Journal of the American Medical Directors Association · 2026
Perturbation-Based Balance Training Reduces Falls and Fall Injuries in Older People: Insights on Mechanisms and Training Parameters From a Systematic Review.
СтатьяСистематический обзорМетаанализПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Sharma Shivam, Szabo Ildiko-Zsuzsa, Danielsen Mathias Brix, Andersen Stig, Nørgaard Jens Eg, Lord Stephen R, Okubo Yoshiro, Jørgensen Martin Gronbech
Аннотация
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.
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.