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, I2 = 0%) and the proportion of fallers (risk ratio 0.51, 95% CI 0.38 to 0.68, p < 0.0001, I2 = 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 to 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.
Reproduced with permission from the BMJ Publishing Group.

Full text (sometimes free) may be available at these link(s):      help

• DOI
• PubMed
• PDF locator
• publisher