A Single Session of Community-Delivered Perturbation-Based Balance Training Is Associated With Reduced Falls in Older Adults

Introduction: Perturbation-based balance training is a promising approach for reducing fall risk in older adults, yet evidence is largely based on laboratory or clinical interventions. To facilitate translation to community settings, we studied the effectiveness of a single-session, low-cost, accessible perturbation training by examining pre-post differences in falls over a year in older adults.

Methods: One hundred community-dwelling older adults (age 75.3 ± 7.5 years; 67% female) participated. Perturbations (n=32) were delivered via a waist-mounted, cable-driven system that pulled participants to the right, with onset manually triggered during treadmill walking. Self-reported falls were collected for the 12 months before training (Pre) and after the intervention via two telephone follow-ups per person (mean follow-up 6.8 and 12.1 months). Pre-post differences in (i) any fall (≥1) and (ii) fall rates were analysed using McNemar’s test and Poisson generalized linear mixed-effects models respectively.

Results: All participants completed the intervention without adverse incidents, and 94 participants completed all follow-ups. The proportion of participants reporting any fall was unchanged pre- to post-intervention (p = 1.00). Mean fall counts were lower over the 12 months after training than in the preceding year (0.69 vs 0.86 falls). Mixed-effects modelling showed that fall rates were 35% lower during the first follow-up period (rate ratio 0.65, 95% CI 0.46 to 0.91; p = 0.013), whereas the cumulative 12-month reduction was smaller (21%) and not statistically significant (rate ratio 0.79, 95% CI 0.61 to 1.03; p = 0.079).

Conclusions: A single session of community-delivered perturbation-based balance training was associated with a significant reduction in fall rates with effect sizes comparable to lab-based interventions. The training was feasible and safe, however attenuation over 12 months suggests that booster sessions can be beneficial for long term retention.