary perturbation categories were identified: treadmill-induced slips (n = 11), platform-based perturbations (n = 12), waist-pull systems (n = 4), overground trips (n = 4), and unspecified methods (n = 1). Single-session protocols were most common (n = 16), with fewer short-, moderate-, and long-duration programs. Balance outcomes were universally assessed, while gait and fall-related outcomes were reported in most studies. Follow-up beyond immediate post-testing was inconsistent, and alignment between training duration and retention assessment was limited.

Mechanically induced perturbation-based balance training research in healthy older adults has been conducted predominantly in controlled laboratory environments and is characterized by substantial heterogeneity in intervention design. While reactive balance improvements were consistently reported, variability in intervention design, reporting practices, and follow-up timing limits direct comparison across studies and highlights the need for greater methodological standardization.