Perturbation Training Can Reduce Community-Dwelling Older Adults' Annual Fall Risk: A Randomized Controlled Trial

Pai, Yi–Chung; Bhatt, Tanvi; Yang, Feng; Wang, Edward

doi:10.1093/gerona/glu087

Cited by 155 publications

(214 citation statements)

References 37 publications

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“…Pai et al . also found a significant reduction in falls incidence after PBT in their study (67 community‐dwelling older adults completed the PBT and 1‐year follow up; mean age 72 years, SD 5.5 years) 31. Participants were exposed to either just one slip or a single PBT session of 24 unannounced slips.…”

Section: Resultsmentioning

confidence: 83%

“…Participants were exposed to either just one slip or a single PBT session of 24 unannounced slips. During the follow‐up period of 12 months, the intervention group had a 50% decrease (34% to 15%, P < 0.05) in falls incidence, whereas no change in falls incidence was seen in the control group, who were 2.3‐fold more likely to fall than those in the intervention group in the 12‐month follow‐up period 31. Finally, Mansfield et al .…”

Section: Resultsmentioning

confidence: 94%

“…Three PBT studies have been carried out with healthy, community‐dwelling older adults that prospectively monitored falls and included a control group 19, 31, 32. Rosenblatt et al .…”

Section: Resultsmentioning

confidence: 99%

“…In the aforementioned studies, a variety of magnitudes were used, that were either fixed or progressive with training. High‐magnitude perturbations, where participants initially require support from the harness to regain stability, appear to trigger fast and significant adaptation in recovery behavior, and long‐term retention of motor adaptations 31, 45, 46, 48. However, studies based in clinical settings have generally used a more progressive increase in perturbation magnitude, starting with lower‐magnitude perturbations and progressing based on the supervising physiotherapist's judgement 34, 37.…”

Section: Resultsmentioning

confidence: 99%

“…In the studies discussed above, two studies applied perturbations that caused a loss of balance in the backward direction 31, 33. Another study applied only perturbations leading to a forward loss of balance,32 whereas three studies applied perturbations in both directions 34, 35, 36.…”

Section: Resultsmentioning

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

184

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: 83%

Section: Resultsmentioning

confidence: 94%

“…Three PBT studies have been carried out with healthy, community‐dwelling older adults that prospectively monitored falls and included a control group 19, 31, 32. Rosenblatt et al .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

184

151

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Effect of Treadmill Perturbation-Based Balance Training on Fall Rates in Community-Dwelling Older Adults

et al. 2023

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ImportanceFalls are common and the leading cause of injuries among older adults, but falls may be attenuated by the promising and time-efficient intervention called perturbation-based balance training (PBT).ObjectiveTo evaluate the effects of a 4-session treadmill PBT intervention compared with regular treadmill walking on daily-life fall rates among community-dwelling older adults.Design, Setting, and ParticipantsThis 12-month, assessor-blinded randomized clinical trial was conducted from March 2021 through December 2022 in Aalborg University in Denmark. Participants were community-dwelling adults 65 years or older and were able to walk without a walking aid. Participants were randomized to either PBT (intervention group) or treadmill walking (control group). Data analyses were based on the intention-to-treat principle.InterventionsParticipants who were randomized to the intervention group underwent four 20-minute sessions of PBT, including 40 slip, trip, or mixed slip and trip perturbations. Participants who were randomized to the control group performed four 20-minute sessions of treadmill walking at their preferred speed. The 3 initial training sessions were completed within the first week, whereas the fourth session was performed after 6 months.Main Outcomes and MeasuresPrimary outcome was the daily-life fall rates that were collected from fall calendars for the 12 months after the third training session. Secondary outcomes were the proportion of participants with at least 1 fall and recurrent falls, time to first fall, fall-related fractures, fall-related injuries, fall-related health care contacts, and daily-life slip and trip falls.ResultsA total of 140 highly functioning, community-dwelling older adults (mean [SD] age, 72 [5] years; 79 females [56%]), 57 (41%) of whom had a fall in the past 12 months, were included in this trial. Perturbation training had no significant effect on daily-life fall rate (incidence rate ratio [IRR]: 0.78; 95% CI, 0.48-1.27) or other fall-related metrics. However, there was a significant reduction in laboratory fall rates at the posttraining assessment (IRR, 0.20; 95% CI, 0.10-0.41), 6-month follow-up (IRR, 0.47; 95% CI, 0.26-0.86), and 12-month follow-up (IRR, 0.37; 95% CI, 0.19-0.72).Conclusions and RelevanceResults of this trial showed that participants who received an 80-minute PBT intervention experienced a statistically nonsignificant 22% reduction in daily-life fall rates. There was no significant effect on other daily-life fall-related metrics; however, a statistically significant decrease in falls was found in the laboratory setting.Trial RegistrationClinicalTrials.gov Identifier: NCT04733222

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Exercise for preventing falls in older people living in the community

Sherrington

Tiedemann

Fairhall

et al. 2019

Cochrane Database of Systematic Reviews

636

586

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Perturbation Training Can Reduce Community-Dwelling Older Adults' Annual Fall Risk: A Randomized Controlled Trial

Abstract: A single session of repeated-slip exposure could improve community-dwelling older adults' resilience to postural disturbances and, hence, significantly reduce their annual risk of falls.

Cited by 155 publications

References 37 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

Effect of Treadmill Perturbation-Based Balance Training on Fall Rates in Community-Dwelling Older Adults

Exercise for preventing falls in older people living in the community

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