Gerards M1,2, McCrum C2,3, Mansfield A4,5,6,7, Meijer K2
1Maastricht University Medical Center (MUMC+), Department of Physical Therapy, Maastricht, Netherlands, 2Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Human Movement Science, Maastricht, Netherlands, 3German Sport University Cologne, Institute of Movement and Sport Gerontology, Cologne, Germany, 4Toronto Rehabilitation Institute, University Health Network, Toronto, Canada, 5Rehabilitation Sciences Institute, Toronto, Canada, 6University of Toronto, Department of Physical Therapy, Toronto, Canada, 7Sunnybrook Research Institute, Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Toronto, Canada
Background: Falls are a leading cause of injury, hospitalization and even death among older adults. Although various strength and balance exercise interventions have shown moderate reductions in fall incidence among healthy older adults, no significant fall incidence improvements have been consistently seen in frail older adults or in patient groups with an increased fall risk (e.g. people with Parkinson's disease and stroke). This might be due to a lack of task specificity of previous exercise interventions to the recovery actions required to prevent a fall. Perturbation-based balance training (PBT) is an emerging task-specific intervention that aims to improve reactive balance control after destabilizing perturbations in a safe and controlled environment. This task-specific intervention has shown promising results in laboratory settings, but its effectiveness and feasibility in clinical practice has yet to be confirmed.
Purpose: To (i) examine the characteristics of PBT studies carried out to date with older adults that assessed prospective fall incidence; and (ii) using this evidence from the literature, present and discuss a number of considerations for applying PBT in clinical settings that could affect the feasibility and effectiveness of PBT for falls reduction among older adults in clinical settings.
Methods: A systematic literature search with search terms relating to perturbations, training, falls and age with date of publication set at 2002 or later was carried out in PubMed and Web of Science databases. Studies were selected for inclusion if they carried out PBT with older adults (mean age of ≥60 years), reported post-intervention falls data and if a control group was included. Studies that carried out PBT, but that did not provide specific details on the intervention, were excluded from the main synthesis.
Results: A total of eight studies met all inclusion criteria. Three of those studies have been carried out with healthy, community-dwelling older adults that prospectively monitored falls and included a control group. Two studies found significant reductions in fall incidence in the intervention group during follow-up. The third study was not powered for this outcome measure, and found a non-significant reduction.
Two studies have examined the effects of PBT on fall incidence among frail or high-risk older adults. Both studies showed clinically relevant decreases in fall incidence during follow-up, however these were not statistically significant.
Three studies have examined the effects of PBT on the incidence of falls in daily life among older adults with Parkinson's disease. One study showed significant reductions in fall incidence during training in comparison to before the training. The other two studies showed significant reductions in fall incidence during follow-up in the intervention group versus the control group.
Conclusion(s): PBT appears to be a feasible approach to reducing falls among older adults in clinical settings.
Implications: Based on the current evidence, it appears that treadmill-based systems and therapist-applied perturbations might be the most practical methods in clinical settings, and PBT that incorporates multiple perturbation types and directions might be of most benefit.
Keywords: Aged, falls, gait
Funding acknowledgements: CM:Kootstra TalentFellowship (Center for ResearchInnovation, Support and Policy), NUTRIM GraduateProgram (MUMC+).
AM: New InvestigatorAward (the Canadian Institutes of Health-Research (MSH-141983)).
Purpose: To (i) examine the characteristics of PBT studies carried out to date with older adults that assessed prospective fall incidence; and (ii) using this evidence from the literature, present and discuss a number of considerations for applying PBT in clinical settings that could affect the feasibility and effectiveness of PBT for falls reduction among older adults in clinical settings.
Methods: A systematic literature search with search terms relating to perturbations, training, falls and age with date of publication set at 2002 or later was carried out in PubMed and Web of Science databases. Studies were selected for inclusion if they carried out PBT with older adults (mean age of ≥60 years), reported post-intervention falls data and if a control group was included. Studies that carried out PBT, but that did not provide specific details on the intervention, were excluded from the main synthesis.
Results: A total of eight studies met all inclusion criteria. Three of those studies have been carried out with healthy, community-dwelling older adults that prospectively monitored falls and included a control group. Two studies found significant reductions in fall incidence in the intervention group during follow-up. The third study was not powered for this outcome measure, and found a non-significant reduction.
Two studies have examined the effects of PBT on fall incidence among frail or high-risk older adults. Both studies showed clinically relevant decreases in fall incidence during follow-up, however these were not statistically significant.
Three studies have examined the effects of PBT on the incidence of falls in daily life among older adults with Parkinson's disease. One study showed significant reductions in fall incidence during training in comparison to before the training. The other two studies showed significant reductions in fall incidence during follow-up in the intervention group versus the control group.
Conclusion(s): PBT appears to be a feasible approach to reducing falls among older adults in clinical settings.
Implications: Based on the current evidence, it appears that treadmill-based systems and therapist-applied perturbations might be the most practical methods in clinical settings, and PBT that incorporates multiple perturbation types and directions might be of most benefit.
Keywords: Aged, falls, gait
Funding acknowledgements: CM:Kootstra TalentFellowship (Center for ResearchInnovation, Support and Policy), NUTRIM GraduateProgram (MUMC+).
AM: New InvestigatorAward (the Canadian Institutes of Health-Research (MSH-141983)).
Topic: Older people; Health promotion & wellbeing/healthy ageing
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: This study is a Systematic Review, there was no ethics approval required to review previous research.
All authors, affiliations and abstracts have been published as submitted.
