The effect of reactive balance training on falls in daily life: an updated systematic review and meta-analysis

ABSTRACT Objective Reactive balance training is an emerging approach to reduce falls risk in people with balance impairments. The purpose of this study was to determine the effect of reactive balance training on falls in daily life among individuals at increased risk of falls, and to document associated adverse events. Data sources Databases searched were Ovid MEDLINE (1946-November 2020), Embase Classic and Embase (1947-November 2020), Cochrane Central Register of Controlled Trials (2014-November 2020), Physiotherapy Evidence Database (PEDro; searched on 9 November 2020). Study selection Randomized controlled trials of reactive balance training were included. The literature search was limited to English language. Records were screened by two investigators separately. Data extraction Outcome measures were number of participants who reported falls after training, number of falls reported after training, and the nature, frequency, and severity of adverse events. Authors of included studies were contacted to obtain additional information. Data synthesis Twenty-five trials were included, of which 14 reported falls and 19 monitored adverse events. Participants assigned to reactive balance training groups were less likely to fall compared to control groups (fall risk ratio: 0.75, 95% confidence interval=[0.60, 0.92]; p=0.006, I 2 =37%) and reported fewer falls than control groups (rate ratio: 0.60, 95% confidence interval=[0.42, 0.86]; p=0.005, I 2 =83%). Prevalence of adverse events was higher in reactive balance training (29%) compared to control groups (19%; p=0.018). Conclusion RBT reduces the likelihood of falls in daily life for older adults and people with balance impairments. More adverse events were reported for reactive balance training than control groups. Impact Balance training that evokes balance reactions can reduce falls among people at increased risk of falls.