A Single Session of Community-Delivered Perturbation-Based Balance Training Is Associated With Reduced Falls in Older Adults
Abstract
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.
Comments
Anxiety
Did participants feel anxious about taking part in perturbation-based balance training? If participants did feel anxious, how did you support them to engage with the intervention?
Anxiety
Great question. We observed less anxiety than expected among participants. There were six dropouts in total: three due to dizziness during treadmill walking and three due to unavailability during the follow-up period. Familiarization with treadmill walking appeared to be more challenging than the perturbations themselves. To support engagement and reduce potential anxiety, each session began with questionnaires followed by a detailed explanation of the training procedure and all safety measures. These discussions took place while participants were seated in close proximity to the treadmill, allowing them to familiarize themselves with the environment and ask questions before training commenced. It should also be noted that the perturbation setup itself was relatively simple, which may have contributed to the low levels of anxiety observed.
Inclusion/exclusion criteria
What great results after one session! Did you have specific inclusion or exclusion criteria in relation to the functional ability of the patients? E.g. did they have to walk without walking aid in order to be eligible for the study, any specific number of falls to be eligible? I notice you had 100 patients but only 81 total falls in the previous 12 months
Promising
What a promising intervention! I can picture this training as great add-on to a falls clinic assessment, instead of having to motivate the patient to see a community physiotherapist with high chance of them not ever getting there. Thank you!
RE: Inclusion/exclusion criteria
Thank you. In this project, we were interested which population subgroups would be interested in joining a single-session perturbation-based balance training. Therefore we had set no exclusion criteria besides the age 60 - 100 years. From the 94 analyzed full datasets, 54 persons had not fallen in the previous year, 20 persons had one fall and 20 persons had more than one fall, summing up to a total of 81 falls. From the reported preconditions, the following were reported most frequently: osteoarthritis (n=24), joint replacement (n=18), osteoporosis (n=16), osteopenia (n=6). People had to come to the ambulant setting, and we explained beforehand that it would be necessary to be able to walk for 30 min, or at least 3 times 10 min, on a treadmill in a convenient self-selected walking speed, therefore people only agreed to take part when they felt comfortable about this requirement, and we had no participant using walking aids in this project.
Great poster
Excellent poster and work regarding Perturbation-based balance training. I have a question - do you offer any modifications for patients with previous Stroke and having falls, but may not be suitable for regular Perturbation-based balance training due to deficits. Thanks, Sharath