Citation

Okubo Y, Schoene D, Lord SR. Br. J. Sports Med. 2016; 51(7): 586-593.

Affiliation

Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales, Sydney, Australia Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.

Copyright

(Copyright © 2016, BMJ Publishing Group)

DOI

10.1136/bjsports-2015-095452

PMID

26746905

Abstract

OBJECTIVE: To examine the effects of stepping interventions on fall risk factors and fall incidence in older people. DATA SOURCE: Electronic databases (PubMed, EMBASE, CINAHL, Cochrane, CENTRAL) and reference lists of included articles from inception to March 2015. STUDY SELECTION: Randomised (RCT) or clinical controlled trials (CCT) of volitional and reactive stepping interventions that included older (minimum age 60) people providing data on falls or fall risk factors.

RESULTS: Meta-analyses of seven RCTs (n=660) showed that the stepping interventions significantly reduced the rate of falls (rate ratio=0.48, 95% CI 0.36 to 0.65, p<0.0001, I(2)=0%) and the proportion of fallers (risk ratio=0.51, 95% CI 0.38 to 0.68, p<0.0001, I(2)=0%). Subgroup analyses stratified by reactive and volitional stepping interventions revealed a similar efficacy for rate of falls and proportion of fallers. A meta-analysis of two RCTs (n=62) showed that stepping interventions significantly reduced laboratory-induced falls, and meta-analysis findings of up to five RCTs and CCTs (n=36-416) revealed that stepping interventions significantly improved simple and choice stepping reaction time, single leg stance, timed up and go performance (p<0.05), but not measures of strength.

CONCLUSIONS: The findings indicate that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%. This clinically significant reduction may be due to improvements in reaction time, gait, balance and balance recovery but not in strength. Further high-quality studies aimed at maximising the effectiveness and feasibility of stepping interventions are required. SYSTEMATIC REVIEWS REGISTRATION NUMBER: CRD42015017357.

Language: en