Jens Eg Nørgaard1,2, Martin Gronbech Jorgensen1, Jesper Ryg3,4, Jane Andreasen5,6, Mathias Brix Danielsen1,2, Daniel Kjærgaard Steiner1, Stig Andersen1,2. 1. Department of Geriatric Medicine, Aalborg University Hospital, DK-9000 Aalborg, Denmark. 2. Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark. 3. Department of Geriatric Medicine, Odense University Hospital, DK-5000 Odense, Denmark. 4. Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark. 5. Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, DK-9000 Aalborg, Denmark. 6. Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, DK-9000 Aalborg, Denmark.
Abstract
OBJECTIVE: falls among older adults are common and can have devastating consequences. A novel task-specific exercise modality, gait adaptability training (GAT), has shown promising preventive effects. This systematic review and meta-analysis synthesise the evidence regarding GATs effect on falls and fall-related fractures in community-dwelling older adults. METHODS: electronic databases (PubMed, EMBASE, CINAHL, CENTRAL) were systematically searched from inception to 18 June 2020. Additional sources include searches of trial registrations, manual screening of reference lists and requests to experts. We included randomised controlled trials (RCTs) evaluating the effect of GAT on falls with at least 6-month follow-up among community-dwelling people aged 60+ years. Two reviewers independently screened studies against eligibility criteria, extracted relevant information and appraised studies for bias. Random-effects meta-analytic models were employed to pool effect estimates. RESULTS: eleven studies with 1,131 participants were included. A meta-analysis in which an outlier study was excluded showed that GAT reduces fall rates by 42% (incidence rate ratio 0.58, 95% confidence interval [CI] 0.39-0.81, I2 = 0.00%; moderate certainty; seven RCTs). Moreover, proportion with fall-related fractures and proportion of fallers was reduced by 81% (risk ratio [RR] 0.19, 95% CI 0.06-0.56, I2 = 0.00%; very low certainty; two RCTs) and 43% (RR 0.57, 95% CI 0.4-to 0.8, I2 = 47.08%; low certainty; 11 RCTs), respectively. CONCLUSIONS: our results show that GAT significantly reduces the number of falls and prevents fall-related fractures in older community dwellers. GAT is a promising and feasible exercise modality; however, studies of high quality should be conducted to support a robust conclusion. PROTOCOL REGISTRATION: PROSPERO; CRD42020191051.
OBJECTIVE: falls among older adults are common and can have devastating consequences. A novel task-specific exercise modality, gait adaptability training (GAT), has shown promising preventive effects. This systematic review and meta-analysis synthesise the evidence regarding GATs effect on falls and fall-related fractures in community-dwelling older adults. METHODS: electronic databases (PubMed, EMBASE, CINAHL, CENTRAL) were systematically searched from inception to 18 June 2020. Additional sources include searches of trial registrations, manual screening of reference lists and requests to experts. We included randomised controlled trials (RCTs) evaluating the effect of GAT on falls with at least 6-month follow-up among community-dwelling people aged 60+ years. Two reviewers independently screened studies against eligibility criteria, extracted relevant information and appraised studies for bias. Random-effects meta-analytic models were employed to pool effect estimates. RESULTS: eleven studies with 1,131 participants were included. A meta-analysis in which an outlier study was excluded showed that GAT reduces fall rates by 42% (incidence rate ratio 0.58, 95% confidence interval [CI] 0.39-0.81, I2 = 0.00%; moderate certainty; seven RCTs). Moreover, proportion with fall-related fractures and proportion of fallers was reduced by 81% (risk ratio [RR] 0.19, 95% CI 0.06-0.56, I2 = 0.00%; very low certainty; two RCTs) and 43% (RR 0.57, 95% CI 0.4-to 0.8, I2 = 47.08%; low certainty; 11 RCTs), respectively. CONCLUSIONS: our results show that GAT significantly reduces the number of falls and prevents fall-related fractures in older community dwellers. GAT is a promising and feasible exercise modality; however, studies of high quality should be conducted to support a robust conclusion. PROTOCOL REGISTRATION: PROSPERO; CRD42020191051.
Authors: Jens Eg Nørgaard; Stig Andersen; Jesper Ryg; Andrew James Thomas Stevenson; Jane Andreasen; Mathias Brix Danielsen; Anderson de Souza Castelo Oliveira; Martin Grønbech Jørgensen Journal: BMJ Open Date: 2022-02-07 Impact factor: 2.692