Does Perturbation-Based Balance Training Prevent Falls? Systematic Review and Meta-Analysis of Preliminary Randomized Controlled Trials

Mansfield, Avril; Wong, Joseph; Bryce, Jessica; Knorr, Svetlana; Patterson, Kara K.

doi:10.2522/ptj.20140090

Cited by 209 publications

(195 citation statements)

References 40 publications

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“…The original publication did not report falls data, but prospective falls data were recorded (reported in Mansfield et al. 29). These data did not show significant reductions in falls incidence; however, the study was not powered for this outcome measure.…”

Section: Resultsmentioning

confidence: 99%

“…PBT), the reactive balance control of older adults could be improved, which might reduce their falls risk. One recent meta‐analysis of randomized controlled trials using PBT indeed reported a significantly lower falls incidence in PBT groups after the interventions,29 with a second meta‐analysis combining studies of PBT with voluntary stepping interventions also reporting reduced falls incidence 30. However, despite this evidence, it is important to consider whether such training is effective and feasible in clinical settings, or whether such benefits are only seen in highly controlled laboratory settings, information that is not yet explored in detail in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Gerards

McCrum

Mansfield

et al. 2017

Geriatrics Gerontology Int

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197

151

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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 falls incidence among healthy older adults, no significant falls incidence improvements have been consistently seen in frail older adults or in patient groups with an increased falls 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. Although early studies were carried out predominantly in research laboratory settings, work in clinical settings with various patient groups has been proliferating. A systematic search of recent PBT studies showed a significant reduction of falls incidence among healthy older adults and certain patient groups (e.g. people with Parkinson's disease and stroke), with clinically relevant reductions in frail older adults. The most practical methods in clinical settings might be treadmill‐based systems and therapist‐applied perturbations, and PBT that incorporates multiple perturbation types and directions might be of most benefit. Although more controlled studies with long‐term follow‐up periods are required to better elucidate the effects of PBT on falls incidence, PBT appears to be a feasible and effective approach to falls reduction among older adults in clinical settings. Geriatr Gerontol Int 2017; 17: 2294–2303..

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Gerards

McCrum

Mansfield

et al. 2017

Geriatrics Gerontology Int

Self Cite

197

151

View full text Add to dashboard Cite

show abstract

“…For example, it is common to use strengthening exercises in conjunction with exercises addressing motor control components of balance, such as seen in the widely used OTAGO exercise protocol [12]. We do have guidelines for determining types of exercise, based on an individualized evaluation [2], although there are newer interventions, such as perturbation training, that show excellent promise as well [13]. We also have some guidelines related to the frequency and duration needed for an exercise program to be effective in certain setting and with certain populations [14].…”

Section: Editorialmentioning

confidence: 99%

Getting the Dosage Right in Balance Exercise Prescription: the Intensity Problem

Reinthal¹

2017

J Nov Physiother

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EditorialAs our population ages, finding effective interventions to treat balance impairments is critical. In the United States Medicare spent over $31 billion in 2015 managing fall injuries. More than 800,000 people a year were hospitalized because of a fall, most often a fractured hip or head injury. Fall injuries are among the top 20 most expensive medical conditions, with an average cost of over $30,000. Furthermore, these direct costs do not account for the long-term effects of these injuries such as disability, dependence on others, lost time from work and household duties, and reduced quality of life [1]. Thus, determining effective means of preventing falls is a significant health care need.There have been a large number of investigations examining various aspects related to balance training and fall prevention, with more than 50 systematic reviews and meta-analyses of this research completed since 2009 [2]. Multiple types of balance interventions have been studied, with populations of varied ages as well as with differing disabilities, and in multiple types of settings [2,3]. However, there is no simple answer about the "best" exercise prescription to prevent falls because the construct of balance itself is so complicated [4]. The ability to maintain the center of mass within the base of support, or balance is a composite impairment that is influenced by strength, flexibility, sensation, cognition, and motor control.Despite the complexity, however, developing evidence based guidelines for effective balance exercise prescription is essential. Physical therapy exercise prescription typically follows the FITT principle [5], referring to frequency, intensity, type, and time, similar to medication administration. For example, when prescribing a drug, a physician determines the correct medication [TYPE] as well as the amount [INTENSITY] and frequency [FREQUENCY] of taking the medication, and the duration to continue taking the medication [TIME]. The physical therapy profession has taken a harder look at how we prescribe exercise over the last decade across multiple domains of practice, from acute care, to orthopedics to geriatric rehabilitation [6][7][8]. Similar to pharmacological interventions, incorrect exercise dosage can be ineffective in targeting the problem, and therefore costly in actual dollars and/or time. In addition, it can be damaging [9].Because balance is a multifactorial construct, exercise prescription is complex. It is for this reason that many individuals will do better with an exercise program customized by a physical therapist rather than attending a standardized group program [10,11]. There are often multiple types of exercise necessary to address different components of the balance problem. For example, it is common to use strengthening exercises in conjunction with exercises addressing motor control components of balance, such as seen in the widely used OTAGO exercise protocol [12]. We do have guidelines for determining types of exercise, based on an individualized evaluation [2], ...

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“…Future work should continue to investigate the effects of PBT with task-specific interventions within this population as well as its impact on standardized outcome measures. 6,[10][11][12][13] associated with fewer number of falls. Perturbation-based balance training (PBT) is defined as "a novel balance training intervention that incorporates exposure to repeated postural perturbations to evoke a rapid balance reaction, enabling the individual to improve 6 control of these reactions with practice."…”

Section: Introductionmentioning

confidence: 99%

“…While ankle and hip strategies have been found to be effective ways to maintain balance and prevent falls following perturbations, a stepping strategy, or reaction, 5 5 has also been found to be successful and even the preferred strategy. Horak, et al defined a stepping reaction as an "asymmetrical loading and unloading of the legs to move the base of 6 support under the falling center of mass" and Mansfield, et al further stated that in order to prevent falls, this motion must occur quicker than a typical voluntary movement. A protective stepping reaction is a necessary reactive balance response to prevent falls resulting from [5][6][7][8][9] postural perturbations, and therefore people with an ineffective stepping reaction are likely 6 at an increased risk for falls.…”

Section: Introductionmentioning

confidence: 99%

Impact of Perturbation-Based Balance Training on Functional Outcomes in a Patient with Chronic Incomplete Spinal Cord Injury: A Case Report

Drake¹,

Mowder-Tinney²

2017

Phys Med Rehabil

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Does Perturbation-Based Balance Training Prevent Falls? Systematic Review and Meta-Analysis of Preliminary Randomized Controlled Trials

Abstract: Perturbation-based balance training appears to reduce fall risk among older adults and individuals with Parkinson disease.

Cited by 209 publications

References 40 publications

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Getting the Dosage Right in Balance Exercise Prescription: the Intensity Problem

Impact of Perturbation-Based Balance Training on Functional Outcomes in a Patient with Chronic Incomplete Spinal Cord Injury: A Case Report

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