Reactive balance training improved stepping but did not prevent falls

Design

Assessor-blinded randomised controlled trial

Population

88 community-dwelling older adults, mean age 72

Primary outcome

Laboratory-induced falls and daily-life falls over 12 months

Effect

No difference in falls (p = 0.19); improved step length and stepping reaction time

This assessor-blinded randomised trial enrolled 88 older adults (mean age 72). Both groups did 8 weeks of home strength training; the intervention group also did ReacStep, a weekly session of tether-release reactive stepping and intentional slips using low-cost equipment, for 6 weeks.

Adherence was 90%. At 8 weeks, the intervention group took longer maximal steps and had faster choice stepping reaction times. But there was no difference in falls during laboratory-induced trips and slips, or in daily-life falls recorded by weekly text message over 12 months (p = 0.19).

Perturbation training remains a promising idea, but this simple version did not yet deliver fewer falls. Falls prevention for community-dwelling older adults should continue to rely on established progressive balance and strength programmes rather than this approach alone.

• Offer established progressive balance and strength programmes for falls prevention
• Do not replace them with short perturbation-based programmes on this evidence
• Measure what matters — falls — rather than stepping performance alone when evaluating programmes

Why it matters

Better performance on a balance test did not translate into fewer falls, which is the outcome that matters.

Don't overread it

A small trial — it cannot rule out a modest falls benefit, but it gives no evidence for one.

The statistics, in plain English

With 88 participants, the trial could detect changes in stepping tests but was small for falls, which are relatively rare events, so a modest benefit on falls cannot be excluded.

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