Review details | Aim | Participant information | Intervention details | Summary of findings of review | Certainty of evidence (GRADE) |
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Citation details: Hayes et al. (2017) Number of relevant primary studies: 13 AMSTAR 2 rating: Moderate Neurological condition: MS | To evaluate the effectiveness of interventions to reduce falls in people with MS, specifically to compare falls prevention interventions to controls and to compare different types of falls prevention interventions. | N = 839 (range: 12–177) Female participants range: 59–98% Mean age = 52 years (range: 36–62 years) Participants in the majority of RCTs included people with mild to moderate severity of MS. | Group-based exercise session or individualised HEP × 1 RCT One-to-one motor and sensory rehabilitation or motor rehabilitation × 1 RCT Balance treatment × 1 RCT Group-based exercise circuit class or one-to-one physiotherapy or yoga classes × 1 RCT FES × 1 RCT Supervised sensory integration balance training × 1 RCT Interactive exergames × 1 RCT Group-based exercise × 1 RCT Wii Fit Plus balance games × 1 RCT Progressive HEP × 1 RCT Exercise or education or combined exercise and education × 1 RCT Activity Through Movement × 1 RCT FES and core stability exercises × 1 RCT | Falls rate: There was no significant effect of exercise compared to control on falls rate (RaR 0.68, 95% CI 0.43 to 1.06). | Moderate |
There was no significant effect of FES compared to exercise on falls rate (RaR 0.91, 95% CI 0.78 to 1.06). | Low | ||||
Number of fallers: There was no significant effect of exercise on the number of fallers post-intervention (RR 0.85, 95% CI 0.51 to 1.43). | Moderate | ||||
There was no evidence of an effect of education-based interventions on number of fallers (RR 0.83, 95% CI 0.40 to 1.76). | Moderate | ||||
There was no evidence of an effect of multicomponent interventions on number of fallers (RR 0.30, 95% CI 0.04 to 2.20). | Moderate | ||||
Citation details: Sosnoff & Sung (2015) Number of relevant primary studies: 9 AMSTAR 2 rating: Critically low Neurological condition: MS | To review the effects of falls prevention interventions on falls incidence among people with MS and determine characteristics of these programmes that might optimise the reduction of falls. | N = 504 (range: 28–111) Percentage of female participants: N/R EDSS median range: 3.0–6.0 (N/R ×3 studies: 1x RCT, 2x NRSIs) Mean age range: 46–63 years | Exercise-based ×7 studies: Motor-sensory rehabilitation or motor rehabilitation × 1 RCT Group physiotherapy or 1-to-1 physiotherapy or yoga × 1 NRSI Wii balance board system training × 1 RCT Exergame training on an unstable platform or single-task exercises on the unstable surface × 1 NRSI Balance exercise targeting core stability, dual tasking and sensory strategies × 1 NRSI Home-based exercise or education or exercise and education × 1 RCT Sensory integration rehabilitation × 1 RCT Technology-based × 2 studies: FES for 12 weeks and exercise with FES for 12 weeks × 1 RCT FES × 1 RCT | Total number of falls: 3x studies reported a significant reduction in the number of falls in the exercise-based intervention groups (1x RCT, 2x NRSIs). | Low |
2x RCTs reported a reduction in total number of falls for groups receiving FES. | Very low | ||||
Number of fallers: 2x RCTs reported that the number of fallers was lower following exercise-based intervention, 1x NRSI reported no difference between groups. | Very low | ||||
Number of recurrent fallers: 1x RCT reported a significantly lower number of recurrent fallers in the exercise-based intervention groups compared to the control group. | Not assessed | ||||
Mean number of falls: 1x NRSI reported that the exercise-based intervention group had a lower mean number of falls than the control group. | Not assessed | ||||
Citation details: Booth et al. (2014) Number of relevant primary studies: 1 AMSTAR 2 rating: Critically low Neurological condition: MS | To evaluate whether virtual reality interventions, including interactive gaming systems, are effective at improving balance in adults with impaired balance. | N = 80 Percentage of female participants: N/R Age: N/R | Nintendo WiiFit balance exercise programme ×1 RCT | Total number of falls: 1x RCT identified that those in the intervention group experienced less falls (n = 10) compared with the control group (n = 14) during the study. | Critically low |
Citation details: Denissen et al. (2019) Number of relevant primary studies: 14 AMSTAR 2 rating: Moderate Neurological condition: Stroke | To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. | N = 1358 (range: 34–170, median: 91) Mean percentage of female participants: 40% (range: 29–65%) Mean age range: 57 (+/−11) - 79 (+/−8) years | Exercise-based interventions ×8 RCTs: Treadmill training without body weight support plus overground walking × 1 RCT Treadmill walking with harness plus conventional stroke rehabilitation × 1 RCT WEBB programme plus HEP plus advice to increase walking × 1 RCT Physiotherapy treatment × 1 RCT Whole-body vibration × 1 RCT External perturbation training × 1 RCT Exercise programme challenging dynamic balance and emphasising agility and multisensory approach in between × 1 RCT Tai Chi or SilverSneakers × 1 RCT Environment/assistive technology ×3 RCTs: Predischarge home assessment visit × 1 RCT Prescription of single lens distance glasses × 1 RCT Walking training using the I-Walker plus exercises on hand recovery, tone control and improvement of global ability × 1 RCT Other interventions/ procedures × 1 RCT: Active repeated tDCS plus physical rehabilitation × 1 RCT Multifactorial intervention × 1 RCT: Multifactorial, individually-tailored falls prevention programme plus usual care after discharge × 1 RCT Multiple intervention × 1 RCT: HIFE programme plus individualised HEP × 1 RCT | Falls rate: There was a significant reduction in falls rate for the exercise group (RaR 0.72, 95% CI 0.54 to 0.94). | Moderate |
There was no significant reduction in falls rate when comparing a home visit to a predischarge assessment in the hospital setting (RaR 0.85, 95% CI 0.43 to 1.69). | Low | ||||
There was no significant reduction in falls rate when single lens distance vision glasses replaced multifocal glasses (RaR 1.08, 95% CI 0.52 to 2.25). | Low | ||||
There was no significant reduction in falls rate for the I-walker group compared to the control group (RaR 0.56, 95% CI 0.19 to 1.66). | Low | ||||
Number of fallers: When pooled, there was no significant effect of exercise on number of fallers (RR 1.03, 95% CI 0.90 to 1.19). | Moderate | ||||
There was no significant difference in number of fallers between the home visit or hospital assessment groups (RR 1.48, 95% CI 0.71 to 3.09). | Low | ||||
There was no significant reduction in number of fallers when single lens distance vision glasses replaced multifocal glasses (RR 0.74, 95% CI 0.47 to 1.18). | Low | ||||
There was no significant reduction in number of fallers for the I-walker group compared to the control group (RR 0.44, 95% CI 0.16 to 1.22). | Low | ||||
There was a significant reduction in the number of fallers in the active tDCS group compared to the control group (RR 0.30, 95% CI 0.14 to 0.63). | Low | ||||
Citation details: Pollock et al. (2014) Number of relevant primary studies: 3 AMSTAR 2 rating: Low Neurological condition: Stroke | To determine the effect of interventions that alter the starting posture on ability to STS independently and to determine the effect of rehabilitation interventions on ability to STS independently. | N = 276 (range: 54–156) Percentage of female participants: N/R Mean age range (intervention group): 60 (+/−7) - 72 (+/−10.4) years Mean time since stroke range (intervention group): 21 (+/−8) – 171 days | Repetitive STS training × 1 RCT Falls prevention programme × 1 RCT Endurance and resistance exercises × 1 RCT | Number of fallers: There was no evidence of an effect of intervention on the number of fallers compared to control (OR 0.81, 95% CI 0.35 to 1.87). | Moderate |
Citation details: Batchelor et al. (2010) Number of relevant primary studies: 10 (based on 7 RCTs) AMSTAR 2 rating: Critically low Neurological condition: Stroke | To systematically evaluate the effects of any interventions on falls in people after stroke. | N = 723 (range: 39–258) Percentage of female participants: N/R ×6 RCTs, 46% × 1 RCT Age = N/R ×5 RCTs, range: 18–90 years × 1 RCT, mean: 74.7 years × 1 RCT Time since stroke range: < 24 h to > 2 years post-stroke | Group STS practice plus usual care × 1 RCT Very early mobilisation plus usual care × 1 RCT Standing symmetry training and STS training plus usual care × 1 RCT Community physiotherapy sessions × 1 RCT Fresnel prisms applied to affected hemi-field plus usual rehabilitation × 1 RCT Sunlight exposure outdoors × 1 RCT Home rehabilitation × 1 RCT | Falls rate: These was no significant effect of exercise on falls rate compared to usual care (RaR 1.22, 95% CI 0.76 to 1.98). | Very low |
The application of fresnel prisms to the affected hemi-field had no significant effect on falls rate. | Very low | ||||
Increased sunlight exposure had no significant effect on falls rate. | Low | ||||
Home rehabilitation with multi-disciplinary outreach service had no significant effect on falls rate. | Very low | ||||
Number of fallers: There was no significant effect of exercise on number of fallers compared to usual care (RR 0.77, 95% CI 0.24 to 2.43). | Low | ||||
Citation details: Rutz et al. (2020) Number of relevant primary studies: 1 AMSTAR 2 rating: Critically low Neurological condition: PD | To investigate the evidence for physical interventions for freezing of gait and gait impairments in PD and establish recommendations for clinical practice. | N = 21 Percentage of female participants: N/R Age: N/R H&Y range: 2–3 All participants had freezing of gait | HEP with rhythmic auditory cueing and functional walking exercises × 1 RCT | Total number of falls: Intervention did not significantly reduce falls. | Very low |
Citation details: Owen et al. (2019) Number of relevant primary studies: 3 AMSTAR 2 rating: Critically low Neurological condition: PD | To identify and review falls self-management interventions for people with PD and, where possible, assess their efficacy for improving patient and caregiver outcomes, quality of life and psychological outcomes. | N = 574 (range: 133–231) Percentage of female participants: N/R Mean age range: 67.9 (+/− 9.6) - 71.4 (+/− 8.1) years Majority participants H&Y stage ≤2 (indicating reduced falls risk) × 2 RCTs Range of participants that had fallen in year preceding intervention: 55–78% | Physiotherapy plus education ×3 RCTs | Falls rate: Physiotherapy plus falls self-management education significantly reduced falls rate. | Moderate |
Number of fallers: Physiotherapy plus falls self-management education did not have a significant effect on number of fallers. | Low | ||||
Number of recurrent fallers: No significant effect of intervention on number of recurrent fallers. | Not assessed | ||||
Citation details: Rodrigues-Krause et al. (2019) Number of relevant primary studies: 1 AMSTAR 2 rating: Critically low Neurological condition: PD | To review dance as a form of intervention to promote functional and metabolic health in older adults. | N = 33 Percentage of female participants: 39% Intervention group mean age = 68.4 +/− 7.7 years Control group mean age = 74.4 +/− 6.5 years | Tango dance × 1 NRSI | Total number of falls: Tango group had reduced number of falls compared to education group. | Very low |
Number of fallers: There was no significant effect of Tango on number of fallers compared to education. | Very low | ||||
Citation details: Winser et al. (2019) Number of relevant primary studies: 1 AMSTAR 2 rating: Critically low Neurological condition: PD | To identify evidence evaluating the cost-effectiveness of physiotherapy treatment techniques for people with neurological disorders. | N = 231 Percentage of female participants: 41.6% Mean age: 70.7 years | Group based exercise classes with home visits from physical therapist and provision of standard fall prevention booklet × 1 RCT | Mean number of falls: Lower mean number of falls in intervention group (4.106 falls) than control group (7.053 falls). | Not assessed |
Citation details: Mak et al. (2017) Number of relevant primary studies: 8 (based on 6 RCTs) AMSTAR 2 rating: Critically low Neurological condition: PD | To investigate the long-term effects of exercise and physical therapy in people with PD. | N = 790 (range: 23–195) Percentage of female participants: N/R Age range: 40–89 years H&Y stage range: 1–4 | Balance training ×4 RCTs: Progressive strengthening, balance, cueing for FOG and fall prevention advice × 1 RCTs Mobility and balance training with movement strategies and fall prevention advice or progressive resistance training and fall prevention advice × 1 RCT Technology-assisted balance and mobility training × 1 RCT Balance and mobility training × 1 RCT Complementary exercises × 2 RCTs: Tai Chi × 1 RCT Tai Chi or progressive strength training × 1 RCT | Falls rate: Balance training significantly reduced falls rate. | Low |
Tai Chi significantly reduced falls rate. | Low | ||||
Citation details: Ramazzina et al. (2017) Number of relevant primary studies: 5 (based on 4 RCTs) AMSTAR 2 rating: Critically low Neurological condition: PD | To assess the effectiveness of resistance training on muscle strength improvement. | N = 154 (range: 29–51) Percentage of female participants: N/R Age: N/R H&Y range: 1.5–3 | Strength training × 4 RCTs: Using pneumatic resistance equipment × 1 RCT Using dynamometers and leg-press machines, in addition to rowing exercises, repetitive step on a 6-in. curb, and weighted walking × 1 RCT Using dynamometers and leg-press machines, in addition to rowing exercises, repetitive step on a 6-in. curb, and weighted walking plus home training × 1 RCT Hydrotherapy with perturbation-based balance and strength training × 1 RCT | Total number of falls: 1x RCT reported a significant reduction with strength training (hydrotherapy), 3x RCTs reported no significant reduction in number of falls with strength training. | Low |
Citation details: Song et al. (2017) Number of relevant primary studies: 3 AMSTAR 2 rating: Critically low Neurological condition: PD | To investigate the effects of Tai Chi/Qigong on motor and non-motor function, and quality of life in people with PD. | N = 305 (range: 34–195) Percentage of female participants: 38% Mean age range: 66–69.5 years | Tai Chi × 2 RCTs Qigong × 1 NRSI | Total number of falls: Tai Chi significantly reduced number of falls compared to control (ES − 0.403, 95% CI − 0.677 to − 0.129). | Moderate |
1x NRSI reported Qigong reduced number of falls. | Low | ||||
Citation details: Shen et al. (2016) Number of relevant primary studies: 8 AMSTAR 2 rating: Critically low Neurological condition: PD | To examine the effects of exercise on improving balance and gait ability and reducing falls among people with PD over the short-term and long-term. | N = 925 (range: 64–231) Percentage of female participants: 38% Age range: 61.6 (+/− 8) - 72.2 (+/− 9.2) years H&Y range: 1–4 | Balance, gait, strength, other exercises × 2 RCTs Gait × 1 RCT Balance × 2 RCTs Balance, strength × 1 RCT Strength × 1 RCT Balance and gait × 2 RCTs | Falls rate: The fall rate showed a significant overall reduction over the short-term with exercise training (RaR 0.485, 95% CI 0.329 to 0.715). | Moderate |
The fall rate showed a significant overall reduction over the long-term with exercise training RaR 0.413,95% CI 0.270 to 0.630). | Moderate | ||||
Numbers of fallers: The number of fallers did not decrease significantly over the short-term with exercise training (RR 0.939, 95% CI 0.822 to 1.072). | Moderate | ||||
The number of fallers did not decrease significantly over the long-term with exercise training (RR 0.787, 95% CI 0.605 to 1.024). | Moderate | ||||
Citation details: Tomlinson et al. (2014) Number of relevant primary studies: 3 AMSTAR 2 rating: Moderate Neurological condition: PD | To assess the effectiveness of one physiotherapy intervention compared with a second approach in people with PD. | N = 469 (range: 64–210) Percentage of female participants: 36% Mean age range: 67.3–69 years Mean disease duration range: 6.7–10.4 years | Tai Chi or resistance training × 1 RCT Movement strategy training and individualised home practice session and weekly structured falls risk education and a single home visit or progressive strength training and individualised HEP and once weekly structured falls risk education and a single home visit × 1 RCT Balance training × 1 RCT | Total number of falls: 1x RCT found number of falls were significantly reduced during the intervention period in the progressive strength training group, 2x RCTs found no significant effect on number of falls. | Low |
Time to first fall: No significant difference in time to first fall between the progressive strength training and the movement strategy training arms × 1 RCT. | Not assessed | ||||
Citation details: Tomlinson et al. (2012a) Number of relevant primary studies: 7 AMSTAR 2 rating: Low Neurological condition: PD | To assess the effectiveness of physiotherapy intervention compared with no intervention or placebo in patients with PD. | N = 532 (range: 18–153) Percentage of female participants: 38% female across 6x RCTs (N/R × 1 RCT, male participants only × 1 RCT) Mean age range: 63.4–73.7 years (N/R × 1 RCT) Mean H&Y range: 2–3.14 (N/R × 2 RCTs) Mean disease duration range: 4.7–9.1 years (N/R × 2 RCTs) | Exercise × 3 RCT Tai Chi × 2 RCTs Cueing × 1 RCT Treadmill training × 1 RCT | Total number of falls: 1x RCT reported a significant reduction in number of falls for the Tai Chi compared with no intervention, 5x RCTs reported no significant effect of exercise-based intervention on number of falls. | Low |
There was no significant effect of cueing intervention on number of falls. | Low | ||||
Citation details: Monti et al. (2011) Number of relevant primary studies: 5 AMSTAR 2 rating: Critically low Neurological condition: PD | To research the effectiveness of physiotherapy intervention on the prevention of falls among people with PD. | N = 456 (range: 18–230) Percentage of female participants: N/R Mean age range: 71.8 +/− 6.4 years to 72.5 years (mean age N/R × 3 RCTs) Age range: 44–91 years (age range N/R × 4 RCTs) | Exercise-based interventions × 4 RCTs: Exercises, cueing with the integration in the ADL plus received a booklet with advice for the prevention of falls × 1 RCT. Treadmill walking, exercise to increase ROM and stretching exercises × 1 RCT Exercises to strengthen the muscles of the legs, to increase the ROM, for the equilibrium, for walking outdoor × 1 RCT Treadmill walking × 1 RCT Cueing intervention × 1 RCT | Total number of falls: 4x RCTs report a reduction in the number of fall episodes for the exercise-based intervention groups. | Low |
The cueing intervention group had a decrease in the number of falls in the ADL × 1 RCT. | Very low | ||||
Citation details: Winser et al. (2018) Number of relevant primary studies: 4 AMSTAR 2 rating: Low Neurological condition: Stroke and PD | To determine whether Tai Chi training improves balance and reduces falls incidence when compared to control conditions of either active treatment or no treatment in people with neurological diseases. | PD: N = 288 (range 17–195) Percentage of female participants: 36% Age: 72 +/− 8.5 years (N/R × 2 RCTs) Stroke: N = 145 Percentage of female participants: 47% Age: 69.9 +/− 10 years | PD: Tai Chi × 3 RCTs Stroke: Tai Chi × 1 RCT | Total number of falls (PD): There was a statistically significant effect of Tai Chi compared with active therapies on total number of falls (OR 0.47, 95% CI 0.29 to 0.77). | Moderate |
There was a statistically significant effect of Tai Chi compared with no treatment on total number of falls (OR 0.29, 95% CI 0.11 to 0.79). | Low | ||||
Total number of falls (Stroke): There was a statistically significant effect of Tai Chi compared with active therapies on total number of falls (OR 0.21, 95% CI 0.09 to 0.48). | Low |