Effects of Perturbation-Based Balance Training on Reactive Postural Control in Community-Dwelling Older Adults
Abstract
Background
Perturbation-based balance training (PBT) is a promising intervention for preventing falls among community-dwelling older adults. Effective reactive postural control is essential to maintain stability when encountering unexpected perturbations. However, the immediate and sustained effects of short-term PBT on reactive postural control in older adults remain inconsistent across existing research. Additionally, the influence of lower limb dominance on PBT training responses remains unclear.
Methods
In this assessor-blinded, randomized controlled trial, 48 community-dwelling older adults were allocated to receive two sessions of either treadmill walking without perturbation (controls, n=24) or treadmill-based PBT (PBT, n=24) experiencing 112 forward or backward perturbations each session, simulating tripping and slipping, while walking. The primary outcome was the margin of stability (MoS) at the first recovery step. Secondary outcomes included grasping reactions and clinical assessments of physical, cognitive and sociopsychological factors at post-intervention and 4-month follow-up.
Results
The PBT group demonstrated both immediate and sustained improvements in reactive postural adjustments compared to controls. Significant improvements in MoS during dominant-leg slips [Mean difference (MD)=1.17, p=0.004] and reduced the total number of handrail grasping reactions (MD=-1.25, p<0.001) post-intervention and at follow-up (MoS: MD=1.00, p=0.043; handrail use: MD=-0.68, p=0.013) were revealed in PBT but not in controls. European Quality of Life 5 Dimensions 5 Levels (EQ-5D-5L) also improved significantly in the PBT group at follow-up (MD=0.05, p<0.001). However, no significant differences were observed in other physical capacity or cognitive function measures.
Conclusion
This study demonstrated that a two-session PBT protocol effectively improved reactive postural adjustments and health-related quality of life in older adults for a duration of at least four months. Effects were more marked in preventing backward slips triggered on the dominant leg. These findings suggest that short-term PBT may offer a time-efficient solution for fall prevention in community-dwelling older adults.
Comments
Nice poster
Based on our observations…
Based on our observations during training, participants demonstrated better reactive performance in the dominant limb following perturbation. Specifically, most participants took fewer and faster steps with their dominant limb. This outcome aligns well with the functional division of the lower limbs documented in prior studies: the dominant limb is primarily engaged in motor skill performance, whereas the non-dominant limb mainly assumes the role of body weight bearing.
Thank you for your question. It remains unclear whether the observed changes in MoS carry clinical significance. To address this concern, we propose conducting correlation analyses to explore the associations between MoS and clinical outcome measures in future research.
Currently, no published studies have established the Minimal Clinically Important Difference (MCID) for MoS. This is mainly because this biomechanical parameter cannot directly reflect patients’ subjective experience. Moreover, its measurement is highly dependent on specialized laboratory equipment, which limits its application in routine clinical practice and community rehabilitation. Existing research also suggests that MoS is less clinically effective than indicators such as gait speed for patient assessment.
Our current study primarily focuses on biomechanical mechanisms. Under your suggestion, we could incorporate further analyses to examine the correlations between the MoS and fall risk-related clinical assessments. A previous study conducted similar correlation analyses and reported significant relationships between MoS and some clinical assessments. Ref: https://pubmed.ncbi.nlm.nih.gov/40948967/